AccountId: 011433970860
ContactId: 0acf59ff-769c-427d-adfa-6e8656f7a149
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 616960 ms
Total Talk Time (AGENT): 295411 ms
Total Talk Time (CUSTOMER): 268690 ms
Interruptions: 9
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/0acf59ff-769c-427d-adfa-6e8656f7a149_20250603T16:46_UTC.wav
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[AGENT][POSITIVE] Thank you for calling. This is. How may I help you?
[CUSTOMER][NEUTRAL] Yes, um, can you hear me OK?
[AGENT][POSITIVE] Yes, I can hear you great. Can you hear me?
[CUSTOMER][NEUTRAL] Yes ma'am, um, I'm just calling to find out um my benefits if I give you my social, can you pull up my account?
[AGENT][NEUTRAL] Yes, sir. Can I first get your name and your callback number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is your social?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, let me look you up real quick, Mr. [PII].
[CUSTOMER][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I called earlier and the explanation I was given wasn't what I've been told previously so I just wanted to ask you the same thing.
[AGENT][NEUTRAL] OK. All right, Mr. [PII], I can, I can check up your benefits for you. First, let me please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then what is your address, phone number, and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] [PII] [PII] [PII].
[AGENT][NEUTRAL] Thank you, I appreciate you verifying all your information for me. OK, and this is just to verify your benefits. It's not a guarantee of payment. This is a supplemental insurance policy. It's billed secondary to the primary, so when you go to a facility, you need to give them your primary insurance card and this card too.
[CUSTOMER][NEUTRAL] Oh what I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] It helps with deductible, co-pay, and co-insurance.
[AGENT][NEUTRAL] So you have, mhm.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] So tell me when I go in to the doctor's office for eye doctor specialist, OK?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What is this, what does this do? this this insurance?
[AGENT][NEUTRAL] So this is not vision insurance, it's, it's for accident or sickness only.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] It's medical.
[CUSTOMER][NEUTRAL] Right, it's medical, but if I go into the doctor's office for an eye problem, for instance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What does this.
[CUSTOMER][NEUTRAL] Pays the deductible correct?
[AGENT][NEUTRAL] OK, so, uh, this is how your benefits work if you go into, right, if you go into a physician's office.
[CUSTOMER][NEUTRAL] The co-pay.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You can use your, your policy for accident or sickness.
[AGENT][NEUTRAL] You've got um.
[AGENT][NEUTRAL] An outpatient per calendar day benefit amount.
[AGENT][NEUTRAL] Of
[AGENT][NEUTRAL] Let me look real quick, real quick.
[CUSTOMER][NEUTRAL] Hi
[AGENT][NEUTRAL] Of $500.
[AGENT][NEUTRAL] Per calendar day. That helps with your deductible copay.
[CUSTOMER][NEUTRAL] OK, OK, I'm going to the eye doctor.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I, I can't explain this plainly to me. If I go into the eye doctor today, the specialist.
[CUSTOMER][NEUTRAL] How do I get reimbursed my co-pay?
[AGENT][NEUTRAL] They will have to file a claim for you.
[AGENT][NEUTRAL] When you give them the card they should be able to file a claim, but this policy is for accident or sickness.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I was
[CUSTOMER][NEUTRAL] OK, I was told before I just present this.
[CUSTOMER][POSITIVE] Um, I get the papers from the doctor, send in the claim, and I'm reimbursed the copay.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right. So you do have physician, physician office benefit.
[CUSTOMER][NEUTRAL] OK, that's not what you're telling me though.
[AGENT][NEUTRAL] You have physician office visits.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Uh-huh.
[AGENT][NEUTRAL] And it'll all depend on.
[AGENT][NEUTRAL] The EOB that comes from your primary care physician and the itemized statement that comes from the facility.
[CUSTOMER][NEGATIVE] But I'm not going
[AGENT][NEUTRAL] And what the diagnosis and procedure codes are on that.
[CUSTOMER][NEUTRAL] I'm not going to my main.
[CUSTOMER][NEUTRAL] I'm not going to my primary.
[CUSTOMER][NEUTRAL] I'm going to a specialist.
[AGENT][NEUTRAL] You'll need to use your primary insurance.
[AGENT][NEUTRAL] Right, but you'll still have to give them your insurance card.
[CUSTOMER][NEUTRAL] Oh no, no, no, I understand that. I'm not using my primary doctor. I know, I know that I'm not going to my primary doctor.
[CUSTOMER][NEUTRAL] You mean primary insurance?
[AGENT][NEUTRAL] Yeah, you'll have to use your primary insurance because they will pay.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And then we pay 2.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so I just get the I get the uh documents from them for the visit and then file a claim and send it into you, correct?
[AGENT][NEUTRAL] Right, and if they don't file the claim for you themselves.
[CUSTOMER][NEUTRAL] They didn't, yeah.
[AGENT][NEUTRAL] Then you'll need to get the.
[AGENT][NEUTRAL] OK, you'll need to get the explanation of benefits from your primary insurance carrier, whoever your primary is, your major medical.
[AGENT][NEUTRAL] And you'll also need the itemized state.
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEUTRAL] Why do I have to get anything from my other insurance?
[AGENT][NEUTRAL] Because this is a secondary insurance and it's based on what your primary pays.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Why isn't it based on what I pay?
[AGENT][NEUTRAL] Because that's not how the policy works, it's a gap insurance that helps with deductible co-pay and co-insurance. It's not the major medical insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I need to get in touch with my primary and have them send me what they paid on this the last time I was there, correct?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes, it's called an explanation of benefits. You can ask them for that.
[CUSTOMER][NEUTRAL] And then I need also from the physician I went what I had done.
[AGENT][NEUTRAL] Yes, you'll need an itemized statement. Yes, you'll need an itemized statement with procedure codes and diagnosis codes.
[CUSTOMER][NEUTRAL] Or not.
[CUSTOMER][NEUTRAL] OK, and so I get reimbursed based on what the primary pays.
[AGENT][NEUTRAL] Right, and, and on what procedure codes were used in the physician's office.
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] That's why we need the itemized statement.
[CUSTOMER][NEUTRAL] OK, it gives a lot of work. I mean, so I gotta get my primary to send that what they paid to the physician and physician's gotta give me explanation of what they did.
[CUSTOMER][NEUTRAL] And then I send that all to you.
[AGENT][NEUTRAL] Yes sir, you'll need those two documents, the explanation of benefits and the itemized statement. You'll also need to fill out the claim form for Medlink, and I can tell you where to get that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'm not to that point yet, but I'll, I'll.
[AGENT][NEUTRAL] Are you signed up
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] I'm sorry. I'm.
[AGENT][NEUTRAL] That's OK. Are you signed up on the online service center?
[CUSTOMER][NEUTRAL] I have no idea. You would know better than I would um you pulled me up.
[AGENT][NEUTRAL] OK, if you
[AGENT][NEUTRAL] I, I pulled you up by your, your social, but if you sign up for the online service center you can um file your claim right through the online service center.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] On the computer.
[CUSTOMER][NEUTRAL] OK, is there a place that explains that on my uh policy papers that I got?
[AGENT][NEUTRAL] Yes, sir, your policy will also be in there. Um, let me give you the website so you can sign up for it.
[AGENT][NEUTRAL] You just let me know when you're ready.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] It's secure.
[CUSTOMER][POSITIVE] Ready.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh lucky
[AGENT][NEUTRAL] And when you go in the first time,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, sir. I am public.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes sir, when you go in there the first time there's under where it says log in on the welcome screen on the bottom left of the log under a log in it'll say create OSC account you're gonna need to click on that the first time you use it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once you're in there.
[CUSTOMER][NEUTRAL] And do I need any numbers?
[AGENT][NEUTRAL] Uh, let me give you your policy number.
[CUSTOMER][NEUTRAL] any.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 259.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 7342.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And in the website, you can get that claim form and it's for Medlink [PII]
[CUSTOMER][NEUTRAL] go.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and there's no uh time frame to have this done?
[AGENT][NEUTRAL] No, sir, we don't have a timely filing limit.
[CUSTOMER][POSITIVE] OK all right I appreciate your help thanks for everything.
[AGENT][NEUTRAL] You're welcome and if you're doing your claiming you need further help, just pick up the phone and call us, OK?
[CUSTOMER][POSITIVE] Yes ma'am, thank you very much.
[AGENT][POSITIVE] All right. You're welcome, Mr. [PII]. I hope you have a blessed day and thank you for calling APL sir.
[CUSTOMER][POSITIVE] Thanks you too.
[AGENT][NEUTRAL] Bye-bye.