AccountId: 011433970860
ContactId: d41f0d3f-30db-48cc-83e7-83762c1672f6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 621580 ms
Total Talk Time (AGENT): 387322 ms
Total Talk Time (CUSTOMER): 191027 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/d41f0d3f-30db-48cc-83e7-83762c1672f6_20250211T18:06_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I need to get some information. Um, so anyway, we, I have the gap insurance through my husband's insurance, uh, I mean, whose workplace, the gap. So I guess I kind of misunderstood how this works, um, because I was speaking to the rep the other day, but it's easier if I just call you and get the right information. But, so anyway, last year I had an MRI.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And I had some X-rays, and I thought the gap was just covers like hospital and stuff, but he says no, it covers up to like $300 for like an MRI um.
[CUSTOMER][NEUTRAL] Anyway, so, uh, you know, I paid it all, whatever, and I just figured this out. So, how, how am I supposed to like process this? Am I supposed to send an EOB? I mean, how does this work? I'm not really sure.
[AGENT][NEUTRAL] OK, so you're the insured and you are needing to file a claim for some diagnostic testing that you had done last year and you're wanting to find out how to do that. Is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] And [PII], will you please spell your last name for me?
[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, please?
[CUSTOMER][NEUTRAL] Um, let me see what's on here, policy number.
[AGENT][NEUTRAL] And you may have an in-hospital or outpatient number.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] Depending on the type of plane.
[CUSTOMER][NEUTRAL] Yeah, I have an in in hospitals number and an outpatient. So which one do you need? Outpatient?
[AGENT][POSITIVE] You can give me the, that will be fine. Yes, and that's fine.
[CUSTOMER][NEUTRAL] 02478
[CUSTOMER][NEUTRAL] 714 M as in Mary L as in Larry 8.
[AGENT][POSITIVE] OK, thank you. So give me a couple of moments to get your information pulled up, please.
[AGENT][NEUTRAL] Hi Ms. [PII], we will need to verify several pieces of information with you first for security. So first off, if you could please verify your husband's name and date of birth and then your date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the phone number that we would have on file for your husband?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Now when your husband has an opportunity to call us we do need to add an email address on file for him so that that will give you all the ability to be able to set up your profile in our online service center portal because you can submit your claims through that portal for review, but we can only provide that information with him because he is the primary policy holder.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So we are here Monday through Friday from [PII] Central time.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, all right, so do you have access to the Internet, [PII]?
[CUSTOMER][NEUTRAL] Yeah, yes.
[AGENT][NEUTRAL] OK, I'm going to give you our website where you can get the claim form that you would need to submit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim form does have the instructions on the first page as to what other documents will be needed.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you would go to [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] When that page pulls up at the top, you will see a link that says claims and forms.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Click on that link, then you're gonna scroll down the page.
[AGENT][NEUTRAL] And they going you're gonna see a small box [PII] that says filter by product and it has a green drop down arrow in it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If you will click on that green drop down, it gives you a list and you're looking for the word med link, like it's on your ID card [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You click on the word med link.
[AGENT][NEUTRAL] And then out to the right of your screen you should see a blue button that says download form.
[AGENT][NEUTRAL] And just click on that and it will open up the claim form again the instructions for completing the form and the other documents that are needed are at the top of that page.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, once you have all of that information together.
[AGENT][NEUTRAL] If we have an email on your on file for your husband where he can set up his profile then you can upload all of that from a computer just for you.
[AGENT][NEUTRAL] Otherwise, on the bottom of page one of the claim form, it lists a PO box.
[AGENT][NEUTRAL] And there's also a fax number. That fax number is a secured fax line.
[AGENT][NEUTRAL] And you could send your information just to attention claims at either that PO box or that fax number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So how does, OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] I mean, I'm not sure how it works. Like on the, one of the claim, I don't know, does it do just MRIs or does it do X-rays too? Covers X-rays?
[AGENT][NEUTRAL] OK, so on your, on this supplemental policy,
[AGENT][NEUTRAL] You do have a $300 benefit maximum per calendar day for covered outpatient services.
[CUSTOMER][NEUTRAL] Per day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So both of those things are things that we can review.
[AGENT][NEUTRAL] Now, office visits or treatment done within a doctor's office, those things are not covered under this policy. But urgent care, you know, an outpatient diagnostic facility or outpatient setting at a hospital, yes, ma'am, those are things that we can review.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK. I mean, like, like the X-ray that I just did, like they made me pay like $120 but when I did the EOB, my responsibility was $35. I mean,
[AGENT][NEUTRAL] OK, so again, because, well, because APL if you file the claim and there's any benefit that is payable, it's going to be paid to you.
[CUSTOMER][NEUTRAL] I don't know how that works.
[CUSTOMER][NEUTRAL] Mhm. Got you.
[AGENT][NEUTRAL] Mhm. Now, in the future going forward, always present your APL card along with your primary insurance card. When you go for medical services, most providers will file both of your insurances. They do have to file your primary first because we have to have a copy of that explanation of benefits from your primary insurance carrier when we're reviewing claims.
[AGENT][NEUTRAL] To see what they've applied to one of the three areas that this policy helps with, which are your co-pays, deductibles and co-insurance amounts of coverage services.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, you know, if they will file it for you, then obviously, you know, any benefits, they will typically call us to verify that you're eligible and let us know, you know, what you're having done. For example, if they call and said, you know, I need to see if she has benefits for an office visit, we would say no, not under the supplemental policy. But however, if they call and say, you know,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, Ms. [PII]'s gonna be having an MRI. Is this something that would be covered? We can't, as I explained to you when we initially started, I can't guarantee payment.
[AGENT][NEUTRAL] We can verify the benefits and I would explain that, yes, an MRI is something that can be reviewed.
[AGENT][NEUTRAL] Under this policy.
[AGENT][NEUTRAL] And once it's been all.
[CUSTOMER][NEUTRAL] So how about if you go for an MRI and you give them both cards and they say, OK, your responsibility is 150, and then they call you up and they say,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You can't guarantee payment. I mean, are they gonna collect the money from me anyway?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] That's up to the provider. We have absolutely nothing to do with how the provider chooses to either make you pay in advance and then be reimbursed because we're not a major medical carrier.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So we don't determine patient responsibility.
[CUSTOMER][NEUTRAL] So you would reimburse me if I had to pay it upfront?
[AGENT][NEUTRAL] Yeah, if you file the claim, yes, ma'am.
[CUSTOMER][NEUTRAL] Right. OK. OK. Let, let me look into all this. I'm at work now. It's uh it's always a hassle to do all this stuff. I know, but I don't even know if it's worth it sometimes, but um I'll look it up and I'll see if I can figure it out.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's a lot, I know, uh.
[AGENT][NEUTRAL] I know.
[AGENT][NEUTRAL] Well, this would help you up to $300.
[AGENT][NEUTRAL] Out of pocket for covered for covered services.
[AGENT][NEUTRAL] So,
[AGENT][POSITIVE] You know, it would definitely, I think benefits you to file the claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I guess it is. I'm just saying it always seems like it's never easy, you know, present your card and that's it, but that's not always how, how it happens. You know, they don't, they don't, you know.
[AGENT][NEUTRAL] And in [PII], most, right, you know, all I can tell you is most providers will file everything for you to save you from having to, you know, do a lot of this legwork if you wanna call it that. But in the event that they don't, then, you know, yes, ma'am, you can certainly file it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so let, let me go on there and get everything and look at it and see if not if I have any other questions, I guess I'll call back.
[AGENT][POSITIVE] Absolutely. We'll be more than happy to assist you in any way that we can.
[CUSTOMER][POSITIVE] OK, thanks.
[CUSTOMER][POSITIVE] Thanks for your help.
[AGENT][POSITIVE] Well, you're very welcome and thank you again for calling APL today, [PII]. I hope you have a very nice afternoon.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Yes, ma'am.