AccountId: 011433970860
ContactId: 0a681b8f-25a2-40c7-aaa8-bdc8d1fe3112
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 625679 ms
Total Talk Time (AGENT): 279605 ms
Total Talk Time (CUSTOMER): 204652 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/0a681b8f-25a2-40c7-aaa8-bdc8d1fe3112_20250106T16:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, yes, hi, [PII]. I am calling to see if I'm eligible for um coverage on a bill I have, um, from my doctor's office on a service that was done. Um, I, the APL, uh, gap insurance was not provided at the time of the service.
[CUSTOMER][NEUTRAL] And my insurance picked up, you know, a portion and then I, and then unbeknownst to me, I got a, a bill in the mail for the, you know, remainder or whatever, so I was trying to look into that.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, alright, I can help you with your benefits. Can you please give me your name and your call back number?
[CUSTOMER][NEUTRAL] Yes, my name is [PII] and my last name is [PII]
[CUSTOMER][NEUTRAL] My callback number is [PII].
[AGENT][NEUTRAL] OK, [PII], what is your policy number?
[CUSTOMER][NEUTRAL] Policy number is
[CUSTOMER][NEUTRAL] One second, um.
[CUSTOMER][NEUTRAL] Are you looking for like group number or?
[AGENT][NEUTRAL] It may also say inpatient certification number or outpatient certification number.
[CUSTOMER][NEUTRAL] I have
[CUSTOMER][NEUTRAL] Yeah, I have those 2 numbers.
[AGENT][NEUTRAL] OK, one of those would be fine.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] OK, um, I have, um, 01480077 M as in Mary L 8.
[AGENT][NEUTRAL] OK, let me look that policy up for you real quick, Ms. [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and this is just to verify benefits, it's not a guarantee of payment. Your policy that you have, the Medlink policy is, as you know, a supplemental insurance policy that is billed secondary to the primary. It does help with deductible, co-pay and co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, those three things, uh, so if you were inpatient, you have a $6600 calendar year benefit amount or if you were outpatient, you have a $3000 calendar year benefit amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so for instance, like the case of this was I had a colonoscopy done in an outpatient and then I paid like a $400 co-pay with from my insurance and then I got a bill in the mail because um if I'm if I'm guessing correctly because he had to take a biopsy or something and it came back that I now owe $398 is that something that would be like considered covered or?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, let me see what your pol I'm gonna pull your policy in to see what your outpatient benefits are um what kind of facility did you use to have it done? Was it uh office visit? Was it?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It was an outpatient center.
[AGENT][NEUTRAL] And E
[AGENT][NEUTRAL] OK, so like an ambulatory center that is a free standing center?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Yeah, like a free standing out uh uh outpatient facility.
[AGENT][NEUTRAL] OK, let me look at your.
[AGENT][NEUTRAL] I'm gonna pull in your policy real quick and we're gonna read it and see exactly what it says.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's gonna be just a second while I pull that in for you.
[CUSTOMER][NEUTRAL] Sure, sure, sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So this is um stating that your outpatient cover charges are.
[AGENT][NEUTRAL] Because of an accident or sickness.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Incurred in a covered outpatient facility.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It looks like um.
[AGENT][NEUTRAL] According to this, physician's offices are covered, um, also ER urgent care center.
[AGENT][NEUTRAL] Or an ambulatory center, so it looks like if you go ahead and send in the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] And like I said, this is to guar is to verify coverage it's not a guarantee event of payment. Go ahead and send in your claim and um send in your explanation of benefits along with your itemized statement.
[CUSTOMER][NEUTRAL] OK, I my statement.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] The itemized statement you should be able to get from the physician's office and the explanation of benefits would come from your primary insurance carrier.
[CUSTOMER][NEUTRAL] Queen.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Explanation of benefits, yeah, they gave me with my bill there is kind of like an itemized it it shows.
[CUSTOMER][NEUTRAL] Um, what it was, the charge, and then it says like Blue Cross, you know, and then what, what was res um what the insurance covered and then what, what I'm responsible for.
[AGENT][NEUTRAL] Uh-huh
[AGENT][NEUTRAL] OK, on your itemized statement, does it have um diagnosis and procedure codes on there?
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] Because you'll need those on your itemized statement.
[CUSTOMER][NEGATIVE] No, oh crap, let me see.
[CUSTOMER][NEUTRAL] No, I don't have codes on here as far as I can tell, there's no code.
[AGENT][NEUTRAL] So it
[AGENT][NEUTRAL] So what you can do is um just ask them if you can get a um
[CUSTOMER][NEUTRAL] OK, so I went.
[AGENT][NEUTRAL] Detailed itemized statement.
[AGENT][NEUTRAL] With procedure codes and diagnosis codes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then where does this stuff get sent to?
[AGENT][NEUTRAL] Let me give you the claims mailing address is [PII].
[AGENT][NEUTRAL] 248
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] That's in [PII], [PII].
[AGENT][NEUTRAL] And then the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes ma'am, and then you'll also um there's, there's several different ways you can send it in if you wanted to sign up for our online service center you can do it all on the computer.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me give you that um site so you can look at it and sign up for it. That is secured [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'll look into that too.
[AGENT][NEUTRAL] And then if you decide you want to fax it in, I can give you the fax number.
[CUSTOMER][NEUTRAL] Fax is not necessary because I don't have a fax, but um, mail and online is fine, that's fine. Um OK, I think that helps me with a start, um, so I will look into that.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Um, I'm gonna give you, yes, I'm gonna give you 11 more website to go to so you can get your claim form.
[CUSTOMER][POSITIVE] I appreciate your help.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] So the 3 pieces of paper will need to be sent in and that is going to be [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And when when you're on that site up in the top right hand corner you'll see claims and forms you'll click on that.
[AGENT][NEUTRAL] You'll go to page 2.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the second one on page two is called Medlink M [PII] K.
[AGENT][NEUTRAL] That's the claim form you'll need.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, Med link, OK.
[CUSTOMER][POSITIVE] OK, perfect. Wonderful. Thank you for your help.
[AGENT][POSITIVE] You're welcome and if you get hung up at any time.
[AGENT][NEUTRAL] Um, fill filling it out yourself or filing it, just call us and we'll help walk you through it, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Wonderful. Thank you so much.
[AGENT][POSITIVE] OK. You're welcome, [PII]. You have a great day and thanks for calling APL. Hm, bye-bye.
[CUSTOMER][POSITIVE] You too. Thank you. Mhm. Bye-bye.