AccountId: 011433970860
ContactId: e49eb77b-ca27-43cc-86d2-9cad630c4755
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 461730 ms
Total Talk Time (AGENT): 213443 ms
Total Talk Time (CUSTOMER): 178294 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/e49eb77b-ca27-43cc-86d2-9cad630c4755_20250108T20:32_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey, I, um.
[CUSTOMER][NEUTRAL] Yes I, I'm a, I guess a client. I just, I don't understand, um, I, I had some medical stuff in [PII] and I did just get something in the mail.
[CUSTOMER][NEUTRAL] And only two things are listed on here and so I just need to make sure like my policy number like what what I need to do to either turn in medical bills or how I make sure that I'm utilizing this um.
[CUSTOMER][NEUTRAL] You know, APL properly.
[AGENT][NEUTRAL] Oh, OK, um, do you have the policy number so I can know the product you have?
[CUSTOMER][NEUTRAL] Yeah it's 02515654.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]
[CUSTOMER][NEUTRAL] And my phone number is [PII].
[AGENT][POSITIVE] Thank you, Mister.
[AGENT][NEUTRAL] OK, and I need to verify your date of birth, mailing address and email address, please.
[CUSTOMER][NEUTRAL] Yep, um, my date of birth is [PII].
[CUSTOMER][NEUTRAL] Um, you said my home address?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And email should be maybe [PII].
[AGENT][POSITIVE] Yes, thank you, Mr. [PII]. All right, let's see.
[AGENT][NEUTRAL] OK, so you have one of our secondary policies, um, which is a supplemental plan.
[AGENT][NEUTRAL] And let's see. So on this one, we do not cover office visit. Um, it looks like we only cover procedures done in the office but no office visits. Um.
[AGENT][NEUTRAL] Miss I.
[CUSTOMER][NEUTRAL] So, I went to like an urgent care in the [PII] area in June. They did like CAT scans, ultrasounds, um, like, like some pretty like bad stomach issues.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And so the thing that I got from you guys it doesn't show anything on that.
[CUSTOMER][NEUTRAL] If I, if I have anything from last year, can I still submit it?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yes, you can always submit claims.
[CUSTOMER][NEUTRAL] And had
[AGENT][NEUTRAL] Uh, go ahead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I just
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Do you get, I just, I'm just curious if I go, do I have to give them a card from you guys so they know to submit it to you or do I submit it to you and then you guys issue something to me?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, the easiest and fastest way will be if you go in, uh, you'll go ahead and present both of your cars, your major medical and this one as your secondary, and have them to submit the claim. That will be the fastest and easiest way to do it. Um, if you need to submit your own claim because you pay out of pocket for a reimbursement, you can do that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, now, you will have to submit the documents and for any claims we request or we require 3 documents. Um, the first document is a claim form which you can find the claim form through our website at [PII]. Um, the second document is the itemized bill with the diagnosis codes and procedure codes which you get that from the place of service that you visited.
[AGENT][NEUTRAL] And then the third document is the explanation of benefits from the primary insurance indicating the amount applied towards the deductible co-payment and co-insurance. So if you're going to submit your own claim, we need those 3 documents for a complete claim, and it needs to be either sent by fax, by mail, or it could be uploaded to your account through the website if you have register, um, and that is um how you can submit a claim for reimbursement.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now, again, if you still owe a balance even though it was for last year, um, you can ask them to submit the claim directly to us so you don't have to go to the troubles of getting all the documents together to send it in. But if you already pay out of pocket, the best thing is to submit the claim for reimbursement, so you have to get all the information and send it to us.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I know there's one it's like a payment plan.
[CUSTOMER][NEUTRAL] So I'll just I'll have them try to submit to you guys.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um and then from there we can kinda I'm sure figure it out but.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So it, it, it like I had a, well, I had a actually a colonoscopy.
[CUSTOMER][NEUTRAL] And I don't remember if that was fully covered by insurance, but then like an endoscopy and some other things. And so if I already paid, could I still have them submit everything to you?
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Or do I need to get all the forms that you discussed and.
[AGENT][NEUTRAL] Yeah, if you already pay out of pocket, then you need to submit your own claim. Now, um, just keep in mind that this policy only covers for diagnostic testing. It will not cover anything that is preventative cause usually those are pay 100% and we don't pay preventative. So, um, it has to be a diagnostic testing, OK?
[CUSTOMER][NEUTRAL] Do all that.
[CUSTOMER][NEUTRAL] OK. So if I go in, like I've been having ongoing stomach issues and I'm going into the like gastro, whatever, and every time, you know, they're, hey, we're gonna try this test, this visit or this medication, that's just not a regular visit, correct?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That is uh diagnostic. That is to resolve a sickness. Um, that's called diagnostic. Um, yeah, preventative is usually when uh it was a family history or you had in the past and they're just trying to avoid for you to have it again, that is preventative. So if it's an ongoing sickness, then more than likely they're having diagnostic testing done. So that is part of your benefit. Um, we cannot guarantee anything over the phone, but yeah, you can just go ahead and submit the claims for those. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, sounds good I'll um.
[CUSTOMER][NEUTRAL] And so for.
[CUSTOMER][NEUTRAL] Let me see, I have the card here.
[CUSTOMER][NEUTRAL] I'm sure they have a.
[CUSTOMER][NEUTRAL] Place to submit or do something here. OK, I'll start making some calls and see if they can supply you with what's needed.
[AGENT][POSITIVE] OK. All right. Is there anything else I'm gonna help you with today? Any other questions or concerns?
[CUSTOMER][POSITIVE] No, you've been very helpful thank you for your time.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good afternoon, Mister.
[CUSTOMER][NEUTRAL] You too goodbye.
[AGENT][POSITIVE] Thank you. Goodbye.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] What time do you have dance?