AccountId: 011433970860
ContactId: d5bc9847-595e-47e0-9c8a-8251f0ce607b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 866729 ms
Total Talk Time (AGENT): 437614 ms
Total Talk Time (CUSTOMER): 464413 ms
Interruptions: 13
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/d5bc9847-595e-47e0-9c8a-8251f0ce607b_20250203T19:41_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, [PII]. Good afternoon. Uh my name is [PII].
[CUSTOMER][NEGATIVE] And I'm calling regarding a couple of things that I'm not sure about and so I want first of all file a couple of claims, old claims. I know that there is no, I mean once I talked to someone they told me that there is no like limit of times that I can file retroactive, so I wanted them to log and log in to start have a new user in order to submit a claim. I'm and I just cannot do it. I'm trying and it tells me that there is an error and called the.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A customer service.
[AGENT][NEUTRAL] OK, so you're the subscriber on the coverage and you're trying to set up your profile in the portal, is that correct? But it's not allowing you?
[CUSTOMER][NEUTRAL] Yes. Mhm.
[AGENT][POSITIVE] OK. So yes, ma'am, I can try and help you with that. So I'm so sorry. Would you please give me your name again?
[CUSTOMER][NEUTRAL] Sure. [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And last name [PII]
[AGENT][POSITIVE] Thank you. And Ms. [PII], what is a good callback number for you please?
[CUSTOMER][NEUTRAL] Yes, sir. [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you and your policy number please.
[CUSTOMER][NEUTRAL] My what?
[AGENT][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] Ah sorry.
[CUSTOMER][NEUTRAL] So, um, what's uh the policy number? It's written as what is the coverage in uh group? What is it?
[AGENT][NEUTRAL] OK. What else is on the front of your ID? It depends on the type of coverage you have as to how it's worded, so.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, so, so she insured coverage group number mhm group number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you say, no, did you say there was an in-hospital and then an outpatient number?
[CUSTOMER][NEUTRAL] There's in a hospital benefit and cert number and outpatient benefit cert number.
[AGENT][NEUTRAL] OK, so your policy number, Ms. [PII], is actually the very first part of either one of those numbers. If you'll notice, prior to the ML.
[CUSTOMER][NEUTRAL] Mhm. Yes.
[AGENT][NEUTRAL] There are those numbers are the same.
[CUSTOMER][NEUTRAL] Yes. Yeah, yeah, you're right. So it's 024.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 733
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 89.
[AGENT][NEUTRAL] OK, thank you. So give me just a moment to get all of your information pulled up, then I will have to verify several things with you uh first for security. So just one moment. You're welcome.
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][POSITIVE] Sure, thanks. Mhm, thanks.
[AGENT][NEUTRAL] OK, so first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] Mhm. [PII].
[AGENT][NEUTRAL] OK, thank you. And then the spelling of your last name one more time, please.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, thank you. Your home mailing address?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, did you say, say that one more time because I think that, go ahead. What's the street number? Yeah.
[CUSTOMER][NEUTRAL] The address is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. The phone number that we have on file for you, [PII] is the same as the one you gave me. So again, that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes. Mhm, yes.
[AGENT][NEUTRAL] OK, thank you and the last piece of information to verify would be your email address?
[CUSTOMER][NEUTRAL] Uh, so it's [PII], and the [PII]
[AGENT][NEUTRAL] OK, we
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this is not your work email that's on file. It looks like it's your personal email. Mhm.
[CUSTOMER][NEUTRAL] My personal, so it's [PII] that maybe because of that, he didn't let me. So it's [PII].
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] OK, that is what we have on file for you. Let me make, just to verify this.
[AGENT][NEUTRAL] [PII] Yes. So your personal email is on file. So if you were trying to use your work email, um Ms. [PII], that is.
[CUSTOMER][NEUTRAL] Uh-huh. It's weird that you have my personal one. OK. Mhm. OK, I'll just do it now. I don't mind. No, you can leave it there, don't, you don't need to change it. I'm gonna say change with my personal one. It's fine.
[AGENT][NEUTRAL] Let me look this.
[AGENT][NEUTRAL] Give me just a
[CUSTOMER][NEUTRAL] I just, I just wanna see if I can open the um account.
[CUSTOMER][NEUTRAL] Yeah, because I couldn't and I didn't think of the email.
[AGENT][POSITIVE] Yes, actually, you and I spoke to each other. Uh-huh, and I, I thought I remembered speaking to you. I spoke to you back in September and that's when we changed it from your, uh-huh, back in September.
[CUSTOMER][NEUTRAL] Oh yeah, now it lets me.
[CUSTOMER][NEUTRAL] Oh, it was you?
[CUSTOMER][POSITIVE] Oh, you were so nice, my [PII], you helped me so much, but I completely forgot about it, and actually someone just left me a message and I thought, I thought to myself, oh my [PII], all of their representatives are so nice. Oh my [PII], I'm so happy I'm talking to you.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, that's OK.
[AGENT][NEUTRAL] I, and I can, I can say we're one of my.
[AGENT][NEUTRAL] Well one of my co-workers, yes, ma'am, she did try to call you and it said she left a voicemail, um.
[CUSTOMER][NEUTRAL] Yeah, I know, that's what I tell myself, oh my [PII], they're actually calling me back. I didn't even expect it.
[AGENT][POSITIVE] Oh, and that's, well, we certainly try to, to do the right thing, so.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Yeah, I'm very impressed, honestly, I'm really very impressed. OK.
[AGENT][NEUTRAL] Uh, well, that's very kind of you to say so, but yes ma'am, it was you and I because we did have your, your uh work email originally on file, but at that time when I emailed you the user guide on how to set it up in the claim form and all of that, that's when we changed it to your personal email.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Ah.
[CUSTOMER][NEGATIVE] OK, and I'm for all that time I'm just like trying in the wrong one basically, and that I just like, you know, when you're not succeed in something, you put it in the side and then you forget about it, obviously.
[AGENT][NEUTRAL] Yes, because there's so many sites and so many of all of that this day and time, yes.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] I totally know.
[CUSTOMER][NEGATIVE] Uh, disaster. Um, OK, so I, so I'll do it now. I actually, I'm just gonna, I'll try to open it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That doesn't make sense. But I wanted to ask a couple of things that I forgot to ask this, uh, then. So what, first of all, uh, I remember, uh, if I did some procedure that included anesthesia, anesthesia, you know, that you put put into sleep, um, that's out of pocket. I know the insurance doesn't cover it, or maybe if it covers it just a little bit, I don't know. Um, the question is, can I submit uh um like uh for that, claim for that or not?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Was this something that you had done for on an outpatient basis?
[CUSTOMER][NEUTRAL] So, I can tell you what is it. I don't know how it counted. And one of them, I, I did it in my OBG, but uh one of them was, uh, I, uh, you know, when after you have a miscarriage and the cleaning that, I don't remember how you call it, IUD, not IUD. I don't remember the name.
[AGENT][NEUTRAL] I mean, or were you
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] DNC.
[AGENT][NEUTRAL] A DNC maybe, a DNC.
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEUTRAL] Uh, don't, I don't think so. Uh, you know that they're cleaning you from all the things that like all the leftover. OK, so yes, so they had to put me to sleep for that. And so I remember then it was like over $500. I don't know, but if you cover or not, and I, mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Again, so, again, we would, we can't pay claims over the phone, Ms. [PII]. So we, we would just have to receive the claim along with your primary insurance company's explanation of benefits. Now, um, to review, and if we're able to approve, it would be, you know, fall under your outpatient.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Benefit maximum which is $500 I'm sorry $300 per calendar day for covered outpatient services so we would just have to.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But theoretically you are uh covering something like that? Like anesthesia you are?
[AGENT][NEUTRAL] But we had, that this was done in your doctor's office. Is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, yes. Mhm.
[AGENT][NEUTRAL] See, on, on this policy, remember, the office visits aren't covered or treatment done within the office setting. This is for when you go and have, you know, at an outpatient facility or diagnostic testing.
[CUSTOMER][NEGATIVE] So if you send that, so if I, so any, anything I did in office, even though it's something that, I mean, I could have scheduled in the hospital, I just didn't, you're not covering.
[AGENT][NEUTRAL] This policy doesn't provide benefits for treatment done in the, in the office. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] And if my daughter, for example, because she just did last week, if she's pulling out her wisdom teeth again under, so again, I don't know exactly how you're considering hospital, like what hospital? She did it in hospital, but it was office in hospital, so I don't know exactly how it works.
[AGENT][NEUTRAL] Wisdom teeth, yes, ma'am, but on your policy, and you can see this in your policy certificate that's in your portal, um, wisdom teeth, that's not a covered benefit under this supplemental medical policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So any anesthesia, unless it's like an ER or something like that, you're not covering.
[AGENT][NEUTRAL] Correct. Like in an outpatient, right, in some type of outpatient setting, not in a doctor's office.
[CUSTOMER][NEUTRAL] If I understand correctly.
[CUSTOMER][NEUTRAL] OK, um, now, what is I want, uh, so if I did city.
[CUSTOMER][NEUTRAL] Uh, like covered in the hospital. I mean, that's, you can do just in the hospital from what I know.
[AGENT][NEUTRAL] That's, that is something that could be reviewed for us. Again, I can't guarantee payment of anything, obviously, Ms. [PII], without, you know, but yeah, go to urgent, right, urgent care, if you had to go to urgent care, if you went to, um, the emergency room or a diagnostic testing facility, those are the types of things that this policy can help you with. Or if you would ever be.
[CUSTOMER][NEUTRAL] Yeah, I know, I know, I'm not expecting you. I, I just know what should I work to submit or not.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Ah, OK. So CT was diagnostics. Yeah.
[AGENT][NEUTRAL] Correct. Diagnostic test done in
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But not within your doctor's office.
[CUSTOMER][NEUTRAL] OK. OK, so.
[AGENT][NEUTRAL] Treatment within the office or an office visit isn't covered under this supplemental policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So in theory, basically, if I'm doing procedure, I mean, whatever, it's done it's done, thank God it's behind me, but in theory, if I'm doing any procedure, it's better to me, for me to do the same procedure in hospital for the coverage.
[CUSTOMER][NEUTRAL] Because, for example, the OBG, she offered me to do it in the hospital. I just prefer to do it in place I know, but in general.
[AGENT][NEUTRAL] And again, we can't, we, we, I teach just honestly, I can't advise on that because
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] We can't legally do that. Yeah, we can't, we, we can't do that because we don't have any.
[CUSTOMER][POSITIVE] Just money wise.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Knowledge of the difference in what your cost and all of that would be, or we don't dictate.
[CUSTOMER][NEUTRAL] Ah, I understand. So it might be even more. OK. Mhm.
[AGENT][NEUTRAL] You know, where this correct. Uh we can just, I can only provide you with the benefits are on this particular plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So now when I'm going now, I'm gonna for a password. I'm gonna, I hope I'll figure it out by myself. I just don't wanna take too much of your time. But after I'm uh putting the, I'm uh logging in, I have my login and I wanna submit claims. So I just need to submit, I, if I remember correctly, it was the payment like the confirmation that I paid and the billing from the hospital, right? This is basically the things I need to get.
[AGENT][NEUTRAL] That's
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And your primary insurance company's explanation of benefits for the data service on the claim form that I emailed you?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The instructions for everything that you need to submit are on the first page.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So you can use that as a checklist to make sure you have everything. So, it's your claim form, your itemized bill with your diagnosis and procedure codes, your primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK, fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. So that's, but that's basically like I just can ask my company all the benefits in one file and I can submit the same thing for all the claims, right? I don't need to have like something separate.
[AGENT][NEUTRAL] You just need to highlight, yes, ma'am, if there's anything that's not, depending on how your primary insurance company are you referring to your primary insurance explanation of benefits?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, they told me I need to submit it. That's what I'm asking.
[AGENT][NEUTRAL] Yes, you would need to cross off anything that's not, you're not wanting us to review because if you submit, you know,
[AGENT][NEUTRAL] Everything is all gonna get reviewed.
[CUSTOMER][NEGATIVE] Uh, that they didn't cover it and yeah, I'm not asking for you as well. Ah, yeah, fine. OK.
[AGENT][NEUTRAL] It's still gonna get right, yeah, we would still have to review it. So, if you know that there's, you know, look at it and said this was an office visit, so I know that's not covered, just right. Either highlight what you want us to look at or what you don't want us to look at and make a note on there regarding that.
[CUSTOMER][NEUTRAL] Oh, yeah.
[CUSTOMER][NEUTRAL] No, that's for sure, yeah, yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, make sure, makes sense.
[CUSTOMER][NEUTRAL] That I didn't get it twice. Mhm.
[CUSTOMER][NEUTRAL] No, no, I'm, I'm not seeing anyone. I'm.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] I'm fine. That's what I paid. I went back. Actually, I paid for so long and I didn't know I'm paying. But, OK. Fine. OK. Thank you so much. I hope I'm gonna figure it out now. Thank you. Mm.
[AGENT][NEUTRAL] Uh
[AGENT][POSITIVE] OK. Well, you are very welcome. Is there anything else that I can help you with this afternoon, Ms. [PII]?
[CUSTOMER][NEGATIVE] No, no.
[CUSTOMER][POSITIVE] No, great. Thank you so much. Thank you so much. Appreciate it.
[AGENT][POSITIVE] Well, well, you're very welcome and it was nice speaking with you again.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] You too, bye bye.
[AGENT][NEUTRAL] Yes, ma'am. Bye-bye.