AccountId: 011433970860
ContactId: 1424371f-ac87-4a9a-ae55-1ba3dc10bede
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 377869 ms
Total Talk Time (AGENT): 181081 ms
Total Talk Time (CUSTOMER): 174410 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/1424371f-ac87-4a9a-ae55-1ba3dc10bede_20250129T22:22_UTC.wav
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[AGENT][POSITIVE] Good Afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Good afternoon. My name is [PII]. I was insured with you until December. I have a question for personal reasons. I was not in the country and uh I need to, I needed to file a claim that is uh for.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um, date of service, uh, [PII].
[CUSTOMER][NEUTRAL] I wasn't sure at the time I called the center and they told me uh that uh probably you won't pay it. Is there a way that you can help me with this? I can fax the information?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, yeah, uh, we can go ahead, you can always submit a claim, Ms. [PII]. Let me go ahead and look at the policy and look at, um, the product you have so I can give you instructions on how to submit a claim. Um, may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I will give you my cell phone because I'm calling from my office [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. And do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, uh, OK. This is a group number? That's what you need?
[AGENT][NEUTRAL] And the policy certificate number if you have it.
[CUSTOMER][NEUTRAL] Uh, I have my card. Uh, OK. Operation certificate number is 02.
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] 295715 M as in Mary, L as in Lee number 8.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Right, thank you.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and for security, may I have your date of birth, mailing address and email address on file?
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] My address is [PII] sometimes because the same um.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The, um, zip code is [PII]. They can put [PII] or [PII] or [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Thank you. And what's your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. All right. Uh, let's see.
[AGENT][NEUTRAL] And you say you don't longer have this policy?
[CUSTOMER][NEUTRAL] Uh, no, this is through my work, so they switched the post.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Got you, OK.
[CUSTOMER][NEUTRAL] It was until [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. So, yes, uh, we don't have timely filing limits for this type of product, um, because this is a secondary supplemental plan to the major medical. This is to help with the deductible co-payment and co-insurance from the major medical. Um, so if you had any claims like prior to the termination date, you can submit claims.
[CUSTOMER][NEUTRAL] OK, um, what should I do? Should I fax you the information with my, um, uh, my card?
[AGENT][NEUTRAL] OK. Well, the fastest way to send it is either by fax or if you register online, you can upload it or you can mail it. Those are the three options you have to submit a claim. Now, you need a couple of documents to send for a claim. So if you have pen and paper, I can give you the list. Mhm. Yes.
[CUSTOMER][NEUTRAL] OK, what do I need to send?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, so the first document is the claim form.
[AGENT][NEUTRAL] In the claim form, you can find it in our website at [PII].
[CUSTOMER][NEUTRAL] OK, and I just claim form.
[AGENT][NEUTRAL] Claim form
[AGENT][NEUTRAL] And um you can find it on our website at [PII]. You're gonna look for Metlink claim form.
[AGENT][NEUTRAL] And um together with that, you need 2 more documents.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The second document is an itemized bill.
[AGENT][NEUTRAL] With the diagnosis codes.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the 3rd document is the copy of the explanation of benefits from the primary insurance showing how much they apply towards the deductible co-payment and co-insurance.
[CUSTOMER][NEUTRAL] OK, uh, so I will need to call the insurance for that.
[AGENT][NEUTRAL] Yes, if you don't get it electronically or if they don't send it to you by mail, you can call them to get a copy, a copy.
[CUSTOMER][NEUTRAL] OK, uh, no, probably I did like I said I wasn't here, so, uh, but the explanation is in, um, in the itemized bill because, uh, is for, um, breast ultrasound.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So uh
[AGENT][NEUTRAL] Was it a diagnostic testing or was it a preventative testing?
[CUSTOMER][NEUTRAL] Yes, it's diagnostic it's a diagnostic.
[AGENT][NEUTRAL] Diagnostic testing. OK. Um, yes, um, the, the information that, that we required is separate information. So the itemized bill will have uh the information coming from the provider of service, so it will have the diagnosis code, the charge amounts, the procedures they did, um, and then the explanation of benefits will come directly from the um from the primary.
[AGENT][NEUTRAL] Insurance
[CUSTOMER][NEUTRAL] The primary insurance? OK, not the primary doctor, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, the primary insurance.
[CUSTOMER][NEUTRAL] OK, OK, OK, and then, uh, your fax number will be [PII]?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][POSITIVE] OK, thank you very, very much.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] No, no, no, that will be it. I'm gonna try to get the other insurance to request this information.
[AGENT][POSITIVE] OK. All right. Well, thank you for calling APL. You have a good afternoon, [PII].
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.