AccountId: 011433970860
ContactId: fb0627e0-26fb-47a5-9d7a-e561138f2cdb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2390479 ms
Total Talk Time (AGENT): 1354990 ms
Total Talk Time (CUSTOMER): 785062 ms
Interruptions: 13
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/fb0627e0-26fb-47a5-9d7a-e561138f2cdb_20250514T22:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, um, I have a question about my supplemental insurance.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] With APL?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] What do I need to give you to look up my benefits?
[AGENT][NEUTRAL] Sure, um, what was your name first please?
[CUSTOMER][NEUTRAL] [PII] [PII]. I mean, sorry, [PII]. I don't know what I'm doing.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That's alright. I'll probably need that later. That's OK. Um, I, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] 01116669
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] There we are, OK, I'm just gonna verify some information really quick. [PII], 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][NEUTRAL] Perfect, um, and you kind of verified your email already. um, I've got it with the number [PII], is that right?
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Yeah, that is correct.
[AGENT][POSITIVE] OK awesome thanks for verifying all of that uh what kinds of questions did you have for me [PII]?
[CUSTOMER][NEUTRAL] OK, so in the past, I visit a chiropractor.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And I pay out of pocket, but he always submitted.
[CUSTOMER][NEUTRAL] My claims and I would get like a $25 credit.
[CUSTOMER][NEGATIVE] He said he got a message that if my primary insurance doesn't cover, APL can't cover the benefit either.
[AGENT][NEUTRAL] That is correct. So as this, no ma'am, so that's always how this was um, it's possible that the facility, um maybe they no longer take that insurance as your primary this policy in order to process claims we have to have the primary EOB showing what they did contribute. So if they didn't contribute anything and this policy couldn't pay anything.
[CUSTOMER][NEUTRAL] Has that changed?
[CUSTOMER][NEUTRAL] And you're saying it's always been that way, but we used to have UMR and now we have Aetna.
[AGENT][NEUTRAL] Oh, so I would honestly, hm, did your, um, chiropractor mention anything about them just not accepting your current primary?
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] The chiropractor is not on my plan, never has been, so I've always visited him out of pocket.
[AGENT][NEUTRAL] Oh, I see.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][POSITIVE] But I was always able to submit some visits and I would get a $25 credit.
[AGENT][NEUTRAL] May I ask when that was?
[CUSTOMER][NEUTRAL] At you know at least up to full.
[CUSTOMER][NEUTRAL] When?
[AGENT][NEUTRAL] Yeah, kind of sort of when you like last received uh credits from us or benefits, excuse me.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Um, I would say last year.
[AGENT][NEUTRAL] [PII]? OK, let's see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so the most recent claim that I have is it um just Family Chiropractic Center is that the name of the facility?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let's see. Give me just a moment.
[CUSTOMER][NEUTRAL] I'm sorry, what did you tell me your name was? I'm sorry.
[AGENT][NEUTRAL] Oh sure, no, it's all right, it's [PII]
[CUSTOMER][POSITIVE] Thank you, [PII]. OK.
[AGENT][NEUTRAL] Of course give me just a moment. I'm gonna try to find um record of that just so I can make sure um the information that was submitted for those claims so bear with me just a moment.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] I do see for this most recent claim looks like that date of service was [PII] of this year and it does state that we need that primary EOB so let's take a look here.
[CUSTOMER][NEUTRAL] That makes sense.
[AGENT][NEUTRAL] And just so that I understand correctly, uh, Irene, it was you always went to this chiropractor, correct? Like this one facility, OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah, many, many, many, many years.
[AGENT][NEGATIVE] I don't see any instance of us paying a benefit for them.
[AGENT][NEUTRAL] I'm back in [PII] now.
[CUSTOMER][NEUTRAL] I would get
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] I do see that you frequent them. No, I mean I've seen what they've sent to us that they've attempted to file claims, um, but none that we paid on it's all stating the same denial reason as us meeting the primary EOB.
[CUSTOMER][NEUTRAL] Nothing in [PII]?
[CUSTOMER][NEUTRAL] I so.
[CUSTOMER][NEUTRAL] This is the first time that we've ever.
[CUSTOMER][NEUTRAL] That, I mean like sometimes there might would be uh.
[CUSTOMER][NEGATIVE] A refusal or something and they would resubmit it and it would go through. This is the first time he brought it to my attention that he submitted some and it got denied.
[AGENT][NEGATIVE] That's interesting, yeah, I mean, I've seen it like I said I didn't go all the way back. I did go about to like [PII], um, and I do see instances of them submitting claims to us, but again I was unable to pay any benefit. Now I do see one and I don't know this might add to confusion. I see a payment of $25 that we paid, but it was for um.
[CUSTOMER][NEUTRAL] But I
[AGENT][NEUTRAL] Cleveland Clinic Foundation, I think.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, is that.
[CUSTOMER][NEUTRAL] Yeah, that was a primary.
[CUSTOMER][NEUTRAL] That I went to
[AGENT][NEUTRAL] OK, so that's irrelevant. OK, that's not relevant to this. OK, so that's really, I see that benefit. I see.
[CUSTOMER][NEUTRAL] That was in
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That's really the only benefits that we've been paying on I mean I again this same provider I see them going back quite a ways but we've never made any payments to them.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Alright, let me see if I can, I don't know if they'll be able to tell me if I go back inside.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] I think it's just worth it while I have you on the phone. What, what.
[AGENT][POSITIVE] Absolutely, yeah, definitely.
[CUSTOMER][NEUTRAL] What could they give you to to to to confirm that I that I would get credits.
[CUSTOMER][NEUTRAL] What would like when you approve something, how does it work?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Again, we really just need for this as being your secondary medical we we need that primary EOB so your primary would have to contribute something towards a copay deductible or co-insurance, and that's what this policy helps with. So if they've contributed anything to that, this policy is designed to help with that.
[AGENT][NEGATIVE] But if they didn't pay anything, then this policy can't pay anything.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] And and you're saying primary, so you mean Aetna now.
[AGENT][NEUTRAL] Who yeah whoever you have.
[CUSTOMER][NEUTRAL] Do you see anything that we used to be with UMR?
[AGENT][NEUTRAL] Um, I don't see any record of who you have as your primary. That's why I never ever mention, um, names or anything because I don't see that information. This is just your secondary, and we need the primary EV.
[CUSTOMER][NEUTRAL] Alright, hold on one second.
[CUSTOMER][NEUTRAL] OK, are you able to show when we would get credit?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] From my secondary? No, OK.
[CUSTOMER][NEUTRAL] When you did or when you will when we did in the past because she's not seeing any record that that this company has paid benefits but we know.
[AGENT][NEUTRAL] That we paid a claim to them, yeah.
[CUSTOMER][NEUTRAL] I can pull up your EOBs. OK, let me see, it'll just take me a minute, you know, yeah.
[CUSTOMER][NEUTRAL] How are you say the girl's gonna pull up my explanation of benefits.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Hey, OK, they're gonna pull up the EOB.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Maybe to show that we got the credit in the past.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I know you definitely did they would do $25.
[CUSTOMER][NEUTRAL] Let's see. Alright, I'm gonna put you on speaker. [PII], hold on.
[AGENT][POSITIVE] Sure, yeah, that's perfect.
[CUSTOMER][NEUTRAL] I'm just slow so.
[AGENT][POSITIVE] No worries. It's about the end of the day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes is OK.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] And I think I'm gonna, I'll go the next year, uh, and last year, pardon me, [PII].
[AGENT][NEUTRAL] Sure, I tried going back to about uh [PII] and I couldn't see any instance. I didn't go past that, but I do see several claims that y'all have sent to us, but I don't see any that we've paid.
[CUSTOMER][NEUTRAL] Yeah, they would they.
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] Yeah, American Public Life would pay $25 at a time.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, it's just, it's gonna take me a while to.
[CUSTOMER][NEUTRAL] It's there. Hang on, come on.
[AGENT][NEUTRAL] Now let me ask you this, ma'am, um, so I do see I've been using this one tax ID there's no other tax ID it could be under correct?
[CUSTOMER][NEUTRAL] No, that's their tax ID at Fico and Charney, um, let's go to see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, I mean, he's pretty on top of it. He, the doctor does all the things.
[AGENT][NEUTRAL] Sure, oh, I do see, yeah, I see all of the claims that y'all sent our way but none that we've paid.
[CUSTOMER][NEUTRAL] None that you paid $25 for?
[AGENT][NEUTRAL] No, none. The only instance like I um told [PII] was I do see some $25 payments, but she said that was for a different, um, I think you said your primary care doctor, was that right? The [PII] Clinic?
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] Yeah, I had
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I had one used this year.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, I'm trying to go back [PII]. Let me see.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Does it matter if I go back to [PII] let me see.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] I didn't go further than that but yeah if you find any instance I'd like to take a look at what we've received.
[CUSTOMER][NEUTRAL] 25.
[CUSTOMER][NEUTRAL] OK, hang on, it's just I have to open each one to see which one.
[AGENT][POSITIVE] You're OK.
[CUSTOMER][POSITIVE] OK, um, he would probably know a better way.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And I don't wanna print all these if they're not. OK, this one, nothing.
[AGENT][NEUTRAL] Well, while you're doing that, I'll continue looking back to and see what I can't find.
[CUSTOMER][NEUTRAL] Yeah, I mean, if you
[AGENT][NEUTRAL] I just kind of stopped at [PII].
[CUSTOMER][NEUTRAL] Uh, uh, did you check all of [PII]?
[AGENT][NEUTRAL] Uh, I think I got to about September, um, so give me just a minute. I can, I can keep looking though.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I think you probably would be better because I have every EOB and most of them are 0 so I have no way of knowing unless I open it. I mean he, he might know.
[AGENT][NEUTRAL] OK, then, no, that's perfectly fine. I can continue looking, um, while I can speak with you though, is there any record because I know she said um she'd recently switched her primary, um, is it that you just y'all don't take Aetna, her current primary?
[CUSTOMER][NEUTRAL] Um, let me look. I don't know if it's that where you don't, it's not a PPO, right? We're out of network, so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Or that you don't have uh chiro benefits. Let me see. Alright, let me get out of where I am since you're gonna check that and see.
[AGENT][POSITIVE] Yes, yes, you're fine.
[CUSTOMER][NEUTRAL] He was
[CUSTOMER][NEUTRAL] Yeah, we, you've had Aetna since [PII].
[CUSTOMER][NEUTRAL] And let me see your back.
[CUSTOMER][NEUTRAL] Um
[AGENT][POSITIVE] I gotta say y'all must be a good chiropractor for her to stick with y'all for this long. That's pretty cool.
[AGENT][NEUTRAL] I used to seeing people go all over the place.
[CUSTOMER][NEUTRAL] Well, he's been
[CUSTOMER][POSITIVE] 39 years and I'm really lucky too because he does all his own billing. He does all his notes every day.
[AGENT][NEUTRAL] Oh,
[AGENT][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Right here, go ahead and take your shoes off again.
[CUSTOMER][NEUTRAL] Maybe.
[CUSTOMER][NEUTRAL] OK, I'll show you that, yeah, alright, hold. Oh, you found one. Hold on, hold on, OK.
[AGENT][POSITIVE] OK, here we go I think I found one bear with me just a minute.
[AGENT][NEUTRAL] Give me just a minute, let me make sure that's the right tax ID.
[AGENT][NEUTRAL] Yes, uh.
[AGENT][NEUTRAL] This the date of service was [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So bear with me. Let me take a look at what was submitted.
[CUSTOMER][NEUTRAL] Um, I read it on.
[CUSTOMER][NEUTRAL] American
[CUSTOMER][NEUTRAL] He supplement and she's like, I'm trying to get the EODs where they pay the 25. Yeah, because they don't do that. And she, none for [PII]. She found one in [PII]. And she wanted to know what's the reason why we didn't take Aetna, but I think she doesn't have thyro.
[CUSTOMER][NEGATIVE] No managed care work.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Here we are. Hi.
[CUSTOMER][NEUTRAL] I'm Doctor [PII]. How can I help you?
[AGENT][NEUTRAL] OK, so I think um.
[AGENT][NEUTRAL] I think the thing is, um, might just be some uh confusion, miscommunication, um, so in short, the way that this policy works this is her secondary medical her whoever she has as her primary medical does have to pay before this policy can.
[AGENT][NEUTRAL] Um, so it's designed to help with copay deductible coinsurance after her primary pays. So she did say that, um, you know that she, she was certain that y'all had paid this before the $25 and I did finally find an instance from [PII], but we did receive an EOB from y'all, uh, from United Healthcare.
[AGENT][NEUTRAL] So, um, I guess the question is, uh, do y'all not accept her current, uh, primary because I do see where y'all had been submitting claims to us, but it's just asking we're stating that we're needing the primary EOB.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] Right, and we have sent the EOB, but we are out of network with the with the HMO.
[AGENT][NEUTRAL] I see, so that being said, this policy would not be able to pay anything uh unless her primary does.
[CUSTOMER][NEUTRAL] How have we been doing go. OK, and that's why I said it's because of Aetna I've changed now, so OK. And United Healthcare.
[AGENT][NEUTRAL] Right.
[AGENT][NEGATIVE] Right, it is confusing.
[AGENT][NEUTRAL] Yeah, but United that was back in [PII].
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] You can't find that.
[CUSTOMER][NEUTRAL] That United or APL has been paying 22 yeah I know, I know, but we got, we got payments in [PII].
[CUSTOMER][NEUTRAL] I don't see any in the file.
[CUSTOMER][NEUTRAL] The [PII].
[AGENT][NEUTRAL] I have no record for [PII]. This was the uh latest payment that I see that we made to this clinic.
[CUSTOMER][NEUTRAL] I went to
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, it looks like it was.
[CUSTOMER][NEUTRAL] [PII]. It's been that long. OK, found it.
[AGENT][POSITIVE] Yes, that's correct, yes, that's exactly the one I'm looking at.
[CUSTOMER][POSITIVE] Perfect. Thank you guys. OK. All right.
[AGENT][NEUTRAL] Well, that was, that was a bit of a hunt.
[CUSTOMER][NEUTRAL] That was OK, so I guess my question to you now is.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I've got some $25 that I didn't use in [PII].
[AGENT][NEUTRAL] Um, let's see, so, let, give me just a moment, let's take a look here. So I will say.
[CUSTOMER][NEUTRAL] Or did my
[AGENT][NEUTRAL] Mhm. The way that you're.
[AGENT][NEUTRAL] Policy pays is so your outpatient benefit is on uh per calendar year it's uh $500 per calendar year and that goes toward co-pay deductible co-insurance as you saw that can also be for your primary so I can see there's no timely filing limit. So if there was anything you believe that you could file for in [PII], you absolutely can.
[AGENT][NEUTRAL] Is that what you're asking?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I'm asking what I'm asking is how many claims did I did did were submitted in [PII], because yeah, I'll have to go back and find other doctors, dermatologists, and make sure they're all.
[CUSTOMER][NEUTRAL] I'm getting my my 4 per year.
[AGENT][NEUTRAL] Yeah, OK, let's see.
[AGENT][NEUTRAL] Let's take a look here.
[AGENT][NEUTRAL] Bear with me just a moment.
[AGENT][NEUTRAL] Let's take a look at [PII] 1st. OK, so for [PII] I am showing of that oh, you're you're talking specifically um office visits, correct? Or just visits in general? OK, you're not meaning you're OK, you're not the benefit as a whole. I see. OK, give me just a moment let's take a look.
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Office
[AGENT][NEUTRAL] So I am showing you've used 3 visits um from [PII] so we paid a total benefit of $75 from your outpatient but let me see how your policy is set up um because sometimes they do, it could be like as a whole or sometimes they're um they separate what that can be like I believe this one like uh urgent care, that one's going to be separate so let me double check that.
[CUSTOMER][NEGATIVE] Cause I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let's see. I'm, I'm getting close.
[AGENT][NEUTRAL] OK, so your physician, that's OK, that's the physician's outpatient treatment writer, so that one is maximum of 4 visits per calendar year of $25. So for last year you've used 3. So if there was one that you had in [PII] that maybe didn't get filed, um, you can absolutely still file that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's take a look at everything else.
[CUSTOMER][NEUTRAL] And then [PII].
[AGENT][NEUTRAL] OK, I will throw in as well. I'm sorry to interrupt you, um, urgent care is separate, so urgent care is going to be a separate benefit. So if you had to go to an urgent care, um, that does not fall under that category. Urgent care itself has 3 visits per calendar year. OK, just wanted to make sure, um, I know that could be a bit confusing. All right.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] That's I, and I didn't, oh, I didn't know that so you could do 3 urgent care visits at no charge.
[AGENT][NEUTRAL] So that is covered under your outpatient benefit, um, which again that comes from that $500 pool per calendar year, so up to that $500 OK so for [PII] I am showing that you used all four of your office visits and then you did reach the maximum $500 outpatient benefit as well for [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then can we just go down the whole list because I probably have some old stuff I'll need to submit.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Oh sure, let's see.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] No, you are perfectly fine. I, I, I think a lot more people should, um, do this, you know, like it's, it's very confusing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So [PII], you used all four of the physicians uh office benefit, um, but nothing additional.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] [PII] you did use all four as well um and $50 of that outpatient benefit.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Um, so I
[AGENT][NEUTRAL] Oh, sorry.
[CUSTOMER][NEUTRAL] What's that mean? I did 4 and the urgent care maybe.
[AGENT][NEUTRAL] For office visits, um, uh, I, let me see if that, I don't know that it'll tell me exactly what it is. Let's see.
[AGENT][NEUTRAL] What was that? [PII]?
[AGENT][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] Oh, it's not going to tell me exactly what it is, but um let's see if I can't just find it.
[AGENT][NEUTRAL] There it is. Oh, that was a lucky guess. All right, let's see.
[AGENT][NEUTRAL] The the way this is set up it's very yes that was an urgent care visit yes, yeah, you were right. Med Express urgent care, um, OK, so then.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], um, you just use those for office visits and nothing additional.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] [PII] you only used one office visit benefit for [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But let me see if that's, I don't believe that's combined because I see at this time um, [PII] was also listed and used 3 benefit or 3 of those visits I believe it's per covered person.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So maybe
[CUSTOMER][NEUTRAL] That's, well, it was when I had her on my family, I think there was a total of 4, was it?
[AGENT][NEUTRAL] No, OK.
[AGENT][NEUTRAL] I'm sorry, go ahead.
[AGENT][NEUTRAL] OK, so I did, I'm looking at your policy right now. It does say $25 per visit, maximum of 4 visits per covered person per calendar year 8 visits combined for all covered persons. So that, so you would still technically have 3 additional um office visits for [PII].
[CUSTOMER][NEUTRAL] For yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So [PII] had used all her 4 at the time.
[AGENT][NEUTRAL] She used 3, no, no, no, she used 3, you used 1.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All righty. And then,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] is almost identical uh so you used one [PII] used three and it looks like she had an urgent care visit as well.
[CUSTOMER][NEUTRAL] So, [PII], hold on, [PII] one.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And [PII]
[AGENT][NEUTRAL] Yes, OK, and then go.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] [PII] you used two.
[AGENT][NEUTRAL] And then I'm not quite sure what that is.
[AGENT][NEUTRAL] It looks like so you have the two office visits and then another benefit that we paid $38.69 for outpatient. I'm not quite sure what that is. Let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you want me to keep looking?
[CUSTOMER][NEUTRAL] How long have I been with APO?
[AGENT][NEUTRAL] Um, since I don't mind at all, um, it, uh, let's say this policy's effective date was [PII].
[CUSTOMER][NEUTRAL] Yeah, because I.
[CUSTOMER][NEUTRAL] Yeah, so let's keep going until [PII].
[AGENT][NEUTRAL] Sure and I will say as well um before I forget [PII], have you ever created an account online with us?
[CUSTOMER][NEGATIVE] I don't think so. I don't think I ever have.
[AGENT][NEUTRAL] I would recommend doing that um it's uh just secured. [PII] um all of the information that we verified at the beginning of the call is the information that you, well, I can check to to see if you did create an account and give you that information.
[AGENT][NEUTRAL] Um, but now it is good that we're going back this far because while you can view claim status, uh, across the board, I believe it only shows claims from the past 24 months so I don't think you would have been able to see these, uh, older ones.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm trying to see what this was.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then I will say as well the earliest claim that we received from you was in [PII], so it does not, I'm gonna verify that no we haven't received anything for.
[CUSTOMER][NEUTRAL] So maybe nothing
[AGENT][NEUTRAL] No, I'm just look nothing for [PII], nothing for [PII], um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, and I think I have those visits.
[AGENT][NEUTRAL] And then of course so
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] So as long as well when I say [PII] it would have to begin um it's from [PII] so everything from that point you can absolutely still file that information and I will say as well the online portal is probably going to be the quickest and easiest way to get claim information to us. It gets to us almost instantly and then from there it's just about 7 to 10 business days where it's processed.
[CUSTOMER][NEUTRAL] Because.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So what happened was when I first when I first got APL I was paying the doctor's office and I didn't submit my.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Supplemental so I have receipts of where I paid so.
[AGENT][POSITIVE] Awesome, yes, awesome OK.
[CUSTOMER][NEUTRAL] I'm gonna send those, yeah.
[AGENT][NEUTRAL] So whenever you are ready if you've still got your pen, I will let you know exactly what we need uh for you to file claims um and you know it's it is a bit different than um a regular bill um it does have to show specific information that you might have to call that facility and ask for.
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me know when you're ready.
[CUSTOMER][NEUTRAL] Understood, but like.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] I'm ready, I'm ready.
[AGENT][NEUTRAL] OK, um, so you would need the itemized statement.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] That shows 00 yes go ahead.
[CUSTOMER][NEUTRAL] Uh, hold on, I
[CUSTOMER][NEUTRAL] Itemized statements OK.
[AGENT][NEUTRAL] Yes, that shows diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] And procedure code.
[AGENT][NEUTRAL] Yes, and then of course uh the only additional thing we would need is going to be the primary EOB and again you wherever you went for treatment, whatever provider facility they will have all of that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So out of my statement, so what if it was a well visit? uh those are free, no, no, you don't pay for those. The other company pays for those, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, this one doesn't necessarily have a wellness benefit it's simply that physician's treatment benefit.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK, but if I went for a well visit I could submit that to you if I had to pay, oh maybe I didn't pay.
[AGENT][NEUTRAL] If your primary contributed anything.
[AGENT][NEUTRAL] Yeah, if your primary contributed anything, yes, um, anything that they, that's the general rule of thumb for this policy is it's designed to help with whatever your primary leaves after, so co-pay, deductible and co-insurance.
[CUSTOMER][NEUTRAL] Contributed dollar wise?
[CUSTOMER][NEUTRAL] OK, so well don't come.
[CUSTOMER][NEUTRAL] Well, visits don't count because they're free.
[AGENT][NEUTRAL] Yeah, so if your primary didn't pay anything, then this policy wouldn't.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] And then just for good measure Irene if you'd like I can I don't know if you have it or not, but I can send you a copy of your policy this this particular policy through APL um there is one particular page that will be your best friend that just lays everything out clear cut and dry, um, you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Know what it's called, how much is covered um frequencies things like that the rest is going to be more definition um that's completely up to you if you I'm a very visual person um but you know you if you get it you have any questions you know definitely give us a call we we know it's very confusing.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, but no, you can totally um.
[AGENT][NEUTRAL] Did you want me to send that to you?
[CUSTOMER][NEUTRAL] Yeah, do you wanna email it to me?
[AGENT][NEUTRAL] Uh, sure, that's easier.
[CUSTOMER][NEUTRAL] Or how, how do you want to send it to me?
[AGENT][NEUTRAL] Um, I can absolutely email it. That is perfectly fine. It's not terribly big. Um, do you want me to just send it to the [PII] that we've got for you?
[CUSTOMER][NEUTRAL] Or do you want to mail it to me? is that what you're saying?
[AGENT][POSITIVE] No, no, I don't either, whatever is easier for you. I mean, I, it does not matter to me. I can send it to you right now. I've got my email up.
[AGENT][NEUTRAL] It's whatever you prefer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] I could do both. I can email it to you and then I can mail you a paper copy if you prefer a physical copy.
[CUSTOMER][NEUTRAL] I mean, yeah, that
[CUSTOMER][POSITIVE] That's a beautiful compromise, yes.
[AGENT][POSITIVE] Best of both worlds yes alrighty let me go ahead and get this sent and then I will uh have a physical copy mailed to you as well um and you know of course again once you get it if you have any questions you're confused uh definitely give us a call back so in.
[AGENT][NEUTRAL] This email uh that I'll be sending you I'll also include the link to our online portal um and so you just click that and then you know set up well let's see I'm sorry I don't mean to keep you let me go ahead and check while you're on the phone to see if you ever created an account so I can get you that information.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] That would be great.
[AGENT][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Oh my goodness. It's thinking about it. Bear with me just a moment.
[AGENT][NEUTRAL] There we are, OK, so you have not, uh, so once you if you click that link, you would of course select the top option that you're an individual, uh, creating an account and then again that uh.
[AGENT][NEUTRAL] The same email that you gave me, that's usually where people get kinda of it has to match what we have in our system, the information that you enter so otherwise I mean 01 other thing as well there will be a spot that asks for a member ID or your social so your mem a member ID is different than the policy number so and this policy doesn't have a member ID so in that spot you would put in your social.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] I have to put in my social.
[AGENT][NEUTRAL] Uh, yes, if you wanted to create the account as this policy doesn't have a member ID.
[AGENT][POSITIVE] It's completely up to you if you prefer not to create an account, you don't have to it's just uh you know I like offering that to people.
[CUSTOMER][NEUTRAL] But that's probably why I didn't do it.
[AGENT][NEUTRAL] Oh well I mean we do have it in our system that's just that it's just that added excuse me, added security that you are the one who's actually creating the account, not somebody pretending to be you, you know.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] There's no member ID.
[AGENT][NEGATIVE] Not for this kind of plan, not for this kind of plan, right.
[CUSTOMER][NEUTRAL] For APL, right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so I know that.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Was information overload. Did you have any other questions for me at the moment?
[CUSTOMER][NEUTRAL] Um, I guess my question is when I look up my receipts and my.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like I got some statements from some of the doctor's office where it shows that I paid how do I submit that to APL now?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so again you can use our online portal if you choose not to create an account that way that's perfectly fine. I've also got um a mailing address and if you have access to a fax machine I've got a fax number as well.
[CUSTOMER][NEUTRAL] OK, mailing address and fax.
[AGENT][NEUTRAL] You want me to go ahead and give you that information?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Sure, let me know when you're ready.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK, so our mailing address is [PII].
[AGENT][NEUTRAL] 248.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] Mhm. And is
[AGENT][NEUTRAL] Yes, and that is in [PII], [PII].
[CUSTOMER][NEUTRAL] Hold on. [PII]oma City.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Mhm zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, [PII]
[CUSTOMER][NEUTRAL] OK, sorry, say that last part again.
[AGENT][NEUTRAL] That's OK, um, [PII].
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] OK, and are you ready for that fax number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] OK, that is [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII] yes and uh you would just put attention claims department.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, at [PII], even if I mail it or fax it?
[AGENT][NEUTRAL] Oh, that's really only necessary for a fax, I think. I mean if you mail it you could probably just put APL is fine. That address is specifically for claims, so they'll know it's claim information.
[CUSTOMER][NEUTRAL] And if I
[CUSTOMER][NEUTRAL] OK, so if I mail it I just say APL.
[AGENT][NEUTRAL] Yes, um, so I'm trying to make sure I cover all bases while you're on the phone [PII]. I apologize um I will also say if you were to file them anyway besides doing it online, you would also have to uh fill out the correct claim form uh so if you go on our public website.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Which you don't need to create an account for um and the link I sent you it's secured. [PII]. Our public website is simply [PII] and on there they've got all of our claim forms you would select the one called Medlink as this is the name of this policy.
[AGENT][NEUTRAL] Um, and you would just fill that out along with all of the information so if you were to send, you know, a bunch of information at once, that's perfectly fine, and you would just need to just do the one claim form. It's really just for as much information as you send at a time needs one claim form. Does that make sense?
[CUSTOMER][NEUTRAL] Not really, so I have to get the claim form from the web.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm I can email you that too if you prefer.
[CUSTOMER][NEUTRAL] And it's meddling.
[CUSTOMER][POSITIVE] That would be incredible.
[AGENT][NEUTRAL] Yeah, Medlink.
[AGENT][NEUTRAL] Yeah, and so from there, of course you know you can make as many copies as you'd like, um, but yeah, so on our website has them if you need or you know you can always give us a call back if you need more if you prefer that way as well that is perfectly fine, um, so I'll go ahead and send you'll get a couple of emails from me.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So I'll send that to you and then oh of course um so yeah I I basically how it works is you know if you get all your stuff together you go to send it off with that claim form and you have something else you forgot if you had to send it separately that would just need its own claim form.
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] Does that make a bit more sense?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I wouldn't do one claim form per.
[CUSTOMER][NEUTRAL] Instant per visit.
[AGENT][NEUTRAL] That is not necessary, right? That is not necessary.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Trust me when I say people have sent in claim information that ranges several years and on a single claim, so you know if you prefer, if you preferred separating them you can do that if it's easier for you um but that's you know again that's that's completely your choice just know that it's not necessary.
[CUSTOMER][NEUTRAL] So I can
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK thank you because yeah I have a friend that she just got like me she got the statements, the receipts, and she just put it in a big old pile and APL figured it out and paid her.
[AGENT][NEGATIVE] Yes yes and that's another thing like I will say and this is what I tell everybody even if you're looking at your policy and you're like oh they're not gonna pay a benefit for that if you're comfortable with it go ahead and just send it to us you know worst case we just say that's not covered best case you get paid.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And then you'll send a check or how does it work? It's been a while, but.
[AGENT][POSITIVE] So you've got, you know what, no, no, I'm glad you asked that because if you prefer I can send this in the same email so you can set up direct deposit. I can send you that form as well uh with this claim form if you prefer now getting that to us is quite a bit easier you can simply fill that out and then email it back to us um or you know you can uh mail it with the claim information um if you don't set up direct deposit we would simply mail you a paper check.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, but yeah, send me that too because I'll probably just do the direct.
[AGENT][POSITIVE] Absolutely.
[AGENT][POSITIVE] I know, well, some people aren't, you know, they're like, I don't know, but I'm like, man, I feel like that's so much safer and so much quicker.
[CUSTOMER][NEUTRAL] OK. Well,
[CUSTOMER][NEUTRAL] Yes, yes, ma'am.
[AGENT][NEUTRAL] OK I think I think we covered all bases.
[CUSTOMER][POSITIVE] Thank you for all your help.
[AGENT][POSITIVE] But if you think of anything else, don't hesitate to give us a call back.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] What
[CUSTOMER][POSITIVE] You have been so wonderful, thank you, [PII].
[AGENT][POSITIVE] This this is beyond, it's confusing, trust me, I know it's confusing. So if I can do anything to kind of help, that's, I love it. So if there was nothing else I can help you with, Miss [PII], I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Have a good evening. Thank you.
[AGENT][POSITIVE] You too. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Uh