AccountId: 011433970860
ContactId: d2da072a-1c10-4b3b-9da3-8fb820884b42
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 912469 ms
Total Talk Time (AGENT): 498214 ms
Total Talk Time (CUSTOMER): 369330 ms
Interruptions: 7
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/d2da072a-1c10-4b3b-9da3-8fb820884b42_20250514T12:57_UTC.wav
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[AGENT][NEUTRAL] Fine, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] How you doing [PII]?
[AGENT][POSITIVE] I'm great.
[CUSTOMER][NEUTRAL] This is [PII] calling. How you doing?
[AGENT][POSITIVE] I'm great. How are you today?
[CUSTOMER][NEUTRAL] Doing well thank you uh I have a payer ID or do you need my group number? What do you, what do you need from me?
[AGENT][POSITIVE] Good. How can I help you?
[AGENT][NEUTRAL] OK. Are you the administrator or are you calling on your own policy?
[CUSTOMER][NEUTRAL] To look on
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] On policy, yeah.
[AGENT][NEUTRAL] OK, and I'm sorry, what was your last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you. And what is a good callback number for you please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and your policy number?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] 02611482.
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] Thank you, give me a moment please to get your information pulled up please [PII].
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Oh you're not supposed to do
[CUSTOMER][NEUTRAL] It.
[AGENT][NEUTRAL] OK, and [PII], how can I help you today first off?
[CUSTOMER][NEUTRAL] So I don't, what, so I know I have this, but so what does this cover basically for so I can have a, uh, what is, is this health like that, that my United uh Healthcare doesn't cover?
[AGENT][NEUTRAL] OK, so you just have some questions on your benefits on this policy and how it works, is that correct? Yes, I can help you with that. And first off one I will have to verify several things with you first for security and then also any information that is provided would be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], yeah.
[AGENT][NEUTRAL] OK, thank you. Also your home mailing address.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that is on file for you is the same as the one you gave me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Thank you. And lastly, your email address and this does appear to be your work email that is on file.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, so it's [PII].
[CUSTOMER][NEGATIVE] That's why I couldn't even register here.
[AGENT][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you. Now I will be happy to update it to your personal email if you want me to do that. I do want to let you know though that because of how, OK, there is a possibility it could revert back to your work email so I just wanted to make you aware of that in advance so you just do wanna leave the work email?
[CUSTOMER][NEUTRAL] No, that's fine.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, all right, thank you.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Now, I can email you were trying to set up your profile in the portal, so yes, if you were trying to use your personal email and it was giving you an error message, that would have been one of the reasons.
[CUSTOMER][NEGATIVE] No, no, no, I'm not, uh, now I'm changing it and they won't let me see if it lets me do it now.
[CUSTOMER][POSITIVE] Oh, now I did it. OK, perfect.
[AGENT][NEUTRAL] OK, now I do have a OK well I have a user guide also one that if you would like for me to send that to you because it gives you some additional information on different things that you can uh do within the portal as far as looking at claims um.
[CUSTOMER][POSITIVE] I was able to do it.
[AGENT][NEUTRAL] ID cards, policy information, submitting claims, if you ever have to do that yourself. Would you like for me to send that to you?
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They
[AGENT][NEUTRAL] So I'm gonna just go ahead and send that to you now, and the email that you're gonna receive from me will come from [PII].
[AGENT][POSITIVE] And I did put APL in your subject line so that that's easy to recognize.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this policy one, it's a supplemental policy to your primary healthcare insurance and it helps.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] In such progress.
[AGENT][NEUTRAL] You with your co-pays and your deductibles.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The registration.
[AGENT][NEUTRAL] OK, so this policy is a supplemental policy to your primary health care insurance, and it is designed to help you with your co-pay, deductible, and co-insurance amounts of covered services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So always present your APL ID card along with your primary insurance card when you go for medical services.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Because most providers will file both of your insurances. Obviously, your insurance has to be, you know, any claims have to be filed with your primary insurance company first and then with APL because we'll have to have a copy of your primary insurance's explanation of benefits when we review claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] On
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that we can see what they've applied to those three areas that this plan helps with.
[AGENT][NEUTRAL] So for now, under your plan, office visits themselves are not a covered benefit. So if you just go for a doctor's appointment, that's not something that's covered. If you go for, you know, some type of testing or outpatient procedure, then you do have um
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] For
[AGENT][NEUTRAL] This plan can help review those types of things lab work.
[CUSTOMER][NEUTRAL] Actually
[AGENT][NEUTRAL] Diagnostic testing.
[CUSTOMER][NEUTRAL] Yeah, I, I specifically have one.
[CUSTOMER][NEUTRAL] If I can show you where it is.
[CUSTOMER][NEUTRAL] And then give me a second, uh.
[CUSTOMER][NEUTRAL] Let me see, and maybe you can help me out with just this one real quick before we continue.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] It's uh I mean um Yeah, I have one from my uh UN trying to look for the.
[CUSTOMER][NEUTRAL] The actual number, but um.
[CUSTOMER][NEUTRAL] So how do I put that one in to get paid?
[CUSTOMER][NEUTRAL] You have to be.
[AGENT][NEUTRAL] OK, so I'm sorry, you have a claim that you're gonna need to file yourself?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, so you can actually go to our public website one.
[AGENT][NEUTRAL] By going to [PII].
[CUSTOMER][NEUTRAL] talked about it
[CUSTOMER][NEUTRAL] I heard about it and offered up the jet that they had which I believe at the moment actually being out.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] Weber reporting.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] A um
[AGENT][NEUTRAL] [PII] uh-huh and just let me know when that page pulls up.
[CUSTOMER][NEUTRAL] But that is interested but for the market.
[AGENT][NEUTRAL] Cause I wanna show you a couple of things.
[CUSTOMER][NEUTRAL] What's it called? [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] OK, I'm here. Give me a second.
[AGENT][NEUTRAL] Sure. But before you, before you click on anything, I wanna explain a couple of things to you. So at the top, you, you see those different tabs.
[CUSTOMER][NEUTRAL] Now I'm trying to look for.
[CUSTOMER][NEUTRAL] I mean
[CUSTOMER][NEUTRAL] Give me, give me 1 2nd, give me 1 2nd.
[AGENT][NEUTRAL] OK, sure.
[CUSTOMER][POSITIVE] For myself this means a lot for like just because you know they want out.
[CUSTOMER][NEUTRAL] So for Indian so far the biggest system goes in [PII] is exposed to the.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] uh you know uh.
[CUSTOMER][NEUTRAL] [PII] revenue, but now we have an offset here in the form of two countries, uh, right here.
[CUSTOMER][NEUTRAL] So University of Miami health system partnered.
[CUSTOMER][NEUTRAL] Have a balance due. OK, so we're uh OK, so I'm AP I'm in, uh, AMP public.
[CUSTOMER][NEUTRAL] Where did I go?
[AGENT][NEUTRAL] OK, so you should see, OK, so do you see all the tabs across the top? Don't click anything yet, but you should see, OK, so there's a claims and forms now where it says sign in if you were to click there that will actually take you to the login page as well for your portal. So I just wanted to show you that. But to get your claim form for this type of policy, click on claims and forms.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Then you're just gonna scroll down the page.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And about middle ways down the page, you're gonna see in bold letters it says claim forms and policy change documents.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Below that there's gonna be a there you should see a small box that says filter by product with a green arrow in it drop down arrow you would click on that arrow.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Then click on the word med link.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now out to the right on your screen you should see a blue button that says download form, click on that.
[CUSTOMER][NEUTRAL] Clarity on how much and how.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And that should open up your Medin claim form. The top section of that claim form one has um 4 bullet points on it.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And those are the instructions for completing the form as well as the additional documentation that you will need to get to submit with the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I can't do it with like with you just to check out anything.
[CUSTOMER][NEUTRAL] So I have to do it this way.
[AGENT][NEUTRAL] If you are going to be filing the claim, yes, sir. You will have to get your itemized bill with your diag
[CUSTOMER][NEUTRAL] do
[CUSTOMER][NEUTRAL] So how do I know if my claim will get how how would I know if my claim will get approved?
[AGENT][NEUTRAL] You don't until we're, until we review it.
[CUSTOMER][NEUTRAL] We just
[AGENT][NEUTRAL] Because we cannot guarantee payment over the phone. We can only provide your benefit information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] on terrorists they're saying that the risk of recession is lower.
[AGENT][NEUTRAL] So again, office visits are not covered. However, if you receive some form of treatment in an office setting, that is something that we could review under your outpatient benefit as well, just not the visit charge.
[CUSTOMER][NEUTRAL] just like that.
[CUSTOMER][NEUTRAL] If this is.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So just use those those bullet points as check marks if you will.
[AGENT][NEUTRAL] To know exactly what you will need to submit and then once you have all of that together you can scan that into your computer and save that as a file and then you can log into your portal and upload it and the user guide that I emailed you explains how to do that.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, so if I go right so fill out my name, all that information.
[CUSTOMER][NEUTRAL] So I have to print this out because that's fine.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] And then you will have to get your itemized bill with your includes that includes your diagnosis code from the provider and also your explanation of benefits from your primary insurance carrier.
[CUSTOMER][NEUTRAL] So, OK, so right now I'm looking at my bill.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] 2 so.
[CUSTOMER][NEUTRAL] My itemized bill.
[CUSTOMER][NEGATIVE] How do I see my item on this bill because it just says pay now and that's it.
[AGENT][NEUTRAL] Correct. So that's not gonna be an itemized bill. That's just like a statement. So you'll have to reach out to the provider and request an itemized bill that includes the diagnosis. You can just read.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] That particular bullet point to him when you speak with them.
[CUSTOMER][NEUTRAL] Alright, so I, I need the itemized bill and which so I need to sign this form and then what?
[AGENT][NEUTRAL] You'll need to complete and sign that form.
[CUSTOMER][NEUTRAL] Buy what's
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Get your itemized bill that includes your diagnosis code from the provider.
[AGENT][NEUTRAL] And also a copy of your primary insurance company's explanation of benefits that shows any amounts applied towards your deductibles, co-pays, or co-insurance charges that are listed on that itemized bill.
[CUSTOMER][NEUTRAL] 4.
[CUSTOMER][NEUTRAL] So all that I have to send you guys.
[AGENT][NEUTRAL] Yes, sir. Mhm.
[CUSTOMER][NEUTRAL] And then I and then I have to fax it or what?
[AGENT][NEUTRAL] No sir, you can save it to all that to your computer and you can log into your portal and you can upload your files. Uh-huh, you can.
[CUSTOMER][NEUTRAL] And then put it there.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now if for any reason. Now it could be on the bottom of page one of that claim form there is also our mailing address, there is a fax number as well, but the easiest and quickest way to get something submitted to us is by uploading it directly into your portal.
[CUSTOMER][NEUTRAL] Let me find out the
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] OK, thank you very much.
[AGENT][POSITIVE] Well, you are certainly very welcome. Is there anything?
[AGENT][NEUTRAL] else that I could help you with this morning?
[CUSTOMER][NEUTRAL] No, that's it.
[CUSTOMER][POSITIVE] No, that's it. Thank you.
[AGENT][POSITIVE] OK, well then, thank you so much. Well, you're welcome and thank you for calling APL. I hope that you have a wonderful day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Sure