AccountId: 011433970860
ContactId: 13fc3c83-02c3-43e8-8f8f-c1e3345358f1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 589409 ms
Total Talk Time (AGENT): 234041 ms
Total Talk Time (CUSTOMER): 182473 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/13fc3c83-02c3-43e8-8f8f-c1e3345358f1_20250319T17:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um.
[CUSTOMER][NEUTRAL] I have this insurance through my, my husband.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And um I didn't know I had it until December, I think.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I believe that I have uh um.
[CUSTOMER][NEUTRAL] I have to give you the the receipt, send you the receipt.
[CUSTOMER][NEUTRAL] I'm not sure
[CUSTOMER][NEUTRAL] How is it that I have to do it do it for the um.
[CUSTOMER][NEUTRAL] The co-payments that I had last year.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] To cover, to cover the, the co-payments, some of the co-payments that I had last year.
[AGENT][NEUTRAL] OK, so yeah, you can file claims online for past services um claims can be filed either online they can be done, you can send them in the mail or via fax. Have you ever logged in to our online service center?
[CUSTOMER][NEUTRAL] No, I haven't.
[AGENT][NEUTRAL] OK, um, so do you by chance have the policy number?
[CUSTOMER][NEUTRAL] The policy number.
[AGENT][NEUTRAL] Our member certificate number?
[CUSTOMER][NEUTRAL] It says I have the group number effective date.
[CUSTOMER][NEUTRAL] In hospital benefits certificate cert number.
[AGENT][NEUTRAL] You can give me that.
[CUSTOMER][NEUTRAL] OK, in hospital, it says 024.
[CUSTOMER][NEUTRAL] 768.
[CUSTOMER][NEUTRAL] 30
[CUSTOMER][NEUTRAL] ML 7
[AGENT][NEUTRAL] All right, thank you. And then, what is your first and last name, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then can I get your date of birth and address, please?
[CUSTOMER][NEUTRAL] Date of birth is [PII]. Address [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You, you get it? You got it?
[AGENT][NEUTRAL] Thank you and then what's the email address that we should have on file?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] [PII] like my name.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] OK. So, um, do you have something you can write down the web address with? Do you want me to, um,
[AGENT][NEUTRAL] What's the best way um for you to, are you by a computer?
[CUSTOMER][NEUTRAL] Can you send me an email?
[CUSTOMER][NEUTRAL] And can I submit the papers uh via email?
[AGENT][NEUTRAL] No they can't be unfortunately emailed because email is not secure to send that type of confidential information so if you would like to do the claims online you're gonna need to visit our website and create a login for the account and then they can be submitted electronically online.
[CUSTOMER][NEUTRAL] And how do, how do I attach get the the.
[CUSTOMER][NEUTRAL] I guess I can attach it to my computer and then from there.
[CUSTOMER][NEUTRAL] Because I have um question um the medications, the co-payments uh with uh Walgreens qualify for, for this type of uh insurance.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Prescriptions. Is that what you're wanting to know if that's covered?
[CUSTOMER][NEUTRAL] Would you guys
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh let me see.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it looks like prescriptions aren't covered under the plan.
[CUSTOMER][NEUTRAL] You're not?
[AGENT][NEUTRAL] Mm mm.
[CUSTOMER][NEUTRAL] OK, so all I have is uh some papers from Memorial Memorial Hospital that I guess I can go online and uh save it in my computer so I can.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Attach it to the
[CUSTOMER][NEUTRAL] To the claim in the online website is the the the address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm, that is correct, yeah. And uh when you get to the website, you want to click the sign in option.
[AGENT][NEUTRAL] And then there'll be a link there you can click for new user.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's where you'll create your username and log in uh to get into the account. Once you've created the log in with the username and password, uh you'll see a blue or excuse me, you'll see a green button once you get logged in that'll say upload files and that's where you'll start the claim process.
[AGENT][NEUTRAL] You have a secondary plan, so what you'll need to file the claim is the med link claim form which also can be found on our website.
[AGENT][NEUTRAL] And then you will need the explanation of benefits from whomever your primary insurance is for that date of service as well. We need to know what they paid and what your responsibility was.
[CUSTOMER][NEUTRAL] Oh my [PII].
[AGENT][NEUTRAL] Usually I do say that if it is an option you may try um since these are in the past I don't know if this is an option generally lose what I recommend to individuals is that if the provider themselves can file the claims that's usually the easiest way uh these are in the past so I don't know that they unfortunately can do that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Anything going forward, I would always just let them know that you have whomever is your primary and then this is your secondary that way they can do it on your behalf.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because 11 was uh emer emergency.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They and another one was the.
[CUSTOMER][NEUTRAL] Ultrasound, a breast ultrasound.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Yeah, so you'll need uh a claim form for each one of those submissions, each claim, and then the explanation of benefits for each date of service with the itemized bill showing, you know what your primary paid and what your remaining balance was.
[CUSTOMER][NEUTRAL] You think if I call my insurance?
[CUSTOMER][NEUTRAL] Who who you think you can give me that information as far as for example, for example, the, the emergency visit.
[CUSTOMER][NEUTRAL] The hospital or my insurance?
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Right, so the explanation of benefits is gonna come from your primary insurance, whoever that is.
[AGENT][NEUTRAL] So you can call them for that. You may have an app or an online, you know, portal where you can log in.
[AGENT][NEUTRAL] But your primary insurance would, would give you that. And then for the itemized bill, that would come from whomever you saw. So if you went to the emergency room, then you would call that hospital.
[CUSTOMER][NEUTRAL] No, that
[CUSTOMER][NEUTRAL] I have that, that I have it says.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The charges, the insurance pay some, uh, what the insurance pay what I was supposed to pay.
[CUSTOMER][NEUTRAL] And everything else.
[CUSTOMER][NEGATIVE] But uh it doesn't have the explanation of benefits.
[CUSTOMER][NEUTRAL] In detail what they did or anything oh it says.
[CUSTOMER][NEUTRAL] Um, emergency this state.
[CUSTOMER][NEUTRAL] Memorials for [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, I'll try to get that information and I'll keep it in mind, uh, your suggestion.
[AGENT][POSITIVE] OK, not a problem. Is there anything else I can help with here today?
[CUSTOMER][NEGATIVE] No thank you.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] OK bye bye.