AccountId: 011433970860
ContactId: 161aa1f7-b891-4324-9b7f-afda2c9a62ef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 554260 ms
Total Talk Time (AGENT): 280416 ms
Total Talk Time (CUSTOMER): 133935 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/161aa1f7-b891-4324-9b7f-afda2c9a62ef_20250527T17:07_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, in April, I had surgery, outpatient surgery at Baskin Palmer, um, Eye Institute, and, um, they at the time, they didn't file, um, for the benefits for the outpatient surgery, um, and I just checked with them and they said that they did file. So I just want to check with you and see if you have a claim pending.
[AGENT][NEUTRAL] OK, so you're wanting, you're the insured and you're wanting to see if we have received a claim for you for an outpatient surgery that you had. Yes, ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK, and [PII], what's a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you, and your policy number, please, with APL.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK. So,
[AGENT][NEUTRAL] It just depends as to how it's worded on the front of your card. It depends. Do you have a
[CUSTOMER][NEUTRAL] Um, I have
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] It says I have insured coverage and group number.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK. Do you see a pole?
[CUSTOMER][NEUTRAL] And a plan.
[AGENT][NEUTRAL] OK, do you see a policy certificate or an in-hospital or outpatient?
[CUSTOMER][NEUTRAL] Yeah, I see outpatient benefits certificate number, um 025.
[AGENT][NEUTRAL] OK, what is that number?
[CUSTOMER][NEUTRAL] 02599274ML8
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, Miss, any information that I do provide today would be a verification of benefits and not a guarantee of payment. I will need to verify several things with you first for security. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you, also your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that is on file for you is the same as the one you gave me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you. And then lastly we do not have an email on file for you, JD. Do you have an email address?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure. Um [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, is that I'm sorry, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so [PII]. I mean, I'm sorry, I said it wrong. I
[CUSTOMER][NEUTRAL] No, no, OK. JJ, it's OK. I know it's OK.
[AGENT][NEUTRAL] I have that typed in correct. [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] And then you said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] OK, and if you would just go ahead and give me the complete spelling of your last name to make sure that that is correct as well.
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] OK, thank you. And what date was your surgery again?
[CUSTOMER][NEUTRAL] Um, [PII] and [PII].
[AGENT][NEUTRAL] And that was of this year?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So let's see, as of now, we have not reviewed any claims. We just received some form of a claim on.
[AGENT][NEUTRAL] [PII], just last week. Let me see what that is for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That's probably it.
[AGENT][NEUTRAL] OK, so the only, OK, this claim is only for one data service which is for 17.
[AGENT][NEUTRAL] There's nothing for 4:10.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But it has not yet been reviewed, but it was received on [PII] and is in line for review.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so you didn't receive anything for 4 for 4:10.
[AGENT][NEUTRAL] No, ma'am. We do not have a claim.
[CUSTOMER][NEUTRAL] OK, I'll call them back.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll call them back and let them know.
[AGENT][NEUTRAL] And then one last thing.
[CUSTOMER][NEUTRAL] OK. Is there anything I can do?
[AGENT][NEUTRAL] Oh, I'm sorry, go ahead with your question.
[CUSTOMER][NEUTRAL] is it possible? I was gonna say, is it, is there something I could submit myself?
[AGENT][NEUTRAL] Well, you can always, yes ma'am, you can always submit the claim to APL. Um, I was going to email you a user guide for our portal so that you can set up your profile. I would wait a couple of days though to do that because there's going to be some changes that are implemented within the next couple of days, JD. So, um, for members that already have their account set up, they're gonna have to redo their information.
[CUSTOMER][NEUTRAL] As opposed to trying to get them.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But I'll email you the user guide for that. I can include the Medin claim form in that email, but there are, and excuse me, there are some additional documents that you will have to obtain from the provider as well as your primary insurance company's explanation of benefits, but those instructions are on page one of the claim form at the top.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And so if you'll give me just a few minutes, well actually let me go ahead and do this while I'm on the phone with you as far as sending you this email.
[AGENT][NEUTRAL] Bear with me just a moment.
[AGENT][NEUTRAL] And this claim form just so that you know it's also on our main web page at [PII] under claims and form and you would be looking for the Medlink claim form. That's the type of policy you'll notice on your card. It says Medlink, but that would be the claim form. But again, I'm gonna attach one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To this email with the user guide I just had to pull one up so just one second.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Oh, you're very welcome.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and the email that you're gonna receive from me is going to come from [PII]. Again, that's [PII]. I have put um APL in your subject line as well so that that's easy for you to recognize it's not being junk mail and you should have that very soon because I just sent it to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][POSITIVE] OK, terrific. Thank you.
[AGENT][POSITIVE] OK. Well, you're very welcome. So is there anything else that I could help you with today?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK, well then, thank you for calling APL and I hope that you have a very nice afternoon.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][POSITIVE] Yes, please. Thank