AccountId: 011433970860
ContactId: d6ebf6c9-2892-4a53-a31c-0c8ea4b78adb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 884710 ms
Total Talk Time (AGENT): 612322 ms
Total Talk Time (CUSTOMER): 194553 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/d6ebf6c9-2892-4a53-a31c-0c8ea4b78adb_20250107T13:27_UTC.wav
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[AGENT][NEUTRAL] Morning, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, I
[CUSTOMER][NEUTRAL] My company, I'm one of the owners of my company, we currently just through our broker got APL, and I still don't fully understand how we're supposed to access it. We had an employee go to a doctor today and it was not a super smooth experience, so I was wondering if I gave you my policy number you could help me understand exactly how it works.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Sure. So you're just wanting to just get a little more information on how to use your APL coverage, is that correct?
[CUSTOMER][POSITIVE] Correct. And what it covers, that's correct, yes.
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] Yes, so I can help you with that. Uh, first off, who am I speaking with?
[CUSTOMER][NEUTRAL] Can I give you my policy number?
[CUSTOMER][NEUTRAL] Oh, [PII]
[AGENT][POSITIVE] Thank you, Mr. [PII], what is a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And now your policy number, please.
[CUSTOMER][POSITIVE] Great, thank you so much. 0258.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] 19
[CUSTOMER][NEUTRAL] 02.
[AGENT][NEUTRAL] OK, thank you. So one moment please, while I get your information pulled up, Mr. [PII], then I will need to verify several things with you first for security, so just one moment please.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, so first off, Mr. [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. So if you could first please verify your date of birth.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you gave me, so that is your best contact number, is that correct?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][POSITIVE] Thank you and lastly your email address and I believe this is your work email.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, thank you. So first off, I can see Mr. [PII] that you have set up your profile in the APL online service center. So that gives you access to your ID card. There's also a complete, uh, policy certificate in there that explains, you know, all, all of your benefits too that you can download in a PDF format.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But this policy is designed to help you with your co-pays, deductibles and co-insurance amounts of covered services. Now on this policy office, so you would first off always present the APL card along with the primary insurance card.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] When you go for medical services. Now, under this plan, office visits are not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] So a copay is not covered.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] For an office visit. That is correct.
[AGENT][NEUTRAL] But if you go for, if they perform some type of treatment within the office, then that is something that can be reviewed under this policy. Um, anything like outpatient diagnostic testing, surgery,
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Therapy, things like that can be reviewed or urgent care visits, but an, an, a doctor's, you know, an office visit charge isn't a covered benefit under this plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the way it works.
[CUSTOMER][NEUTRAL] OK, so the office procedure. Go ahead, go, go ahead, go ahead.
[AGENT][NEUTRAL] Uh-huh. No, no.
[AGENT][NEUTRAL] OK, so an office procedure, yes, so that is something that could be reviewed for us, I mean under this plan.
[CUSTOMER][NEUTRAL] No, please continue.
[AGENT][NEUTRAL] Now the way it works is your provider, most providers, I will say most providers will file both insurances, however, if for some reason.
[AGENT][NEUTRAL] They do not file the supplemental plan, then you can do that yourself and if that ever arises that need arises, you can call us and we can explain, you know, about where to obtain the claim form and you know how to go about that because you can actually send that claims through that portal as well so it's highly encouraged for all of the members to set up their portal.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Once the insurance has to be filed first with your primary, and then once it's been filed with the primary, then filed with APL because we do have to have a copy of the primary insurance company's explanation of benefits. That's one of the documents that we have to have so that we can see the copays, deductibles and co-insurance amounts that they.
[CUSTOMER][NEUTRAL] Got it. So, got it.
[AGENT][NEUTRAL] Processed under your primary.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So how do you get this explanation of benefits for?
[AGENT][NEUTRAL] Typically, I mean your primary insurance company depending on how you have that set up with them, they either would mail that to the provider, most times it's mailed I would say um you may have a portal with your primary insurance company that you could also print that from like you can have access to our explanation of benefits through this portal through the online service center.
[CUSTOMER][NEUTRAL] Got it. So, basically, when you go to the doctor, is it any doctor or just got it. OK. You present your insurance card in this.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes, so this plan.
[AGENT][NEUTRAL] Uh-huh. This plan does not have a network. It would follow your primary insurance company. Also, with this plan, if something is not covered at all by your primary insurance, it would not be covered by APO.
[CUSTOMER][NEUTRAL] I see, got it. So if I go to the doctor, like I'm hearing impaired. If I go to the doctor and they clean up my ear wax and they do some investigations inside my ears.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] They should cover it, they should take this as for the procedures.
[AGENT][NEUTRAL] Correct. That is something correct. Not for the visit itself, but for treatment that's rendered. So yes, if they perform some type of procedure. For example, if you cut your finger and you went to, you know, maybe um the doctor and they were able to stitch it up or, you know, X-rayed it or something in the office, then yes, that's things that we can review under this policy. Just the visit charges itself.
[CUSTOMER][NEUTRAL] Not for the COVID, not for the co-pay, for the procedures.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right. Would it cover things done in urgent care? Would it cover things done in the urgent care?
[AGENT][NEUTRAL] Yes, our urgent care is one of the facilities that um we can review for benefits for under this policy as well.
[CUSTOMER][NEUTRAL] Got it. In your experience, what percentage of doctors accept this? How many, and I guess in your experience, what percentage of people are are are presenting having them do the claim form process?
[AGENT][NEUTRAL] Most, most providers, especially in the state of [PII] because we have so our business is so large in [PII], they will usually.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, file this for you.
[CUSTOMER][POSITIVE] Got it. OK, got it.
[AGENT][NEUTRAL] Yes, sir. But again, I, you know, I can't, I can't say 100% on that, but should you have to file it, if, if they say, oh well, we, we don't file secondary insurances, then just, you know, OK, and then you can call us and there's a, a, a web, excuse me, there's a specific claim form for this Medlink policy that can be obtained from our website.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] And it has the instructions at the top of the first page that tells you what documents you need to submit along with the claim form for our review.
[CUSTOMER][NEUTRAL] Got it. OK, how long is the claim form process usually take?
[AGENT][NEGATIVE] I just don't wanna
[AGENT][NEUTRAL] Usually, 7, it's approximately 7 to 10 business days.
[CUSTOMER][NEUTRAL] Got it. OK.
[AGENT][NEUTRAL] And if for any reason you were to submit a claim, for example, maybe you submitted a claim but forgot to send us the explanation of benefits from the primary insurance, we reviewed it, it got denied because we were missing that piece of information and all you would need to do would be to obtain that you could then submit that to us and you know we could complete the review.
[CUSTOMER][NEUTRAL] Got it. So again, I go there.
[AGENT][NEUTRAL] And there is no timely filing limit either, Mr. [PII], with APL and some insurances you must file a claim within the next number of days, um, but for APL we do not have a timely filing limit for our members.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it. OK. So again, can you give me other type of procedure so if I go to the, if I go to the doctor and they.
[CUSTOMER][NEUTRAL] Uh, you know, draw blood, would that be covered?
[AGENT][NEUTRAL] Uh, let's see, um.
[AGENT][NEUTRAL] That is something that we have, let's see.
[AGENT][NEUTRAL] Yes, there is diagnostic testing in an independent lab facility that's under here.
[AGENT][NEUTRAL] Um, it's on your policy.
[AGENT][NEUTRAL] Under the policy, it states as far as it states other treatment in physician's office, not including the physician's office visits.
[CUSTOMER][NEUTRAL] Got it, so it's basically procedures done in the office. It doesn't include the copay.
[AGENT][NEUTRAL] If you had to, if you were.
[AGENT][NEUTRAL] Just not the office copay for the visit, right.
[CUSTOMER][NEUTRAL] Got it. OK, so services performed. So if you went to the dermatologist and there was a co-pay of $50 and then the dermatologist did like some skin work, the skin work should be covered.
[AGENT][NEUTRAL] Again, I can't guarantee payment, but yes, sir, the, the procedure, if you had to have a place removed or burned off in the, in the dermatology, we could review that procedure part. Yes, sir.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][MIXED] Got it. OK, but the likelihood of people accepting this is pretty high because I know somebody just went to the doctor and they had no idea what it was. Somebody I know went to the doctor and they had no idea what it was. The doctor had no idea what this was.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh, yes, sir, in my experience, because the volume of business that we do in the state of [PII], most providers.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] are familiar with it.
[AGENT][NEUTRAL] Or will at least call us to get the benefit information. Most providers will call us to verify a policy is active, and if they're not familiar with it, they're like, OK, well this our patient presented us with this insurance card, but we don't, we've never heard of APL and it's kind of like our conversation.
[CUSTOMER][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You know, they wanna know if the policy is active we give them the effective date and you know and they, we ask them what type of benefit information they're needing inpatient, outpatient or office they'll say, you know.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Just for office, you know, visit. And I would explain the same thing that the physician's office visit isn't covered. However, you know, we can review treatment.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Got it OK.
[AGENT][NEUTRAL] So if for example, you were had to go to physical therapy, whether that's at a physical therapy facility or at some type of therapy that they can perform in the office, that's something that we could review, occupational therapy, speech therapy, outpatient surgeries.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sleep studies.
[CUSTOMER][NEUTRAL] Got it. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it. OK
[CUSTOMER][POSITIVE] All right, great. Alright, this is very, very helpful. OK.
[AGENT][NEUTRAL] And I
[AGENT][NEUTRAL] And again you can you if you go to your portal like I said, and click on your policy number you should see a little PDF icon and you can click on that. It will download your policy certificate which is uh probably about 30 pages total in length um of 28 I think it looks like it's 28 pages and it will list out the different places that are covered.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what any limitations and exclusions are. And like under the, because there's definitions for what an inpatient benefit is or an outpatient benefit.
[AGENT][NEGATIVE] And it also will tell you in there, like I explained that if it's not covered by your major medical, it would not be covered by this plan either.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got it. OK, alright, well that's very helpful. OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Well, is there anything else?
[CUSTOMER][POSITIVE] OK great well thank you so much.
[AGENT][NEUTRAL] Yes, so you're certainly welcome, and I do actually, um, when you set up your profile, did anyone email you Mr. [PII], the user guide that sells for the portal or did you kind of just do that on your own?
[CUSTOMER][NEUTRAL] I don't recall seeing a user guide the portal.
[AGENT][POSITIVE] OK, well, I'll be happy. I could email that to you and you know, you could.
[AGENT][POSITIVE] Provide that to your employees as well because like I said it's encouraged to set that up just so that everyone can have access to their information online.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] And I can do that for you in just a moment. Give me one second and I'll send it to you right now.
[CUSTOMER][POSITIVE] Yeah, great.
[CUSTOMER][POSITIVE] I appreciate that thank you.
[AGENT][POSITIVE] Absolutely, you're welcome.
[CUSTOMER][POSITIVE] Alright thank you so much.
[AGENT][NEUTRAL] Well, you are certainly very welcome and this will be coming to you in just a moment and the email that you're going to receive, Mr. [PII] is gonna come from [PII] [PII].
[AGENT][NEUTRAL] And also I put in the subject line for you APL so that you can recognize that.
[CUSTOMER][POSITIVE] Oh thank you so much.
[AGENT][POSITIVE] All right, well, you're very welcome and we're glad to um have you all as customers.
[CUSTOMER][POSITIVE] Fantastic. Alright, thank you. I appreciate that so much. Look forward to a long relationship together.
[AGENT][POSITIVE] Uh yes, I hope so too, and I thank you again for calling APL and I hope that you have a wonderful day.
[CUSTOMER][POSITIVE] You too as well thank you so much bye bye.
[AGENT][POSITIVE] Yes, sir. Thank you. Bye bye.