AccountId: 011433970860
ContactId: 1a7506fa-9116-4634-b975-f024a1272359
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 734210 ms
Total Talk Time (AGENT): 318885 ms
Total Talk Time (CUSTOMER): 282876 ms
Interruptions: 4
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/1a7506fa-9116-4634-b975-f024a1272359_20250429T20:35_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, good afternoon, [PII]. Um, I'm trying to file the claim for my urgent care. Um,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, so I noticed there is a form I need to submit it, but I don't know which one I should download. There's a direct deposit or there's diagnosis, so which form I should yeah.
[AGENT][NEUTRAL] OK, I can help you um with which form you need to um file your claim. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, um my name, first name is [PII] Last name is [PII]
[AGENT][NEUTRAL] OK, Ms. [PII], may I have the um a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. Uh, the contact number will be the same, [PII]. And the policy number.
[CUSTOMER][NEUTRAL] Policy number. Where can I find the policy number? There is a group number and plan.
[CUSTOMER][NEUTRAL] Any hospital benefit number. Uh-huh.
[AGENT][NEUTRAL] Do you
[AGENT][NEUTRAL] These are you looking at the card or where are you looking? Do you have like paperwork?
[CUSTOMER][NEUTRAL] Um, I'm looking at the
[CUSTOMER][NEUTRAL] The card, my ID card.
[AGENT][NEUTRAL] OK, on the ID card, it should say in hospital or outpatient policy cert number. It should start with a 01 or 02.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, right.
[CUSTOMER][NEUTRAL] Right, 02.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, you need both or outpatient or in hospital?
[AGENT][NEUTRAL] The number, the numbers are the same, the ML 7 or 8 at the end is different. I just need the numbers.
[CUSTOMER][NEUTRAL] Oh, OK. Uh, so 02.
[CUSTOMER][NEUTRAL] 45
[CUSTOMER][NEUTRAL] 6418.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] M L
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Alright, if you've already given me your first and last name, I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Mm, yeah, sure.
[CUSTOMER][NEUTRAL] My, so.
[CUSTOMER][NEUTRAL] First name is [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Um, you've already provided your name. I just need your date of birth, your mailing, and email address.
[CUSTOMER][NEUTRAL] Be him on that one
[CUSTOMER][NEUTRAL] OK, so the it's a [PII].
[CUSTOMER][NEUTRAL] And the email is um my [PII].
[CUSTOMER][NEUTRAL] And what else?
[AGENT][NEUTRAL] Your home address?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] In [PII].
[AGENT][NEUTRAL] And your city, state and zip?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So you're looking for the Medlik claim form because you have a Medlik policy.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] So I choose the claim and form and there's one asking me, OK, [PII].
[CUSTOMER][NEUTRAL] So what I found is an accident claim form and authorization to disclose information or cancel claim or change. Yeah.
[AGENT][NEUTRAL] Are you on our website?
[AGENT][NEUTRAL] OK, hold on one second. So, on the website, because you can't use the, you can't use any other form except mailing because that's the type of policy you have. So hold on one moment.
[AGENT][NEUTRAL] When you click on claims and forms, if you see the accident claim form, you just need to scroll down a little more to where you see um a 1, a 2, and a 3 right under everyday solutions claim form.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 43.
[CUSTOMER][NEUTRAL] 12, OK. Oh, next page, right?
[AGENT][NEUTRAL] Right. And then you'll go to the 2nd page and Medlink is the 123rd claim form on that list.
[CUSTOMER][NEUTRAL] Oh OK. Oh, OK. I would just download this one.
[AGENT][NEUTRAL] Yes, ma'am. You'll download that form and then you can upload it onto the online service center, um, you can fax it or you can mail it to us, along with
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So any claim that you send in?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're going to need the explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] And the itemized billing from the provider, if it's a doctor, hospital, urgent care, um, you'll just need their itemized billing. It needs to have the diagnosis codes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm, what, what, uh, can you repeat one more time? What's the, OK, so first one, I got the, um, what's the name for that one? The form, right?
[AGENT][NEUTRAL] The, the
[AGENT][NEUTRAL] Yes, so the Medley Kla farm.
[CUSTOMER][NEUTRAL] No, uh, the primary.
[AGENT][NEUTRAL] So I'm going to give you all the things you need to file a claim.
[AGENT][NEUTRAL] So the first thing you need is a meddling, your meddling claim form.
[AGENT][NEUTRAL] The second is the primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, explanation, where, oh, I can, I can't, so where can I find out?
[AGENT][NEUTRAL] So your primary insurance, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, it is up now.
[AGENT][NEUTRAL] 2691, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm showing as Amed. So the claim has to um go through AMed first because they're primary, then you'll submit the explanation of benefits and the itemized billing from the hospital.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Or doctor's office.
[CUSTOMER][NEUTRAL] So the explanation, OK, so the first one is for the second one is the explanation of the benefits, and 3rd 1 is the billing.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Because I already uh the billing is what I paid, right? The invoice, kind of the invoice.
[AGENT][NEUTRAL] But it needs to be specific. You need to ask for the item, their copy of the itemized billing. It can't be the patient copy. So when you call them, you're going to ask for an itemized bill that has the diagnose everything I just listed, the diagnosis code, the procedure codes, and all the charges, their version of it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK. I itemized, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That's called itemized itemized bill, billing, itemized billing. That's why I call.
[AGENT][NEUTRAL] Yes, when you call them, you're going to ask for an itemized bill.
[CUSTOMER][POSITIVE] Wow
[AGENT][NEUTRAL] And list the things that it needs to have so that they know it can't be your patient bill, because your patient bill is just going to show what you received and how much you paid.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, is it alright if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, sure, no problem.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Miss [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, thank you so much for holding. I apologize for that wait. Um, so yes, we're just trying to make sure that it's their version of the bill and not yours, because the patient version only shows the treatment and the charges.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] OK, not the, not the patient version.
[CUSTOMER][POSITIVE] OK, so those 3 items should be good.
[AGENT][NEUTRAL] Right, that's all, you'll need to file the claim.
[CUSTOMER][NEUTRAL] OK, um, if I have a different visit date, I will just upload to different, uh, claims, right, to create a new claim for each visit.
[AGENT][NEUTRAL] Right, for each day of service.
[CUSTOMER][NEUTRAL] OK. Is there a time limit if, uh, like 22 years during the 2 years, the age should be or whenever um I have the insurance.
[CUSTOMER][NEUTRAL] It can be covered. Can I submit the claim for the?
[AGENT][NEUTRAL] A time limit to file the claim?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, no, ma'am. There's no filing limit, um, or a timely filing limit as long as your policy is active on the data service, you can file the claim at any time.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Um, OK, got it. Thank you so much. Oh, and one more thing is, what about the, um, the, like, um, a visit a doctor for surgery and uh for the doctor visit fee?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] So, will the doctor, doctor visit fee gonna be covered?
[AGENT][NEUTRAL] Are you asking me if going to the doctors is covered on your policy?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, it's gonna be, yeah.
[AGENT][NEUTRAL] OK, um, let me take a look and see.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Um, you don't, so.
[AGENT][NEUTRAL] You don't have any coverage for like the office setting. This is more so for inpatient, if you're admitted into the hospital, and then you have outpatient, so like your urgent care, your emergency room, outpatient surgeries, um, you don't have any in-office coverage.
[CUSTOMER][NEUTRAL] OK, but for the surgery, it has to be for the surgery fee not for the like consultation, doctor visit.
[CUSTOMER][NEUTRAL] That won't be covered, right?
[AGENT][NEUTRAL] Right, there's no in-office coverage, but you do have like outpatient um surgery coverage and then you have inpatient coverage if you are admitted into the hospital.
[CUSTOMER][NEUTRAL] He
[CUSTOMER][POSITIVE] OK. OK, got it. Thank you so much.
[AGENT][POSITIVE] You're welcome. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Um, no, I'm good. So everything should, the, so the urgent care should send it to me. The AT can just send it to you guys directly, right?
[AGENT][NEUTRAL] Yes, they can. If they have, if you give them our policy number like when when they ask for your insurance, you would give them your your ID card and have them um bill us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, but if you already are paid, can they still do that or right, but maybe that question is for them.
[AGENT][NEUTRAL] Anytime you do anything medical, just submit your medical ID card so that they can handle the billing. Um, if you've already paid.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Mm, right.
[AGENT][NEUTRAL] If you've already paid and you're submitting the claim for like reimbursement, then I mean they can still submit it, but if you've already paid, I would just file it myself if I was you, but that's up to you.
[CUSTOMER][POSITIVE] Exactly
[CUSTOMER][NEUTRAL] of
[CUSTOMER][POSITIVE] OK. Um, OK, yeah, got it. Thank you so much.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. Was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] Uh, no, I'm good, thank you.
[AGENT][POSITIVE] You're welcome. Well thanks so much for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.