AccountId: 011433970860
ContactId: 324b7661-dc5d-4c9e-9254-ff839299004a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 395269 ms
Total Talk Time (AGENT): 189770 ms
Total Talk Time (CUSTOMER): 106662 ms
Interruptions: 4
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/324b7661-dc5d-4c9e-9254-ff839299004a_20250210T18:20_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Um, yes, um, my husband had this, um, the insurance with you guys through his work, and he no longer works there, um, but I was wondering if.
[CUSTOMER][NEUTRAL] We have claims from the time that um we didn't get submitted that.
[CUSTOMER][NEUTRAL] That was like from
[CUSTOMER][NEUTRAL] The time he was paying for it, could we still submit those claims?
[AGENT][NEUTRAL] Can I have the policy number?
[AGENT][POSITIVE] And I'll be able to assist you.
[CUSTOMER][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Do you have his social?
[CUSTOMER][NEUTRAL] His social is [PII].
[CUSTOMER][NEUTRAL] Alright, my computer is being slow.
[AGENT][NEUTRAL] And what is your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], could you verify your mailing address and your date of birth?
[CUSTOMER][NEUTRAL] [PII] Welcome, [PII].
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[AGENT][POSITIVE] Thank you and what is a good call back number for you just in case the call is disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEGATIVE] And you're calling to verify if you guys had claims for any date of service for while the policy was active, so there is no timely filing. It looked like your policy had became active November, I'm sorry, [PII], and you had it all the way up until [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So there's no timely filing. So if you had claims between [PII] until [PII], then you could submit those claims.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. Is there somewhere that tells, is, is there somewhere that tells me like.
[AGENT][NEUTRAL] Is there anything else that I can assist you with, [PII]?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] I need to upload as far as like for the doctor visits and that kind of thing. Is there like an instruction thing for.
[AGENT][NEUTRAL] So you would need.
[AGENT][NEUTRAL] Yeah, there is instructions on [PII] if you have an account with us, an online account.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And it's gonna be the Metlink claims form and it should tell you what all you would it it may tell you what all you would need, but if it doesn't, I'm gonna tell you you need your primary EOB which is your explanation of benefits from your primary insurance company and your diagnosis codes from the provider for those dates of services.
[AGENT][NEUTRAL] And your diagnosis code is your ICD 10s, ICD 10 codes or ICD 9 depending on what year you're bringing them, you're requesting the claims from.
[CUSTOMER][NEUTRAL] OK, and we
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Your um ELB.
[CUSTOMER][NEUTRAL] And we can submit up up to 4, right? 4?
[AGENT][NEUTRAL] Um, no, you can submit as many as you want, but not saying that all of them will get paid just if the services are covered then it will, we will pay the claims until your benefits are maxed out.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And you have, you had benefits for.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] You said, um.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] I know sorry.
[AGENT][NEUTRAL] Yeah $2500.
[AGENT][NEUTRAL] But it doesn't say what it's called.
[AGENT][NEUTRAL] But as long as it says $2500 but it doesn't say what is covered under the policy. Give me one moment.
[AGENT][NEUTRAL] So you had, you had outpatient benefits of the
[AGENT][NEUTRAL] $250 per calendar day. Then you had 3 $3500 per year for inpatient benefits and you had a physician rider as well, and you had an urgent care rider. And this is not a guarantee of benefits, just a disclaimer of the policy's coverage.
[AGENT][NEUTRAL] So did you have any inpatient stays?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I have no idea. I think my husband probably did, but uh, I mean, I know like I went to the emergency room.
[CUSTOMER][NEUTRAL] In December
[CUSTOMER][NEUTRAL] Um, so I don't know if it would cover any of that.
[AGENT][NEUTRAL] So you're inpatient?
[AGENT][NEUTRAL] So yeah, that will fall under your outpatient benefits. So that'll fall under your outpatient benefits of 250 per calendar day and then your inpatient is 18 hours or more.
[CUSTOMER][NEUTRAL] No, I just went to the emergency room.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'll have to go back and look at his um.
[CUSTOMER][NEUTRAL] Stuff and then wasn't it something for like doctor visits like.
[AGENT][NEUTRAL] Yeah, you have an office visit right or you have 4 visits per calendar year?
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Right, yeah, that's the one.
[AGENT][NEUTRAL] Per person up to $8 per policy, and it's $25 per visit and this is not a guaranteed benefits just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, well I'll try to get working on this to.
[AGENT][NEUTRAL] Uh, let me give you the policy number just for, just in case you need it. Let me know when you're ready for it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] It's 1,884,060. That's 1,884,060.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] That's good, thank you very much.
[AGENT][POSITIVE] Thanks for calling APL [PII]. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thanks, goodbye.