AccountId: 011433970860
ContactId: 2f0b28e6-a5e9-4e79-ad81-d726469c5de6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 775320 ms
Total Talk Time (AGENT): 414740 ms
Total Talk Time (CUSTOMER): 281356 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/2f0b28e6-a5e9-4e79-ad81-d726469c5de6_20250411T15:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, uh, here, how are you? My name is [PII], and I want to see if you can pull up my policy.
[AGENT][NEUTRAL] Sure, yeah, I can get that pulled up. Uh, [PII], can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] OK, a good callback number will be [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, I do on the APL card that will be under.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Another group number that'll be the in-hospital benefit certification number.
[AGENT][POSITIVE] Yes, that, that's definitely will that will work.
[CUSTOMER][NEUTRAL] OK, it's 02 34 51 76 M as in Mary, L as in Larry, number 7.
[AGENT][NEUTRAL] OK, and then just gonna verify some information really quick. [PII], can I get your date of birth please?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Um, I've got a different address for you, [PII].
[CUSTOMER][NEUTRAL] Hm, that's my mailing address. Maybe they have my old [PII].
[AGENT][NEUTRAL] Oh hold on now you did say OK [PII], is that what you said right?
[CUSTOMER][NEUTRAL] [PII], yes, of course, yeah.
[AGENT][NEUTRAL] OK, yeah, so we've got that as your physical address, mailing address. I've got [PII]. Does that need to be changed?
[CUSTOMER][NEUTRAL] Oh no, that's, that's, that's another, that's another property, but that's, I haven't lived there in 7 years.
[AGENT][NEUTRAL] Oh goodness, OK, yeah, I will go ahead and get that changed um and then the last thing I need is the email address we've got on file for you uh looks like it's a Gmail account.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] Perfect. OK, thank you for verifying all of that, [PII]. Uh, what can we help you with today?
[CUSTOMER][NEUTRAL] Um, I had a procedure done.
[CUSTOMER][NEUTRAL] I want to say it was 8 months to 9 months ago and um most of it was covered by my by Easy Health, my main policy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] But, uh, for the last couple of weeks I've been getting some, um, calls and some emails from stuff that were denied by my primary policy.
[CUSTOMER][NEUTRAL] And I was instructed by my HR manager to give you guys a call um because right now I have two bills that they declined and she said that I could put place a claim with you guys.
[AGENT][NEUTRAL] OK, um, I'm sorry, just so that I understand correctly, your primary insurance would not cover this or they just covered a bit?
[CUSTOMER][NEUTRAL] Well, my primary insurance covered the, the surgery and everything else, but there's certain smaller item, uh, stuff that they did not cover.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I will let you know the way that this policy works, [PII], is your primary does have to pay for we need to have them pay at least a little bit anything um co-pay, deductible co-insurance that's what this policy helps with if it's something that they won't pay this policy can't, it can't be used instead. Does that make sense?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, well, I mean I had a surgery. It was like I don't know, like $70,000 and they paid for everything else, but I have one bill left over for $300 and then I have one bill left over for $9800.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And those are the ones that they wouldn't pay anything on?
[CUSTOMER][NEUTRAL] From the same hospital, Baptist Hospital.
[CUSTOMER][NEUTRAL] Uh, I don't know because I'm, I'm inside a portal right now and it just gives me an option of pay or don't pay.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK. All right. So,
[AGENT][NEUTRAL] Let's see what I would do for [PII] is reach out to them and see if they did try to file those claims with us because I've only got a few claims on file for you and we paid each one.
[AGENT][NEUTRAL] So see if they might have maybe they forgot it um to try to file that with us um if they have if they haven't or if they just seem to give you a run around and you prefer to do it yourself you can absolutely file that claim yourself with us we would need um let me know when you're ready if you wanna write this down I'll let you know what we need for claims.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] OK, so we would need the itemized statement.
[AGENT][NEUTRAL] That shows diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then we would also need the explanation of benefits from your primary insurance.
[AGENT][NEUTRAL] And the provider or facility wherever you went for treatment or for the surgery, they will have all of that information. So if you were to reach out to them and just ask for that specific information, they'll be able to give that to you.
[CUSTOMER][NEUTRAL] So I gotta reach out to the hospital or I gotta reach out to my primary health uh.
[CUSTOMER][POSITIVE] Beneficiary.
[AGENT][NEUTRAL] Wherever you went for the treatment, so the provider, um, so if it was for the surgery, it would, it would be the hospital. Wherever you went for that, they will have all of that information.
[CUSTOMER][NEUTRAL] So you need to have the itemized what?
[AGENT][NEUTRAL] Itemized statement.
[CUSTOMER][NEUTRAL] What was the first you said statement.
[AGENT][NEUTRAL] Itemized statement that shows diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] OK, and an explanation of benefits?
[AGENT][NEUTRAL] Yes, from your primary insurance again just showing that they paid something.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] OK, alright, so before I can place a claim with you guys need to have all this information.
[AGENT][NEUTRAL] Correct, um, and then I will say, um, have have you created an account on our online portal, [PII]?
[CUSTOMER][NEUTRAL] Oh, for you guys? I don't think so. I have an account for my primary, but not I don't think I have one with you guys for a secondary. It's the first time that I use you guys. Well, first time that I call.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Sure, um, do you have access to a desktop or a laptop computer?
[CUSTOMER][NEUTRAL] Yeah, of course, I'm front of my computer right now.
[AGENT][NEUTRAL] Awesome. OK, the reason I ask is our online portal does not have much support for mobile devices like phones or tablets, so to upload claim information it would have to be done, um, so our website is it's the word secured with an ED.
[CUSTOMER][NEUTRAL] Yes, what would be the website?
[AGENT][NEUTRAL] [PII]. So [PII].
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so whenever you create that account, yes uh and to create that account you would just use the exact same information um it does have to match what we have in our system uh so it would be the same email all of that information.
[CUSTOMER][NEUTRAL] And then I click on new user.
[CUSTOMER][NEUTRAL] I'm an individual with an APL insurance policy.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Next
[CUSTOMER][NEUTRAL] Quite a bit um 768.
[CUSTOMER][NEUTRAL] [PII]. The residential zip code, would that be the old zip code or the the rest the where I where I'm at now?
[AGENT][NEUTRAL] I am actually
[CUSTOMER][NEGATIVE] Because I wanna get that wrong.
[AGENT][NEUTRAL] Changing that right now um so we will make it the correct one, so the [PII] is the correct one, right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yes, um, so you would use that one. I did just go ahead and change that.
[CUSTOMER][NEUTRAL] OK, so last name [PII], my social, my zip code, my full email and date of birth next.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Next
[CUSTOMER][NEUTRAL] Your account has been created log in.
[CUSTOMER][POSITIVE] OK perfect I'm in.
[AGENT][POSITIVE] Awesome. OK, so on that main page there should be a spot that uh where you can upload information. So of course and that's where you would put that out of my statement and the explanation of benefits and then um.
[AGENT][NEUTRAL] You can find the correct claim form on the website as well and so this policy, the name of it is called Medlink so you would just fill out that correct claim form.
[CUSTOMER][NEUTRAL] Mm
[AGENT][POSITIVE] And then that would be it um that's gonna be the quickest and easiest way to get claim information to us um it gets to us almost instantly.
[CUSTOMER][NEUTRAL] Claim forms.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh you don't, I click on Metlink secure group, OK.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, and now I would hold off uh don't submit anything until you have all of the information for the claim um because it will start processing and then deny as we're missing information.
[CUSTOMER][NEUTRAL] OK, so how can I start a new claim?
[AGENT][NEUTRAL] So once you have
[CUSTOMER][NEUTRAL] Because I see here there's already a I already see there's a uh Metlink select group met supplemental and it says something from June.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, that's just your plan name.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's the effective date.
[CUSTOMER][NEUTRAL] Um, OK.
[AGENT][NEUTRAL] Yes, right, um, so once you have.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] And then where would I go for?
[AGENT][NEUTRAL] Once you have all of that correct information that you need that out of my statement and the explanation of benefits, then you would upload that information I believe I'm not quite sure where it's at on the main page I think it might be closer to the bottom.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I see the upload documents file yeah.
[AGENT][POSITIVE] Awesome yes so that's exactly where you would put that and then of course you would fill out that claim form as well.
[CUSTOMER][NEUTRAL] But where's the, where can I find the claim form? I click on claim forms and then I scroll to.
[CUSTOMER][NEUTRAL] Oh, OK, see I'm here.
[AGENT][NEUTRAL] Do you see Medlink?
[CUSTOMER][NEUTRAL] Critical illness.
[CUSTOMER][NEGATIVE] No, I don't see my thing gonna go to page 2.
[CUSTOMER][NEUTRAL] Medin claim forms, OK.
[AGENT][NEUTRAL] Yes, sir. That's it.
[CUSTOMER][POSITIVE] Perfect, perfect, perfect, perfect.
[AGENT][NEUTRAL] And then so once you upload all that information again it gets to us very quick, uh, and then from that point it can take about 7 to 10 business days for claim information to process. It may not take quite that long but that's probably the safest guess and then of course uh from there you can view the status uh on the website or you're more than welcome to give us a call if you'd like.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, alright, perfect.
[AGENT][NEUTRAL] And then I, I will say as well if you're going to file the claim [PII] on the website you can also set up direct deposit if you prefer uh for that benefit amount um otherwise we would mail a paper check to you.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh, so this will get mailed to me or or they will get paid to the.
[AGENT][NEUTRAL] Yes, so if
[AGENT][NEUTRAL] So if the provider is the one.
[CUSTOMER][NEUTRAL] Because I already see here at the bottom that that it is a uh it says pro you guys have processes uh other payments.
[AGENT][POSITIVE] Yeah absolutely and that's where so if the provider.
[CUSTOMER][NEUTRAL] Um, [PII], 23 and 400.
[AGENT][NEUTRAL] Yes, right, so if the provider is the one to file the claim with us we would send that that payment to them if you file that claim we would send that to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so am I better off calling the hospital and have them create a claim with you guys so that way I'm out of the picture?
[AGENT][NEUTRAL] I would, I mean that's completely um honestly it's whatever you prefer um I would definitely have them try as it's just going to be easier on you because they have all of that information right there, you know, um, and then you won't have to worry about a thing, but again it depends on the provider. Some really don't like messing with any sort of secondary or supplemental insurance at all, and they may not do it um so in that case, you know, you can still file that claim.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Then that's exactly what I'll do.
[CUSTOMER][NEUTRAL] OK, alright.
[AGENT][NEUTRAL] Alright, I know that was quite a bit of information. Do you have any other, yeah, do you have any other questions for me?
[CUSTOMER][POSITIVE] OK perfect thank you very much for your help. You were very helpful.
[CUSTOMER][NEGATIVE] No, that was it. It's just those two claims. I think those are the last two that they're pestering me about and then hopefully.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] That'll be it.
[AGENT][POSITIVE] All right, well thanks for giving us a call, [PII]. I hope you have a great rest of your day and a great weekend.
[CUSTOMER][POSITIVE] Thank you very much and you too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.