AccountId: 011433970860
ContactId: 2309d317-b160-471b-aa98-5d92d9d8fc1d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 862179 ms
Total Talk Time (AGENT): 471773 ms
Total Talk Time (CUSTOMER): 176958 ms
Interruptions: 5
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/2309d317-b160-471b-aa98-5d92d9d8fc1d_20250624T14:06_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, uh, I just, I had an appointment or not appointment, I had a visit to the emergency room a few months ago, um, and I received the bill for it, and I didn't, uh, have my supplemental this gap insurance ID at the time and so I was wondering how I can apply that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so you
[CUSTOMER][NEUTRAL] To this this ER bill.
[AGENT][NEUTRAL] OK, so you're wanting to find out how to file a claim with us, is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][POSITIVE] Yes, sure I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Can you please spell your name for me?
[CUSTOMER][NEUTRAL] Definitely, yeah, first name is [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], and then last name is [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, Mr. [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] It's gonna be [PII].
[AGENT][NEUTRAL] Thank you. And what is your policy number, please?
[AGENT][NEUTRAL] It would be on your ID card.
[CUSTOMER][NEUTRAL] I'm OK.
[CUSTOMER][NEUTRAL] Yeah, I see a group number in hospital benefit number.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Depending, yes, sir, you can give me that either the inpatient or the outpatient. It doesn't matter.
[CUSTOMER][NEUTRAL] OK, the inpatient is 023.
[CUSTOMER][NEUTRAL] 297.
[CUSTOMER][NEUTRAL] 06 M as in Mary L as in Larry 7
[AGENT][NEUTRAL] OK, thank you. So give me a moment please to get your policy information pulled up, Mr. [PII], and then I will need to verify several things with you first for security and also any information that I provide for you today will be a verification of benefits and not a guarantee of payment. Just one moment.
[CUSTOMER][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so first off, um, as I stated before, any information provided will be a verification of benefits and not a guarantee of payment. So if you could first please verify your date of birth.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] 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][POSITIVE] Correct.
[AGENT][NEUTRAL] Thank you and lastly I do need to add an email on file for you. What is your email address?
[CUSTOMER][NEUTRAL] It's just my [PII] last [PII], so [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] [PII], is that what you said?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. So it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So Mr. [PII], we have a portal that is called the online service center in which you can set up your profile and you can have access to your ID cards, your policy information, and you can also submit claims in this portal for our review. So I can email you the user guide on how to set your profile up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, in addition to a guide that will explain.
[CUSTOMER][NEUTRAL] Please
[AGENT][POSITIVE] How to use it. It gives you some tips on using it.
[AGENT][NEUTRAL] Now give me just a second to go ahead and send you that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I'm gonna the email that I'm actually gonna send to you is going to have 3 attachments, OK? Um, one of them is going to be, as I said it before, how to create and log in to your portal. The next one is going to be using it and then I'm also gonna go ahead and send you the Medlink claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That you'll need to submit along with the other required documentation that's listed on that claim form on page one of the claim form, it gives you instructions at the top, OK? And so you can use that as a checklist for the other documents that you're also gonna need to provide for us to review a claim and once you have all of your documentation together, you can actually upload all of that into your portal.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For our review.
[AGENT][NEUTRAL] So that email that I'm sending to you and I just sent it, it may take a minute to come in, but it's gonna come from care team.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And I did put APL in your subject line. I don't think that it'll go to your junk or spam folder.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But if you haven't seen it in your regular inbox in, in a couple of minutes, you might wanna check.
[AGENT][NEUTRAL] One of those two other folders to see since we've not emailed you before.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][POSITIVE] You did get it? OK. Now I'll be happy to try and set your profile up just to set it up with you if you would like while we're on the phone or you know, if you don't have time right now and you want to do that on your own, you can call us back obviously if you have.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Any issues with it?
[CUSTOMER][NEUTRAL] Uh, I mean, I'm, no, I have time, um, I'm on the link it says create your OSC account, so I click on that?
[AGENT][NEUTRAL] Uh-huh. Yes, sir. So you'll click there.
[AGENT][NEUTRAL] And then on the, um, you're gonna select insured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then click next.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, then on that next screen, only fill in the boxes that have the asterisk next to them.
[AGENT][NEUTRAL] I believe that's gonna be your last name.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] Email and date of birth.
[AGENT][NEUTRAL] Email and date of birth, correct.
[AGENT][NEUTRAL] And then you'll click next, I believe.
[AGENT][NEUTRAL] There's recently been an update Mr. [PII] to our portal so.
[AGENT][NEUTRAL] It's a, it's still a little new for me as well.
[AGENT][NEUTRAL] As far as helping you set it up.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] It's it's uh now it's asking me to send a verification code.
[AGENT][NEUTRAL] Uh-huh. So you, that'll be sent to your email, correct. And that may come very quickly or it might take a minute or two for that to come through.
[CUSTOMER][NEUTRAL] Which I should get to my email.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But once you get that, you're just gonna copy and paste it in that um box and then click once you paste it, go ahead and click verify code. Uh-huh. You'll do that before you set up your password.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Verify.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm up to the password part.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then for display name is I just choose something or how does that work?
[AGENT][NEUTRAL] Yeah you can just, yes, I mean, it's gonna, that's, it's essentially what's gonna show up like welcome, you can put your first name there and then, you know.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Your last name and the surname, that's fine.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And then it should prompt you to check the boxes as far as agreeing to the terms of use and privacy policy.
[CUSTOMER][NEUTRAL] Yeah, I guess I gotta do a verification code again to log in. Let's see.
[AGENT][NEUTRAL] You will, yes. It says it's essentially like a multi-factor authentication. Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] That's good.
[CUSTOMER][NEUTRAL] Sorry text message notifications. OK.
[AGENT][NEUTRAL] Mhm. So that way when a claim is processed, you can receive a notification. Now you may not be able to instantly sign into your portal to see the status once you receive that text, because it'll have to go through our overnight processing before your explanation of benefits will be viewable in the portal, but you know, if we process a claim and you get a text, you can call us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] To get the status over the phone.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] If I hit start claim here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm still gonna need to go open the the form that you sent me in that email as well.
[AGENT][NEUTRAL] Yes, because you're correct, because you're going to have to submit the claim. What you're gonna need to do is to complete the claim form.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you'll have to acquire the additional documentations that that's listed in the instructions that's required. Once you have all of that together, just save it on your computer and then you will log in to your portal.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Select the start a claim and then you're gonna be and you'll walk through the steps to upload your files.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Are your file.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Into the portal and you should receive a confirmation once you've uploaded them, you know, that it was successful and it should show you a confirmation number.
[AGENT][POSITIVE] That it was successfully submitted.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I guess I'll get started on that.
[AGENT][NEUTRAL] OK. Well, is there anything else that I can help you with at the moment?
[CUSTOMER][NEUTRAL] Uh, no, I guess, um.
[CUSTOMER][NEUTRAL] Just a general question of, of what would and wouldn't be covered if you know.
[AGENT][NEUTRAL] OK. So I cannot, as I stated before, I, any I can only verify your benefits. I can't guarantee payment, right. Now, you have an outpatient benefit maximum per calendar year for covered outpatient services of $3500 with no outpatient deductible. And your emergency room, it's per occurrence, but there's no
[CUSTOMER][NEUTRAL] There's no guarantee, yeah, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The emergency room deductible is 0 per cover person per occurrence.
[AGENT][NEUTRAL] So again, on this policy, the maximum that the plan would pay for covered outpatient services per calendar year is $3500.
[CUSTOMER][NEUTRAL] It's 3500.
[AGENT][POSITIVE] Correct. Yes, sir.
[CUSTOMER][NEUTRAL] And, and so, so emergency is 0, is that what I understood?
[AGENT][NEUTRAL] Well, no, it's a zero deductible per occurrence. And per occurrence on your policy means for the same or related condition unless separated by 90 days.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] There is no deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Do you have any other questions?
[CUSTOMER][NEUTRAL] I guess I'll see what happens.
[CUSTOMER][NEUTRAL] No, that was it.
[AGENT][POSITIVE] OK. Well, if that is all then at the moment that I can help you with, thank you again for calling APL and I hope that you have a very nice day, but if you have any other questions come up, please give us a call and we'd be very happy to help you.
[CUSTOMER][POSITIVE] No problem thank you so much.
[AGENT][POSITIVE] OK, well, you're very welcome and thank you again for calling APL.
[CUSTOMER][POSITIVE] Take care bye.
[AGENT][POSITIVE] All right, Mr. [PII], have a great day.