AccountId: 011433970860
ContactId: 0a142b39-ba6d-4711-ac2b-efffc96c60ca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 426690 ms
Total Talk Time (AGENT): 174320 ms
Total Talk Time (CUSTOMER): 218560 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/0a142b39-ba6d-4711-ac2b-efffc96c60ca_20250131T21:16_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Yes hi how are you?
[AGENT][POSITIVE] Great, how are you?
[CUSTOMER][POSITIVE] I'm good, thank you. Um, do you need my um ID number?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, it is
[CUSTOMER][NEUTRAL] [PII] [PII] like Mark L like lollipop 8.
[AGENT][NEUTRAL] And may I have your first name and a good callback number?
[CUSTOMER][NEUTRAL] Yes, first name is [PII]. Number is [PII].
[AGENT][NEUTRAL] Thank you. Can you verify your date of birth, your mailing address, and your email, please?
[CUSTOMER][NEUTRAL] Date of birth is [PII]. Mailing address is [PII], and I forgot I didn't.
[CUSTOMER][NEUTRAL] What was the last thing you wanted?
[AGENT][NEUTRAL] Your email address?
[CUSTOMER][NEUTRAL] Oh, [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim, and I have your file pulled up and how may I help you today?
[CUSTOMER][NEUTRAL] OK, so I visited um Doctor [PII] back in [PII]. Uh, I was told when I went there that I was responsible for the deductible, which was $70. Um, I have since then.
[CUSTOMER][NEGATIVE] Been billed for an additional, I think it was $15 by the doctor's office and now I just got another invoice from Quest Diagnostics for $40 and I just was trying to make sure before I paid this that this wasn't covered by.
[CUSTOMER][NEUTRAL] The gap insurance.
[AGENT][NEUTRAL] OK, let me get those benefits pulled up.
[AGENT][NEUTRAL] You do have the lab benefit and you also have the office treatment benefit.
[CUSTOMER][NEUTRAL] 561.
[CUSTOMER][NEUTRAL] For just inpatient, like, like going in for, uh, I went in just for a labs.
[AGENT][POSITIVE] Yes, you do have the lab benefit.
[AGENT][NEUTRAL] And you also have the office treatment benefit. Was this inpatient?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, it wasn't, it was just like an annual thing.
[AGENT][NEUTRAL] OK, so yes, you do have the office treatment and you do have the lab benefits.
[CUSTOMER][NEGATIVE] But when I was there, I called APL and they told me no, it didn't cover it.
[CUSTOMER][NEGATIVE] When I was there for the for the $70 I was told that it wasn't covered.
[AGENT][POSITIVE] I do apologize for that.
[CUSTOMER][NEUTRAL] Uh, unless I was unless I was hospitalized, or it was some sort of surgery or something like that.
[AGENT][NEUTRAL] No, ma'am. Under this policy, you do have inpatient and outpatient benefits. You do have per calendar day benefit amounts of about $1000 for outpatient, which would include office treatment and the lab.
[CUSTOMER][NEUTRAL] So it would pay for the $70 visit, the, the, the payment to the um consultation or whatever the fee is the doctor charged.
[AGENT][NEUTRAL] Yes, ma'am. Was it for a sickness or injury?
[CUSTOMER][NEUTRAL] No, it wasn't. It was just for labs. I just went in for uh uh my annual.
[AGENT][NEUTRAL] OK. So, under this plan, let me bring it back up the labs.
[CUSTOMER][NEUTRAL] Oh, no, no, no, it, it, it, it wasn't an annual. I went in because I, I wasn't well and I went in to get tests done.
[AGENT][NEUTRAL] Yes, ma'am. So that, in that case, it would cover it only if you go in for your wellness.
[AGENT][NEUTRAL] The diagnosis, so, OK. So, yes, and you can submit the claim yourself. You would need 3 items and you can file the claim yourself.
[CUSTOMER][NEGATIVE] No, it wasn't wellness. Mhm.
[CUSTOMER][NEUTRAL] OK. What do, what would I need?
[AGENT][NEUTRAL] You will need your itemized bill from your provider.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You would need your major medical explanation of benefits.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] What is that?
[AGENT][NEUTRAL] It's from your primary insurance. It shows us what was applied to your co-pay, co-insurance, and our deductibles.
[CUSTOMER][NEUTRAL] So then I have to call Amed for that?
[AGENT][NEUTRAL] They normally have a website and you can get it off the website if you don't have a copy of it.
[CUSTOMER][NEUTRAL] OK, and then what would be the 3rd thing?
[AGENT][NEUTRAL] The Metlink claim form, which you can go to [PII], go under forms.
[CUSTOMER][NEUTRAL] Hang on one second.
[CUSTOMER][NEUTRAL] Let me do that one second. Uh.
[CUSTOMER][NEUTRAL] say, say that again. AM.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Have you registered your account?
[CUSTOMER][POSITIVE] I believe so, yes.
[AGENT][NEUTRAL] You can also obtain it there and upload your claim there as well.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, let me see if I
[CUSTOMER][NEUTRAL] I'm sure I have a, yes, I do have a, I have a login ID and everything, so.
[CUSTOMER][NEUTRAL] Let's please submit.
[CUSTOMER][NEUTRAL] So I'm in it, um, and so I need to
[CUSTOMER][NEUTRAL] Medlink
[CUSTOMER][NEUTRAL] uh, claims, I need to go to claims form.
[AGENT][POSITIVE] Yes, ma'am, and I believe it's on the 2nd page, I believe.
[CUSTOMER][NEUTRAL] Online service center.
[AGENT][NEUTRAL] For under forms.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Some somehow when I tried to click on it it signed me out.
[CUSTOMER][NEUTRAL] It took me
[CUSTOMER][NEUTRAL] When I signed into my account, it took me out, let's see.
[AGENT][NEUTRAL] So if you're on the [PII].
[CUSTOMER][NEUTRAL] Mm, I'm, mhm.
[AGENT][NEUTRAL] At the top
[AGENT][NEUTRAL] There's claims and forms.
[CUSTOMER][NEUTRAL] It says claims and forms correct. So I went there and um
[AGENT][NEUTRAL] And then scroll down the page and it'll ask you for a mail paper form.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then I click on that and then I believe it's the 2nd page.
[AGENT][NEUTRAL] For Medlink.
[CUSTOMER][NEUTRAL] Filter by product or just keep looking down metal cans.
[AGENT][NEUTRAL] Scroll down, I believe it's on page 2.
[CUSTOMER][NEUTRAL] 2, got it. I see.
[CUSTOMER][NEUTRAL] Meddling claim forms, new details. So I need to get that, the form then with the form, got it.
[AGENT][NEUTRAL] And then you would download.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so let me do this and um I need the itemized bill from my doctor, right? And what about this lab? I can, I can scan the lab and send it to you though, right?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, I'll do that. I'll upload all that information now. Thank you so much.
[AGENT][POSITIVE] You're so welcome. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No thank you that's it just us, thank you.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great weekend. Bye-bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.