AccountId: 011433970860
ContactId: e92f47cb-1ffb-4abf-814a-91bfd49c3879
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 758840 ms
Total Talk Time (AGENT): 397756 ms
Total Talk Time (CUSTOMER): 257750 ms
Interruptions: 8
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/e92f47cb-1ffb-4abf-814a-91bfd49c3879_20250611T21:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, this is one [PII]. How are you today?
[AGENT][POSITIVE] I'm doing well how are you?
[CUSTOMER][NEUTRAL] Good, thank you. Listen, I'm trying to log into my account um at APL but I'm having some issues. I wanted to check up, I guess I, I wanted to.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I guess uh get online and see if I could uh submit a claim.
[AGENT][NEUTRAL] Of course, OK, so I do apologize ahead of time for all of the confusion, um, so as of last week our website did undergo quite a big change and with that change it is requiring users to, um, you create new accounts essentially so you would have to go like you don't have an account, yes.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, it, it makes sense because I, I have.
[CUSTOMER][NEUTRAL] Yeah, I have read uh the credentials for my other account and it didn't require an email. Now it is asking me for an email.
[AGENT][POSITIVE] Yes, I'm so sorry about the confusion right.
[AGENT][NEUTRAL] That's yes that's right so after you create this new account it would be of course with all of the same information um but now of course you would not use a user name you would use the log in but you do have to create that new account first.
[CUSTOMER][NEUTRAL] OK, um, do you know my member ID? I, oh no, I can put in put my social. Never mind.
[AGENT][NEUTRAL] Um, so you would put in your social in that slot.
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[AGENT][POSITIVE] Alright, well, was there anything else I could help you with? I'm sorry about the confusion.
[CUSTOMER][NEUTRAL] Regarding the
[CUSTOMER][NEUTRAL] No, it's OK regarding um.
[CUSTOMER][NEUTRAL] And maybe you can, you can um answer this question. So, last week Friday I went uh
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] To see the doctor and perform an ultrasound.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, they charged me $190. Um, it was my understanding that that was covered, uh, initially by the, by the insurance, but they said no, and then I was OK, maybe my gap insurance can cover that.
[AGENT][NEUTRAL] Oh, OK, well I can clear up that confusion, um, so your secondary medical policy, it is very dependent on whoever you have as your primary, so they would have to pay first before your secondary can. So if your major medical does not pay, the secondary cannot.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, can you repeat that? if my, if my primary, primary insurance doesn't pay.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] If, if your primary does not right then no your secondary could not pay anything. It is very dependent on your major medical, so whoever you have as your primary, the policy is designed to help with co-pay, deductible and co-insurance after your major medical pays. So if they don't pay this policy can't.
[CUSTOMER][NEUTRAL] No, that's what I'm saying. That, that, that's what I'm, I, I, I believe I was under understanding it correctly because that's basically what the gap is for, right? For to cover any non, um, non-covered charges by the, by the primary insurance, and which I believe this is the case.
[AGENT][NEUTRAL] No, sir. Not this one.
[AGENT][NEUTRAL] No, sir, so this policy, as it's secondary, um, it's not really considered gap it is secondary, uh, to your major medical, so it's designed to supplement your major medical. If they don't pay, this policy can't. If they do, then this policy helps with co-pay, deductible and co-insurance.
[CUSTOMER][NEUTRAL] Well, but
[CUSTOMER][NEUTRAL] Help me, help me clarify something. When you say they don't pay, what do you mean by they don't pay?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] If they don't contribute anything, so if it's like from what I understand you're saying they wouldn't pay for the ultrasound, is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, not for all, the ultrasound, yeah.
[AGENT][NEUTRAL] OK, so if they contributed some then yes it can. OK, maybe I just wasn't understanding correctly. I apologize so then yes.
[CUSTOMER][NEUTRAL] No, no, maybe I didn't, I didn't, I didn't, I didn't make myself very clear. I'm sorry.
[AGENT][NEUTRAL] That's OK. No, no, no, that's perfectly fine just so that you are aware, uh, major medical does have to contribute at least a bit before this policy can. So if that's the case, then yes, you can absolutely file that claim.
[CUSTOMER][NEUTRAL] And then how do I know how much my primary insurance pays?
[AGENT][NEUTRAL] Um, I don't know how much your primary paid. Um, that would be information you would get from your provider wherever you went.
[CUSTOMER][NEUTRAL] On the claim?
[CUSTOMER][NEUTRAL] That's what I'm, I mean, that's what I'm saying because what, what, what.
[CUSTOMER][NEUTRAL] What kind of documentation you guys are gonna need in order for me to to submit a claim, you know?
[AGENT][NEUTRAL] Of course, yes, uh let me know when you're ready if you'd like to write uh write it down and I can give that information to you.
[CUSTOMER][NEUTRAL] OK, uh, before that, it says that no user ID or no user name, no user, I'm sorry, was found.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, so let's go ahead and just get no worries, let's go ahead and get your uh policy pulled up, um, before we go any further, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Trying to, to create my account.
[CUSTOMER][NEUTRAL] Absolutely, uh, [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and I apologize, what was your name?
[CUSTOMER][NEUTRAL] And never mind, I was able to, to continue what was my last thing.
[AGENT][NEUTRAL] OK, I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] One, OK.
[AGENT][NEUTRAL] Thank you. OK, so and then you said that you were able to get the account created or continue?
[CUSTOMER][POSITIVE] Yes, yes, yes, yes.
[AGENT][POSITIVE] Awesome, OK.
[AGENT][NEUTRAL] Alrighty, did you still want me to get your policy pulled up so we could see uh your benefit amounts?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, um, let's see, do you have your policy number one?
[CUSTOMER][NEUTRAL] Uh, no, but I can get it
[CUSTOMER][NEUTRAL] Well, give me one second.
[AGENT][POSITIVE] No worries, uh, if it's easier I can start choosing your social as well.
[CUSTOMER][NEUTRAL] Yes, uh, if you bear with me, I can, I can look it up before I do give my social.
[AGENT][NEUTRAL] Sure, whatever is easier for you.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK, I was able to log in, so let me.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Give you the uh where, where do I see my
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I'm looking for the um the account number bear with me.
[AGENT][NEUTRAL] Sure, uh, yeah, no, anything that says a policy number or cert number or anything like that, um, I know the website changed quite a bit over on the left there I think under, oh goodness, it might be under my profile, um, and that's where you could, you could even pull up your ID card that way and find it there.
[CUSTOMER][NEUTRAL] ID oh here says your ID, uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, policy number, got it. Uh, 260.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 5352.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] There we are just gonna verify some information really quick one, can I get your date of birth please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address that we've got on file for you. Looks like it's a Hotmail account.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Awesome thank you so much for verifying all of that. OK, give me just a moment let me take a look here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And of course I will let you know verification of coverage is not a guarantee of payment for claims so your outpatient benefit, which is what that would fall under, uh, per calendar year it pays up to $2000 and if you'll give me one moment, I will see if any of that has been used if you've got a remaining balance.
[AGENT][NEUTRAL] OK, so I'm not showing you've used any of that benefits so far this year, so you should have that full $2000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For example, uh, I'm, I'm seeing here just as an example, uh, there was, I, I, I just logged into my uh UnitedHealth, which is my primary insurance, and I went to claims, and there was one that was processed today.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, from a visit back on [PII], I think it was, and it's charging me for a
[CUSTOMER][NEUTRAL] Uh, I guess like a copay. So total amount bill was $100 plan discount and then plan paid and then the, the amount that I owe. In this case, if I understood correctly from you, this amount that I owe, I can submit this claim to to you guys.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] That's correct. And again, as long as they've paid even a little bit, this policy, that $2000 benefit is designed to help with co-pay, deductible and tells insurance right up until you reach that $2000 cap for the calendar year.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and in, in, and how does it work? Should I submit the payment and then submit a claim for you guys for you to refund me or you guys pay directly or how does it work?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so you've got a couple of different options um so you can give this information to wherever it was that you received treatment, uh, so you'd give them this policy number and see if they'll file the claim for you on your behalf uh sometimes providers, you know, they will, and other times they don't want to mess with any sort of secondary or supplemental, um, I would definitely try though.
[CUSTOMER][NEUTRAL] Yeah, I'll go, I'll go with the, with the latter.
[AGENT][NEUTRAL] Well, I understand it's a lot I know um so as far as you filing these claims, um, let me know when you're ready if you'd like to write this down. I'll let you know exactly what we need.
[CUSTOMER][NEUTRAL] Uh, one second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] OK, so this information you can get it all from the provider wherever you went for treatment they would have all of this information uh so we would need the itemized statement.
[AGENT][NEUTRAL] That shows
[CUSTOMER][NEUTRAL] And my stay, OK.
[AGENT][NEUTRAL] Mhm. That shows diagnosis.
[AGENT][NEUTRAL] And procedure codes.
[CUSTOMER][NEUTRAL] Diagnosis and procedure codes.
[AGENT][NEUTRAL] Correct, yes. So then we would need of course the explanation of benefits from your primary insurance, essentially just showing us what they did pay towards the treatment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Explanation of benefits, special benefits from my
[AGENT][NEUTRAL] Primary, yes.
[CUSTOMER][NEUTRAL] Primary
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, so again the wherever you went the facility provider wherever you went for treatment, they will have all of this information, uh, and they can give that to you once you've got it you can just upload it to our system, um, file the claim there it gets to us very quick, uh, it can take about 7 to 10 business days for claim information to process and I will say, um, so since you are the one who would be filing the claim, we would send that benefit amount to you.
[AGENT][NEUTRAL] And so on the website you do have an option to set up direct deposit if you prefer, if not then we would simply mail you a paper check.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, understood, and then that uh direct deposit option, um, I can set it up online, I guess.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes sir, absolutely.
[CUSTOMER][NEUTRAL] OK, right, understood.
[AGENT][NEUTRAL] Alright, I know that was quite a bit. Did you have any other questions for me?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][POSITIVE] No, it was actually very clear. I appreciate that very much.
[AGENT][POSITIVE] Awesome, yes, if you have any other questions feel free to give us a call back we'll do what we can to help you out. I hope you have a great rest of your day stay safe.
[CUSTOMER][POSITIVE] Great
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.