AccountId: 011433970860
ContactId: ede3a935-270f-4c3d-80f2-09814bd603af
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 790900 ms
Total Talk Time (AGENT): 503656 ms
Total Talk Time (CUSTOMER): 239951 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/ede3a935-270f-4c3d-80f2-09814bd603af_20250204T19:38_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]. My name is [PII], and my company recently changed their, our insurance over to Florida Blue, and we are using you as our supplemental.
[CUSTOMER][NEUTRAL] And I just had a couple of questions, because I went to the doctor today and uh they, they did my Florida blue card or whatever. And I have to have like an outpatient surgery. So I said, I have the supplement. Is there any way this helps, you know, towards the bill or anything? And she looked at it and she said, there's no ID number on here. There's no number on here.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] So she's, I don't know what I'm supposed to do with this. So I was like, well, I've never used it before either, so I don't either, so maybe I need to call. She's so nasty. I was like, oh my [PII].
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Wow. OK. So you're trying to find out uh just some general benefit information on your policy that you have now with APL M. Frazier, is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If, yeah.
[CUSTOMER][NEUTRAL] Yeah, I need to have a er uh.
[AGENT][NEUTRAL] And about your policy number?
[CUSTOMER][NEUTRAL] I have a payer ID number, a group number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A plan name in and outpatients uh certification number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's your numbers that you, OK. So yes ma'am. So first off, Ms. [PII], I can help you with this. I'll be able to help you, but let me, um, what is a good callback number for you in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, because we really have a terrible connection I have to say, but my number here is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. So your um policy number either give me if you'll notice Miss [PII], the in hospital and outpatient numbers.
[CUSTOMER][POSITIVE] It has an in hospitals benefit.
[AGENT][NEUTRAL] At the very beginning.
[AGENT][NEUTRAL] And an outpatient. That is correct. The first part of both of those numbers is the same prior to the letters ML. OK, so that's your actual policy number, the ML 7 and 8, that just indicates whether it's an inpatient.
[CUSTOMER][POSITIVE] And an outpatient benefit.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Or an outpatient service. Mhm. So just give me the first part of either one of those numbers.
[CUSTOMER][NEUTRAL] Or outpatient, OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. Give me a moment to get your information pulled up and I will have to verify several things with you first for security and any information disclosure that I provide for you today will be a verification of benefits and not a guarantee of.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] OK, well, it's really staticky. I'm just trying to understand what you're saying, but OK.
[AGENT][NEUTRAL] Payment. So,
[AGENT][NEUTRAL] You can't understand me?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEGATIVE] You're breaking up on me. Do you wanna call?
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][NEGATIVE] I do hear you, but it's breaking up constant.
[AGENT][NEUTRAL] Yeah, I don't.
[AGENT][NEGATIVE] I don't, yes, ma'am. I, I don't know that that's gonna be helpful, unfortunately.
[CUSTOMER][NEUTRAL] Why are your phones always like this?
[AGENT][POSITIVE] We'll just do the best
[AGENT][NEUTRAL] I don't know. Today, it's, there has been some static on the lines and sometimes other people, I'm not able to hear other people.
[CUSTOMER][NEUTRAL] All right, well, we could try our best, I guess.
[AGENT][NEUTRAL] So I don't know which end of it.
[AGENT][NEUTRAL] So, first off, I do need to verify your information and again, anything that I do provide for you as far as benefit information would be, would be that uh it's not a guarantee of payment. So if you could first please verify your date of birth for me.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Your zip code?
[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 the best number we should have, is that correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, thank you. And lastly your email address?
[CUSTOMER][NEUTRAL] Um, I, I have like 3 emails. I did they put my work one? Is it [PII]?
[AGENT][NEUTRAL] No, ma'am, it appears, this is a personal.
[CUSTOMER][NEUTRAL] Uh, OK, so then my name [PII].
[AGENT][NEUTRAL] OK, thank you very much for verifying all of your information. So this policy, yes ma'am, Ms. [PII], it does help you with your co-paypays, deductibles, and co-insurance amounts of covered services. And you said that you are scheduled for an outpatient procedure. Is that right?
[CUSTOMER][NEUTRAL] Yeah. It's a, uh, a surgery on my hand, but it's outpatient.
[AGENT][NEUTRAL] OK. I mean, so it'll be done at a, like a surgery center or an outpatient?
[AGENT][NEUTRAL] At the hospital, or is it gonna be in the doctor's?
[CUSTOMER][NEUTRAL] Uh, yeah, it's kind of like a, it's like a hos it's like a hospital building. It's not the doctor's office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on your policy that you have with APL, your outpatient benefit maximum per calendar day for covered outpatient services is $500.
[AGENT][NEUTRAL] And there is no deductible per calendar day for outpatient.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So the provider would file your primary insurance if they will file both. If for any reason they won't file your supplemental coverage or with us, Ms. [PII], you can do that, OK? Um, but if they're gonna do it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Will be filed with your primary insurance first and then with APL because we will always have to have a copy of your primary insurance company's explanation of benefits along with the claim for review.
[AGENT][NEUTRAL] Because we have to be able to see the any amounts that they applied towards your deductible, co-pay or co-insurance.
[AGENT][NEUTRAL] When we're reviewing a claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But you do have this $500.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Benefit maximum that we could review that we could review that type of procedure under. If you were to have, you know, a even a procedure in your doctor's office, you have benefits, they all fall under that same $500 per calendar day, but an office visit itself is not covered by this plan.
[CUSTOMER][NEUTRAL] Per day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, that's fine. I, I understand that. I didn't think it would be. I was just wondering about the surgery, like how much it's gonna cost me out of pocket. Now, let me ask you something else. I, I think insurance has changed over the last couple of years, but probably since COVID, but they wanted me to pay today for.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] My surgeries, doctor charges, and
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What the heck else did she say?
[CUSTOMER][NEUTRAL] The doctor, anyway, it was like almost $1800. So, I guess that's the way things are done now, you prepay before they.
[CUSTOMER][NEUTRAL] Send it to your insurance company?
[AGENT][NEUTRAL] Again, that is, that is completely up to the provider, honestly, Ms. [PII]. Now, most, most providers will call us.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And to check to make sure your policy is active, they'll get your eligibility and then they'll, you know, for example, say that they're checking your outpatient benefits for an outpatient surgery. So if you were the provider calling me right now, I would have told you the exact same thing. You know, any information I provide you will be a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] And I would let them know that you do have a $500 per calendar day.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Outpatient benefit on this plan for coverage services.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So then how they want to handle that as far as, you know, on their billing side, we have nothing to do with that.
[AGENT][NEUTRAL] Some will wait to see if your insurance is gonna pay before they bill you and then, yes, ma'am, some will make you.
[CUSTOMER][NEUTRAL] OK, so either
[AGENT][NEUTRAL] Pay in advance, but
[CUSTOMER][NEUTRAL] OK, because it sounds like they're gonna charge for it now even though it's 2 weeks away.
[CUSTOMER][NEUTRAL] So, I don't know if the benefits will pay it that way, or they wait until it's done, or
[AGENT][NEUTRAL] Yes, I'm obviously.
[CUSTOMER][NEUTRAL] But you need them to.
[CUSTOMER][NEUTRAL] The file first with Florida Blue to send you.
[AGENT][NEUTRAL] Mm. And if for some reason, correct, because even if they don't file, if they said, well, no, ma'am, we're only gonna file your primary insurance and you have to file the claim with us then, you'll still have to present us the same information as they would.
[CUSTOMER][NEUTRAL] The explanation of benefits.
[AGENT][POSITIVE] Um, what I'm gonna do is, oh, yes, ma'am, absolutely. And what I'm gonna do is we have a portal.
[CUSTOMER][NEUTRAL] OK, but I can do that if they.
[AGENT][NEUTRAL] Um, it talked about our online service center portal.
[AGENT][NEUTRAL] When you got your ID cards, your ID cards were attached to a document that talks about that at the top, but I have a user guide that I'm gonna email to you because once you set up your profile in the portal, it's gonna give you access to all of your policy information, your ID cards, you'll be able to see claims that we have on file for you and if you ever have to submit your own claim, you actually can do it from a computer. It doesn't currently, it's not supported, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Via mobile devices, but you can upload all of your information from a computer directly into that portal for us to review.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I will email you the user guide and I'll go ahead and include one of our the Medlink claim forms if you'll notice on your ID card it's a Medlink policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, yeah. Mhm.
[AGENT][NEUTRAL] Because our claim form has the specific instructions.
[AGENT][NEUTRAL] Of what you need to send to us to review a claim on this type of policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you would just use that a checklist. But y[PII], ma'am, if you can call them, you said she acted like she didn't know.
[CUSTOMER][POSITIVE] That would be great.
[AGENT][NEUTRAL] What the car was, or, oh, OK.
[CUSTOMER][NEGATIVE] Uh, she didn't even want to be bothered. It was, yeah.
[AGENT][NEUTRAL] Well, if you can get them.
[CUSTOMER][NEUTRAL] I don't know if she was having a bad day or.
[AGENT][NEUTRAL] Yeah, sure. Um,
[CUSTOMER][NEUTRAL] But then you go there, it takes an hour to get there from where I live, and then you, they make you wait for over an hour.
[CUSTOMER][NEUTRAL] And then you're in there for like 10 minutes and it's like, well, what card do you wanna put it on?
[AGENT][NEUTRAL] You know,
[AGENT][NEUTRAL] Right
[AGENT][NEGATIVE] They, I mean, unfortunately.
[CUSTOMER][NEUTRAL] Like I've never done this before.
[AGENT][NEGATIVE] Unfortunately, Ms. [PII].
[CUSTOMER][NEUTRAL] I've never done this before.
[AGENT][NEUTRAL] I know you're in [PII] and I'm in [PII], but that's just the norm these days, unfortunately, but it is in most places.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, let's see
[AGENT][NEUTRAL] So the email that I'm gonna send to you with these form with the user guide for the portal and also the med link claim form, it will come from care team at [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I will put APL in your subject line.
[AGENT][NEUTRAL] So that that's easy to
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I will look for it.
[AGENT][NEUTRAL] You um recognize second to do that and I'll.
[AGENT][NEUTRAL] Um, just one moment.
[AGENT][NEUTRAL] And this claim form too should you know.
[AGENT][NEUTRAL] You ever need another one?
[AGENT][NEUTRAL] You can get these from our website.
[AGENT][NEUTRAL] By going to our public website at [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there's a link for claims and forms and you would just click there and scroll down.
[AGENT][NEUTRAL] And they're in alphabetical order and you're looking for a med link claim form, but again, I'm, I'm attaching one and I had just sent that to you, um.
[AGENT][NEUTRAL] Uh, one second.
[CUSTOMER][POSITIVE] Perfect
[AGENT][NEUTRAL] So yeah you should have that within just a minute or so.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] Well, you are certainly very welcome. So do you have any other questions or is there anything else that I could help you with?
[CUSTOMER][NEUTRAL] Um, not right now, maybe later on though, and I have your number.
[AGENT][POSITIVE] Yes, ma'am. Well, if you need us, you just call us and we'll be more than happy to help you.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're very welcome and I hope you have a nice afternoon and I hope everything goes well with your procedure. And thank you again for calling APL Ms [PII].
[CUSTOMER][POSITIVE] Thank you. You have a great day.
[AGENT][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] OK, bye-bye.
[AGENT][NEUTRAL] Bye bye.