AccountId: 011433970860
ContactId: f1ddffc7-f7ff-4476-8572-7cb2456b9aed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 460399 ms
Total Talk Time (AGENT): 282842 ms
Total Talk Time (CUSTOMER): 159927 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/f1ddffc7-f7ff-4476-8572-7cb2456b9aed_20250430T14:02_UTC.wav
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[AGENT][NEUTRAL] Contacting APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. I had submitted a claim, um, last week for a proceed um um office visit that I had because I was sick and under my, um, gap plan I was wondering, are office visits for illnesses included as reimbursement?
[AGENT][NEUTRAL] Well, let's look at your policy. Um what is your policy number, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, 1791957.
[AGENT][NEUTRAL] OK, I appreciate that. Thank you. If I could verify your name, and date of birth, and your phone number, please.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure, it's [PII]. Phone number [PII] and the birthday is [PII].
[AGENT][POSITIVE] I do appreciate that. Thank you.
[AGENT][NEUTRAL] So let's see what we have here. This is for data service, [PII]. Does that sound right?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Correct, mhm, yeah.
[AGENT][NEUTRAL] OK, your policy does not cover office visits, um.
[AGENT][NEUTRAL] It does cover treatment within the physician's office. So when, uh, or what you did with your primary care specialist, we just need the we just need the uh diagnosis code, you know, what you went in for. Um, I realized that you, you were saying that you weren't feeling well. Um, usually when they give you the walkout paper, uh, you know, when they, you know, when you leave, they will give you a walkout paper that says, you know, we saw you, this is who you saw, this is what happened. And so if you have something like that and it tells us what um
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, uh, what, you know, what you went in for. Otherwise, you can contact your physician. So let's look over your, your, uh, benefits and see exactly what you do have. Um, of course, you have inpatient and outpatient hospital. Uh, that goes without saying, um, you have treatment within the physician's office. Now, with the outpatient, there's also the urgent care, um,
[CUSTOMER][NEUTRAL] Um, let me see
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] There's a cancer treatment, uh, independent labs such as Quest, you know, usually you'll have uh, uh, lots of tests done, uh, durable, uh, medical equipment. Um, so sometimes, um, it, it just depends, uh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If, uh, you know, if you went to the, uh, urgent care, and that would, the visit there would be covered. It's just that the physician's office, uh, the only thing that, and it's actually, it's usually more expensive is the treatment or, or procedures, but the office visit co-pay is not. So on your visit for the [PII], uh, we just need to know what you went in for and then we can pay for those procedures. Um, and you will be getting that explanation of benefits just any time.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, but, um, you can uh download the, the, uh, that walkout paper or your, you know, what you get from your physician, um, and then we can get that taken care of.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, I just uploaded something um that I had got from the, I think from the provider, the Blue Cross Blue Shield, cause all the doctor gave me was like, you know, the receipt and I thought that would have been OK, but cause I don't think I've ever used this before, like this particular um.
[AGENT][NEUTRAL] Now
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] For, you know, anything in the past, at least not for me. I don't know for my husband if I can't remember submitting, but I just uploaded something. I don't know, this is what I printed out from the um from Florida Blue and it has like the diagnosis codes and all that stuff, so.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Well, let me look at it. Um, it's excuse me, uh, excuse me just a minute here, and I do apologize. My computer is just being a little bit slow, but yes, if I, I can look at it and then we can see whether it's, whether it will work. Um, if not, then, uh, I, I don't know whether, um, your physician has an, uh, a, um, usually they will have an online portal, um, where, uh, they will, um, you know, they'll tell you about your visit, your visit summary and things like that. You may also, uh, look at that as well.
[CUSTOMER][NEUTRAL] OK. I don't know if this is.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, for the diagnosis code, but let's see what we have here and then, um,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let's see, so this is for the data service, um, [PII] for a primary care specialist. OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And thank you for holding on. I'm sorry that my computer was so slow, so let's see what we have there.
[CUSTOMER][POSITIVE] Yeah, no problem. That's OK.
[AGENT][POSITIVE] OK, so this looks like your like your uh explanation of benefits, which is great, um, we can certainly always use that, uh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Oh, OK. All right, I see. Oh, perfect. OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, yes. OK. So this is, this is good. So, OK. Um, I do see that, that is, that is wonderful. That is what we're, um, I love these explanation of benefits when they give you this. So that's what we're looking for where it says diagnosis code. OK, great. So we did receive that, um, that will go back to an examiner, uh, and they will be able to uh take care of that for you. Um.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now, is there anything else at all that we could help with? Is there anything else about your uh your um secondary insurance that we could, uh, that we can be helpful with?
[CUSTOMER][NEUTRAL] Um, no, cause, um, the, this one was just, as I said, I was, I had, I had a lingering cough. So, you know, I went to get it checked out just because I didn't want it to be like, uh, if I had like, you know, pneumonia or bronchitis or something. And then whilst I was there, they were on some blood work and everything just to make sure that everything was, you know, um, OK. So that's what, that was the initial. There wasn't like a well visit or anything. I have that coming up.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] I think in like a couple of months, but um yeah I was just like a sick visit.
[AGENT][NEUTRAL] OK, OK. Well, I, um, I have put those notes on there and uh as I mentioned before, we do have that. So that will be going to a, um, for an examiner and then we can see what we can do about getting that processed. And usually, it, it's, uh, we, we say 6 to 10 business days. Um, usually it's less than that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, but, um,
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, I've noticed. Yeah, yeah, I know. No problem. Yeah, you guys are timely with your turnaround. So, um, because I would, I think I had read something online like it, it doesn't cover like as, as you said, like office visits, um, for like just like a checkup, but I think I remember seeing like an illness in there like if you went in for an illness.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, you know, so that's what I wanted just clarification on.
[AGENT][NEUTRAL] Let me check
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, could you excuse me just a moment please because I, my computer, it just seems to have stopped. I want to, I do apologize. Excuse me just a moment.
[CUSTOMER][POSITIVE] Oh yeah, absolutely.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Sorry, I was on the phone. Hi.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Oh no, not us, um.
[AGENT][NEUTRAL] that
[AGENT][NEUTRAL] Oh, OK. 2825.
[AGENT][NEUTRAL] Might be them, um, yeah, I would try them.
[AGENT][NEGATIVE] Oh yeah, no, it's not us, yeah, I would try there. Yeah, absolutely, no kind of right, thank you so much.
[AGENT][NEUTRAL] OK, I think it's back up now, so, um, but yes, uh yes, if you do have any, have, have any questions about your um about your policy or about submitting a claim, please let us know, but you will be hearing from us very soon about this one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right. OK, thanks very much.
[AGENT][POSITIVE] Well, thank you very much for contacting API.