AccountId: 011433970860
ContactId: d909b1db-cb8f-4f50-a633-b80caea4bf7a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 791929 ms
Total Talk Time (AGENT): 341876 ms
Total Talk Time (CUSTOMER): 317223 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/d909b1db-cb8f-4f50-a633-b80caea4bf7a_20250606T15:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], this is [PII]. Um, I'm calling on a few things. Uh, the first is I'm trying to access, uh, the portal online, and I want to go to forget password. OK, so when I went to forget password, it asked for me to put in my email address. So I did, and then I put in the code and verified, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] But then it won't let me like it it doesn't do anything after that, um.
[AGENT][NEUTRAL] Right, OK, so I will say that um just as of a few days ago our website did undergo quite a big change and with that um you would have to like register again to create a new account uh it would be all of the same existing information that you had had yes it is a bit confusing and I apologize for that um but yes that's why it's not finding you as it has to be set up again essentially.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] So I need to create an OSC account?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] It would be should be all of the same information. The biggest difference is going to be uh that instead of a user name you would after recreating the account you would start logging in with your email.
[CUSTOMER][NEUTRAL] Oh, OK, um, and then while I'm doing this, uh, is there, so I, I had a claim come through from Quest, um, I thought that the insurance covered everything that was under the, uh, ACA.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, and so when I went to the doctor just for like a routine checkup, you know, they did my blood work and everything, um, and all of that should be, I would think, covered under like preventative, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You know, just because like they were checking my cholesterol levels and everything else, um, so I, I know that there was one test, um, just for like an extra add on that I knew probably wouldn't be covered fully, um, and so in class that claim was around I think $300 something, but I only paid the $100 something uh but the other panels that I thought would have been covered under ACA, they're billing me $1000 for that.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, and so I'm just wondering as to why, uh.
[AGENT][NEUTRAL] OK, we can get that pulled up.
[AGENT][NEUTRAL] Sure, yeah, I can definitely get that pulled up and take a closer look so we can get clarification on that um I will say that these policies they are um of course their own policies uh having specifics as to what is and is not covered so we can take a look and get uh further clarification regarding that um [PII] before we go any further, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][POSITIVE] I'm, I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII].
[AGENT][NEUTRAL] Thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Uh, I do not, um, actually, well, no, my wallet's in the car, but I was hoping I could get online to find it, um.
[CUSTOMER][NEUTRAL] Uh, what is it not recognizing?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So I'm trying to do the online so I put my last name, social, everything, uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I think what might be the issue is when I created this account a long time or a couple of years ago, I used a joint email um that my ex-wife and I were using.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, and, but I had everything rerouted to my personal email, but the username which was still the, I guess, joint email.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And so I don't know, let me, I'm gonna.
[AGENT][NEUTRAL] We can get that changed.
[AGENT][NEUTRAL] So the, the information that you entered there it does have to match what we have in our system. So if I can get your uh policy pulled up, we can go through and verify all of that um if you don't have your policy number I can start using your social.
[CUSTOMER][NEUTRAL] I'm gonna put in.
[CUSTOMER][NEUTRAL] I know
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK thank thank you one moment.
[CUSTOMER][NEUTRAL] OK, so I didn't recognize that zip code either.
[AGENT][NEUTRAL] Alrighty, so I did find you, um, I was just gonna verify some information really quick. Uh, can I get your date of birth please?
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] OK, so it's one of a few, um, my current address for my, I guess, family, um, or my mom's house anyway is uh [PII].
[AGENT][POSITIVE] Perfect. OK, that is what we have, so that is correct?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then the last thing I need is the email address that we do have on file um it looks like it might be the one that you were referring to the joint email.
[CUSTOMER][NEUTRAL] OK. Uh.
[CUSTOMER][NEUTRAL] Correct, the [PII].
[AGENT][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] It is a Gmail account.
[CUSTOMER][NEUTRAL] Oh, it might be [PII].
[AGENT][NEUTRAL] Yes, uh, is that correct or does that need to be changed?
[CUSTOMER][NEUTRAL] Uh, it's that one.
[AGENT][NEUTRAL] OK, so, and again I just wanted to verify that is [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, OK, yeah, so that would be all of the information that you enter when creating this new account.
[CUSTOMER][NEUTRAL] Right, so I did that and it's saying that there's an error that there's no account found.
[AGENT][NEUTRAL] OK, so, um, and just to confirm you are selecting the option where it's that you're an individual insured, uh, when you're going to create this account?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, um, and you are entering your social in a spot that asks for that or a member ID?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, uh, using the same zip code and this identical email address.
[CUSTOMER][NEUTRAL] Yeah, the [PII] and then the [PII].
[AGENT][NEUTRAL] Yes, OK, and again, I'm sorry, that was [PII]
[AGENT][NEUTRAL] In that email address.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, just wanted to verify that. OK, let's take a look here.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] And then I just have to go through all of these. I apologize that this is a bit redundant. Um, are you using a uh desktop or a laptop computer or are you using a mobile device?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Desktop
[AGENT][NEUTRAL] You are using a desktop awesome um are you using um what what browser are you using? Is it, uh, Google Chrome?
[CUSTOMER][NEUTRAL] Um, this is.
[CUSTOMER][NEUTRAL] Uh, I think it's edge.
[AGENT][NEUTRAL] Edge, OK, um, I believe there is support for Edge um however I know that we have the best support with uh Google Chrome. Do you have that browser?
[CUSTOMER][NEUTRAL] Microsoft
[CUSTOMER][NEUTRAL] Um, I'm on my work computer, but let's see.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I don't think I do. I think it's just edge.
[AGENT][NEUTRAL] OK, OK, um, so I would recommend giving that a try, um, maybe when you're off of work, um, otherwise I would continue refreshing that, um, and then trying just making sure it's that identical information that you're entering um I can, however, go ahead and provide some insight regarding those claims you were referring to um do you have those claim numbers or the dates of service?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, they would be like the last, um, few claims I would think, I think it's sometime in April beginning.
[AGENT][POSITIVE] Bless you. OK.
[AGENT][NEUTRAL] OK, let's take a look here.
[CUSTOMER][POSITIVE] OK, so I was able to, I refreshed the page and it seemed to have worked.
[AGENT][NEUTRAL] That's yeah, it is as it's very new I imagine it's got quite a bit of uh kinks like that so I apologize, but at least it's working now. OK, bear with me just a moment. I do see this one from Quest so let's take a look here. OK, so the reason this one was not covered through Quest is that per this policy, um, it does not provide any coverage from independent labs.
[AGENT][NEUTRAL] So covered places of service would be like a physician's office, clinic, urgent care emergency room, um, but as Quest is an independent lab, it's not going to be covered.
[CUSTOMER][NEUTRAL] Oh well.
[CUSTOMER][NEUTRAL] Oh, well, when I called they said quest was covered because the quest was at the
[CUSTOMER][NEUTRAL] Um, the office, um, and I said, well, do you accept requests? and they said yes, so.
[AGENT][NEUTRAL] There might be some confusion regarding that sure and I I do apologize um so I'm not seeing that the confusion might have been if you know obviously if it was a physician's office and they were the ones that build it that's how these claims work so as Quest itself is an independent lab since they're the ones that build it um it wouldn't be covered. Does that make sense?
[CUSTOMER][NEUTRAL] If I had known
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I, I understand what you're saying. My thing is,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] When I was in the doctor's office, they're the ones that
[CUSTOMER][NEUTRAL] Ordered the test for Quest to do and they have a quest of uh employee in house.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So if the doctor's the one that ordered it, is that not coming from the doctor's office?
[AGENT][NEUTRAL] It's not um I am seeing it coming from a quest.
[CUSTOMER][NEUTRAL] Uh, OK. Um.
[CUSTOMER][NEUTRAL] So then I guess my question would be, well how is that?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Ever covered from in-house if most offices always thing outside for like a reference lab.
[AGENT][NEUTRAL] Sure, it really does depend. each provider and each facility they operate very differently and some have their own uh labs in their office that are affiliated with them and not through an outside source so it really does just depend on how each provider works, uh, doing that.
[CUSTOMER][NEUTRAL] OK, so there's nothing that I can do in terms of.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I guess that that bill.
[AGENT][NEUTRAL] Right, so unfortunately as it does come from Quest and they are considered an independent lab, it's not going to be covered under this policy.
[CUSTOMER][NEUTRAL] OK, and that's just for like the ACA stuff, right?
[AGENT][NEUTRAL] This is your limited indemnity medical plan.
[CUSTOMER][NEUTRAL] Right, but as far as ACA is concerned.
[CUSTOMER][NEUTRAL] Um, it's just not covered because they didn't do it in house.
[AGENT][NEUTRAL] Right, and again it's all very particular on you know the where it's at and then of course who builds it and so as it was from Quest who is considered an independent lab that's why it's not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so I guess they, I don't think I can have quest to build the office and the office bill.
[CUSTOMER][NEUTRAL] You guys, um.
[AGENT][NEUTRAL] I'm not sure to be completely honest I'm not sure um you could try talking to them and see if they're willing to do that but I don't know if they would be able to.
[CUSTOMER][POSITIVE] OK, well, thanks so much.
[AGENT][NEUTRAL] Yeah, sorry there wasn't more for you to help. Did you have any other questions for me?
[CUSTOMER][NEUTRAL] Uh, that's it.
[AGENT][POSITIVE] Alrighty well thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thanks you too bye.
[AGENT][POSITIVE] Thank you bye bye.