AccountId: 011433970860
ContactId: 2109d748-427b-4982-8094-0e9f1554738c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 699820 ms
Total Talk Time (AGENT): 344892 ms
Total Talk Time (CUSTOMER): 344906 ms
Interruptions: 3
Overall Sentiment: AGENT=1.3, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/2109d748-427b-4982-8094-0e9f1554738c_20250205T15:41_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, yes, I'm trying to find out how to take care of a claim. Um, do I pay the bill first and then put in the claim?
[AGENT][POSITIVE] Well, it would be my pleasure to assist you. Do you happen to have your policy number available?
[CUSTOMER][NEUTRAL] I don't have the policy number.
[AGENT][NEUTRAL] I can look it up by your social if that's OK.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] And what is your name please, ma'am?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And can you verify your date of birth, current mailing address, email, and phone number?
[CUSTOMER][NEUTRAL] [PII]. My email address is [PII]. My address is [PII].
[AGENT][POSITIVE] And then finally a good callback number just in case we get disconnected I can get right back to you.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And by the way, I'm a July baby too and that's uh July girls are awesome.
[CUSTOMER][NEUTRAL] Huh? You what?
[AGENT][NEUTRAL] I said I'm a July baby too.
[CUSTOMER][NEUTRAL] Oh,
[AGENT][POSITIVE] I said you like girls are awesome.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right, so I've got your policy pulled up, Miss [PII], and I can help you with that claim information. Now, there's several options. You can give your policy information to the provider.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] When you go for medical services, and they can file the claim for you and we can pay them directly. That is basically the easiest.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And they're telling, and they're telling me no.
[AGENT][NEGATIVE] They're telling you no.
[CUSTOMER][NEUTRAL] They told me that I have to go where they bill me.
[CUSTOMER][NEUTRAL] And get a claim form there and fill out the claim, but then the people there tell me I'm supposed to put it through to the doctor.
[CUSTOMER][NEUTRAL] So now can I do it after the it's paid?
[AGENT][NEGATIVE] You're confused.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] Can I do it after the bill is paid and then it gets reimbursed to me?
[AGENT][NEUTRAL] Yes, ma'am, if the services are covered, what type of services will they be for?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] One of them is um it's a biopsy that I had done, a cancer biopsy.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEGATIVE] Which might even, it, it, it depends if it, if it's cancer, my Aflac or whatever it's called would pay for that. But if not, I would put it on my gap insurance and I'm just trying to find out because everybody's so mixed up. I'd rather just pay the bill and be reimbursed because it's just gonna mess everything up the other way.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] I understand. Yes, ma'am. Now I can, um, and I can email you a copy of your card if you don't have one available.
[CUSTOMER][POSITIVE] Yes, if you can that would be great.
[AGENT][NEUTRAL] I'm doing that right now for you. So what we're going to need, now, this is your secondary policy to your primary insurance. Who is your primary insurance with?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I don't know who it is. It says UMR and then on the bottom it says United Healthcare, but when I call them, they tell me they're not United Healthcare, so I don't know.
[AGENT][NEUTRAL] You know, like
[AGENT][NEUTRAL] Well, let me see if I can find that out for you as well. Hang on just a second.
[AGENT][POSITIVE] I'm gonna look that up for you.
[AGENT][NEUTRAL] Or at least to see who we have on file.
[CUSTOMER][NEUTRAL] But what's happening with them.
[CUSTOMER][NEGATIVE] What's happening with them is the deductible is just so high and I just put out over $2000 out of my pocket already and then I have to put out another $2000.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] And it, it's just too much.
[AGENT][POSITIVE] Yeah, that is a lot, and this policy will assist for the covered services.
[AGENT][NEUTRAL] Um, now, we pay towards your deductible, copay, or co-insurance, whatever is applied from your primary.
[CUSTOMER][NEUTRAL] Oh yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so we will
[CUSTOMER][NEGATIVE] Well, the primary bill, that's not even included in the, the primary bill is $500.
[CUSTOMER][NEGATIVE] That's not even including the biopsy because the health insurance is refusing to even cover the doctor appointments.
[CUSTOMER][NEGATIVE] They don't wanna cover anything. They're giving me a hard time with absolutely everything, so, um, yeah, they're telling me that it's a $33,500 deductible but now, no, it went up, it just went up the other day. Now it's $3750 and then they only cover 70% after that until you hit $7000.
[AGENT][POSITIVE] Oh my goodness.
[AGENT][NEUTRAL] That is crazy.
[CUSTOMER][NEGATIVE] And I took the I took the best policy that they have. I would rather pay more money and have less of a deductible, but they don't offer that.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] So what we will need if you want to file a claim now on this email that I'm sending you there is our website and you can create a login and password.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] And for you to file a claim, there is a form for Medlink M E D L I N K.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You use the Medli claim form.
[CUSTOMER][NEGATIVE] So I won't
[CUSTOMER][NEUTRAL] So then I won't need to go to the place to pick up the form. I would just go in online and do it.
[AGENT][NEUTRAL] We will need an itemized bill from the facility with diagnosis codes and procedure codes.
[CUSTOMER][NEUTRAL] Yeah, the bill, the bill I'll have this is the problem. I'm a truck driver and I'm over the road and I'm out for a couple of months, so I could get the bill. Somebody could snapshot the bill for me, you know, as far as my mail goes, but for me to get to that office just to pick up a paper to fill out is is.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Two days off from work and it's a whole big hassle just to pick up a form so that's why I said I could just.
[AGENT][NEUTRAL] Yeah, it's, well, let me ask.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Do this online if I could just do this online, that's even better.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] You can submit the claim documents online, but we will need, is that the um the bill from your biopsy?
[CUSTOMER][NEGATIVE] I didn't get the bill yet it should be coming. I don't even know what the results are yet, so I'm still waiting for that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So when you talk to them.
[CUSTOMER][NEUTRAL] So as far as the.
[AGENT][NEUTRAL] I'm sorry, go ahead. I apologize. Go ahead.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, that's OK. No, that's OK.
[AGENT][NEUTRAL] So what you can do is when you speak to that provider.
[AGENT][NEUTRAL] Or I don't know if they're gonna mail you the results or, or speak with you regarding the results, but ask them for an itemized bill with diagnosis codes. A lot of times when they send that billing in the mail, it will not have the diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But tell them that you need a medical document with the diagnosis code. That could be in the form of medical notes. It could be in the form of an itemized bill, but we have to have the diagnosis code because your plan only pays towards sickness or injury. That diagnosis code does indicate to us that it is for a sickness or an injury to in order to be able to release payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We'll also need, well, I do show you have UnitedHealthcare as your primary insurance. So once they process the claim, we'll need a copy of the, it's called an explanation of benefits. That's what you normally get in the mail when your primary insurance has processed the claim.
[CUSTOMER][NEGATIVE] Yeah, they haven't sent me anything.
[AGENT][NEUTRAL] OK. So,
[CUSTOMER][NEGATIVE] They haven't sent me anything.
[AGENT][NEUTRAL] Once they process that claim, you should receive something by mail and we'll need a copy of that as well along with the claim form that can all be submitted online on that portal, the online service center once you create that login and password.
[CUSTOMER][POSITIVE] Thanks
[CUSTOMER][NEUTRAL] OK, so I'll need, uh, let's start this again, the medical diagnosis and what else other than uh explanation of benefits from the, and that's from the insurance company.
[AGENT][NEUTRAL] There's a
[AGENT][NEUTRAL] That it would be from United. Mhm.
[CUSTOMER][NEUTRAL] Is the medi
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then we'll need um the claim form submitted as well for Medlink.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][POSITIVE] Uh, but you know, later on down the line, if you have further questions, you'd never hesitate to give us a call because we're here to help you. And if you ever have any problems or run into, you know, situations at the doctor's office or they're giving you grief for whatever reason.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Call us and let us talk to them because a lot of times once we explain that we are secondary and we do pay providers if they file the claims, a lot of times they'll go ahead and submit those claims for you then you don't have to worry about.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All that work. Let them do the work for you.
[CUSTOMER][NEUTRAL] OK, now did you send that link to me yet or?
[AGENT][NEUTRAL] I did send it via email to your email address online, and it's from the care team.
[CUSTOMER][NEGATIVE] Yeah, it didn't come through.
[AGENT][NEUTRAL] Sometimes it does take a minute.
[CUSTOMER][NEUTRAL] Yeah, it didn't come through. Did you, did you put two L's in it's F L A W L L.
[AGENT][NEUTRAL] Yes, ma'am. [PII]?
[CUSTOMER][NEUTRAL] ESS.
[CUSTOMER][NEGATIVE] Yeah, yeah, it didn't come through.
[AGENT][NEUTRAL] You might want to check your spam folder a lot of times.
[AGENT][NEUTRAL] It'll go to your spam, and sometimes it just takes a minute. And like I said, it's going to be from the care team.
[CUSTOMER][POSITIVE] OK, I got it I got it.
[AGENT][NEUTRAL] Now, while I've got you on the line, can you open that attachment?
[CUSTOMER][NEUTRAL] OK, alright, so.
[AGENT][NEUTRAL] And let's just make sure you can.
[CUSTOMER][NEUTRAL] Um, I'm kind of driving right now, so I didn't wanna do that.
[AGENT][NEGATIVE] Oh, don't do that then. No.
[CUSTOMER][NEUTRAL] Yeah yeah yeah I could probably try to figure out how to set up an account and do all that and then look through everything and then if I have a problem I could always call back. I'm just trying to I don't care how it gets paid whether it gets paid through me or whatever and if I'm missing something somebody could always call me back and tell me what they're missing and I could try to get it [PII]ugh them but um.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] You know, I, I just wanna know what my options are, so now that I know, um, see, and I asked them, I asked my doctor if they take that and they thought, oh no, we don't do that.
[CUSTOMER][NEUTRAL] We don't take it and I was like so maybe they can and I'll have to call them back again.
[CUSTOMER][NEUTRAL] And um,
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] And if, like I said, if you ever have problems, give us a call while you're there and we can talk to them.
[CUSTOMER][NEUTRAL] Because most likely.
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] It's been my pleasure. Now, when you um download that bedli claim form, there are instructions as to what's needed to file a claim there as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right thank you so much.
[AGENT][POSITIVE] Oh, it's been such a pleasure to assist you, [PII]. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's it. You helped me out a lot. Thank you, bye.
[AGENT][POSITIVE] It's been my pleasure. Call us if you have any further questions or concerns, and I hope you have a lovely day.
[CUSTOMER][POSITIVE] You too thank