AccountId: 011433970860
ContactId: 31756707-f812-473d-9202-bd233e9572fe
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 576780 ms
Total Talk Time (AGENT): 197460 ms
Total Talk Time (CUSTOMER): 283456 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/31756707-f812-473d-9202-bd233e9572fe_20250319T17:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, [PII]. My name is [PII] and I need some assistance. I, um,
[AGENT][NEUTRAL] OK, Ms. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I had, unfortunately, an accident a couple of weeks ago.
[CUSTOMER][NEUTRAL] And um went to the ER and then had to go to a hand surgeon and then had surgery and all that good stuff. So um I only had my, my, my medical with me, my medical card without my APL so I wanted to know how I, how I could um put my claims in to see if I can get any assistance in helping me with the monies that I had, had to put out.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, Ms. [PII], um, I can help you with the claim, ma'am. Can I please get your uh policy number?
[CUSTOMER][NEUTRAL] Um, on the APL.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. I have two of them. One's in hospitals benefit and one's outpatient benefit. Which one do you need?
[AGENT][NEUTRAL] Either number will be fine.
[CUSTOMER][NEUTRAL] OK, I'll give you the outpatient. 01975687 M as in Mary, L as in Larry, 8.
[AGENT][POSITIVE] OK. Thank you so much for that, Ms. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, let's pull it up. And Miss [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then I'm also going to need for you to verify your address, phone number, and email address.
[CUSTOMER][NEUTRAL] My home address is [PII], and my phone number [PII] and my email address is [PII]. I'm not sure which one you have. I'm on your, I have the APL.
[CUSTOMER][NEUTRAL] On my computer, but I have to reset my password so I wasn't able to log in, but it looks like you have um uh let's just do [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you so much. I appreciate you verifying all of your information for me, Ms. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And um so there's two ways you can do the claim, you can go back to where you went to to have your services done and see if they'll file it for you if I give you the payer ID number.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me give you that payer ID number.
[AGENT][NEUTRAL] It's 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Wait a minute, one second. I'm sorry. I, I, I broke my right arm, so I'm, I'm, and I'm a righty, so I'm a left. I'm ready. OK, can you start again?
[AGENT][POSITIVE] Oh bless your heart.
[AGENT][NEGATIVE] Oh no. You poor thing.
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] Yes, it's 60.
[AGENT][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] 6
[CUSTOMER][NEUTRAL] 60.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] 6
[CUSTOMER][NEUTRAL] 6081
[AGENT][NEUTRAL] No, 60801.
[CUSTOMER][NEUTRAL] 60801
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what is that number reference to?
[AGENT][NEUTRAL] And if you
[AGENT][NEUTRAL] It's a payer ID number.
[CUSTOMER][NEUTRAL] Ha
[CUSTOMER][NEUTRAL] Oh, I feel like a kindergarten.
[CUSTOMER][NEUTRAL] OK, payer number.
[AGENT][POSITIVE] Bless your heart.
[CUSTOMER][NEUTRAL] I know that's what I forgot about my APL. I usually don't have, have medical issues and, and so I forgot about the APL and it wasn't with me in my wallet. Everything happened so fast and so quick, so that what's that called that 60801 is the payer what?
[AGENT][NEUTRAL] Yeah payer ID number.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] ID number.
[CUSTOMER][NEUTRAL] ID number OK, so I have to physically go back to the people and see if they'll take this?
[AGENT][NEUTRAL] Or
[AGENT][NEUTRAL] Or or you can call them and see if they'll take the information over the telephone.
[CUSTOMER][NEUTRAL] OK, so that's one way. What's the second way? That sounds difficult because I have 3 different places I have to go to.
[AGENT][NEUTRAL] OK, so the second way is to file the claim yourself, um, let me look and see, are you signed up with our online service center?
[CUSTOMER][NEGATIVE] I am. I just have to change my password. Apparently my password expired.
[AGENT][NEUTRAL] OK, so you can also file through the online service center.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And when you file the claim,
[AGENT][NEUTRAL] You're gonna have to choose the med link claim.
[AGENT][NEUTRAL] Form
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you'll need to send in your explanation of benefits from your primary insurance carrier.
[AGENT][NEUTRAL] You'll also need your itemized statement.
[AGENT][NEUTRAL] With the procedure and diagnosis codes.
[CUSTOMER][NEUTRAL] Oh [PII].
[CUSTOMER][NEUTRAL] Yeah, I just got the receipt for my payment.
[AGENT][NEUTRAL] You'll need 3 things.
[AGENT][NEUTRAL] Yes, you'll need the explanation of benefits from the primary insurance, your itemized statement with the procedure and diagnosis codes, and then you'll also need to fill out the claim form for Medlink.
[CUSTOMER][NEUTRAL] OK, so for instance when I went to the ER I had a $100 copay. I don't have any breakdown. Will that be sufficient enough? I have, I have the receipt that when I went there that they, they took a $100 copay just for just for one instance.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] No, ma'am, you'll need those 3 things. You'll have to have the explanation of benefits, the itemized statement.
[AGENT][NEUTRAL] And the claim form.
[CUSTOMER][NEUTRAL] All right, hang on, I'm trying to write that down.
[CUSTOMER][NEUTRAL] Explanation of what?
[AGENT][NEUTRAL] Benefits
[AGENT][NEUTRAL] It's also called an EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so that's number one explanation of benefits. So apparently it's better to go in person to these different places to get this information or I can call them and ask them if they can scan it to me or email it to me.
[AGENT][POSITIVE] Right, right, yes, ma'am. That would be wonderful if they could do that because then you can just upload it from your computer.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Right. And then the second piece of information besides the EOB?
[AGENT][NEUTRAL] Your itemized statement.
[AGENT][NEUTRAL] And you want the detailed one because the detailed one has the um diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Itemized statement.
[CUSTOMER][NEUTRAL] With details.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, and the 3rd.
[AGENT][NEUTRAL] You'll need the med link, you'll need the Medlink M E D L I N K.
[CUSTOMER][NEUTRAL] The 3rd 1?
[AGENT][NEUTRAL] Claim form
[CUSTOMER][NEUTRAL] And that I'll get on the website, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So for all my receipts, I'll need those 3 things.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, so like the ER I can call them and ask them if they could send me the explanation of benefits and itemized statement with details and then the form I would do that I would get the form from the from the APL website correct?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, let me see if I can get that information.
[AGENT][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] And um
[AGENT][NEUTRAL] Well, I'm sorry that you got hurt and I hope you get to feeling better, Ms. [PII], and everything heals good for you.
[CUSTOMER][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] Thank you me too. This has been a nightmare. It's been crazy, but
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] All right. Thank you.
[AGENT][NEUTRAL] All right, well, is there anything else I can help you with or any other questions you may have before we go?
[CUSTOMER][POSITIVE] Nope, I'm good thank you so much I appreciate it.
[AGENT][POSITIVE] You're welcome. You have a wonderful day and thanks for calling APL.
[CUSTOMER][POSITIVE] OK thank you you too.
[AGENT][NEUTRAL] Bye-bye, ma'am.