AccountId: 011433970860
ContactId: 34d26d02-d890-4d03-b9cc-7ec7db7f2a2a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 282429 ms
Total Talk Time (AGENT): 104364 ms
Total Talk Time (CUSTOMER): 131099 ms
Interruptions: 1
Overall Sentiment: AGENT=1.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/34d26d02-d890-4d03-b9cc-7ec7db7f2a2a_20250505T13:50_UTC.wav
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[AGENT][POSITIVE] Hey, thank you for calling. My name is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] No, my name is [PII]. Um, I have, um, like a gap policy with you guys.
[CUSTOMER][NEUTRAL] And I'm just curious. I'm calling about my son, but I know he's, he, I, I'm not able to talk about his, so I just want a general question about our policy because we have the same one. do you want me to give you the numbers?
[AGENT][NEUTRAL] Yes, what is your policy number?
[CUSTOMER][NEUTRAL] I have a uh the group number and then in hospital benefit you want that one?
[AGENT][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] OK. 02166586 M like Mary, L like Laurie 7.
[AGENT][NEUTRAL] OK, thank you. And may I have your name and date of birth?
[CUSTOMER][NEUTRAL] Sure, [PII] [PII].
[AGENT][POSITIVE] Thank you and your callback number for disconnected please Ms. [PII].
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, and verify your mailing and email addresses, please.
[CUSTOMER][NEUTRAL] Uh, I hope you have the right mailing, but, um, my email is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And my mailing is [PII].
[AGENT][POSITIVE] OK, yes, we have that information correct. Yes, that is correct.
[CUSTOMER][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] OK, that I changed it to move fairly recently.
[AGENT][POSITIVE] OK, and that can I help you please? Thank you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK. So my question is, um, again, it's, uh, my son works with our company. I'm, I'm, I'm, it's a general question. I know you can't talk to me about his, but like, he went into the hospital over the weekend, um, for like, uh, um, he had a really, really bad stomach bug. Um, and he went to the ER.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I, so I'm just curious, is there coverage for any of that, um, with this policy?
[AGENT][NEUTRAL] Um, for your policy there is coverage for an ER visit. Your policy pays like per day max. So each day we will pay up to $1000. Um, please note verification of benefits provided does not guarantee payment, but an ER is a covered place of service. It has to be due to a sickness or an injury, and we pay up to $1000 and that's to help with your major medical deductible, co-pay or co-insurance.
[CUSTOMER][NEGATIVE] OK, so does he, so do we need to fill something out to get that because he hasn't even billed yet. He's not, you know, they brought him home that day, but like he hasn't even billed yet. So do we, um, what is it that he fills out and then like, do, I mean, because we don't, if that just doesn't automatically happen like the other stuff. I know a lot of times you guys just automatically process the other stuff because it's like, that are already billed to you, but I doubt, I don't know if this is.
[AGENT][NEUTRAL] Well, if he has not been billed, um, what he can do is provide the ER his secondary insurance information and they can bill it for him.
[AGENT][NEUTRAL] Or if
[CUSTOMER][NEUTRAL] OK, so if he didn't do that yet, he can, OK. Yeah.
[AGENT][POSITIVE] Yes, you can still do that, yes.
[AGENT][NEUTRAL] Or he can file a claim on his behalf and what he'll need, or he can file a claim on his behalf and what he'll need would be the meddling claim form.
[CUSTOMER][NEUTRAL] OK, what was the second choice?
[AGENT][NEUTRAL] Which is downloadable on the the website. He'll also need the itemized bill that has the diagnosis and procedure codes on it from the ER.
[AGENT][NEUTRAL] And his explanation of benefits from his major medical or your major medical.
[CUSTOMER][NEUTRAL] I need to do an explanation of benefits.
[AGENT][NEUTRAL] Yes, and it's very important that that itemized bill has the um please diagnosis code on it. It's very important.
[AGENT][NEUTRAL] Procedure and diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, I appreciate it. Thank you very much. That answers my question. What's the name of that form? Just, I'm just making notes here. What is the name of the form? Is it is meddling claim form? That's it.
[AGENT][POSITIVE] You, you, you're welcome, Miss [PII] and thanks for calling AP. Thank you. You have a great day.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] That is it, yes.
[CUSTOMER][NEUTRAL] There's nothing, no other like hospitalization and no other um name for that form.
[AGENT][NEUTRAL] No, it's Metlink claim form.
[CUSTOMER][POSITIVE] OK all right perfect all right thank you very much.
[AGENT][POSITIVE] You're welcome have a great day thanks for calling APL.
[CUSTOMER][NEUTRAL] You too bye. OK, bye.
[AGENT][NEUTRAL] Bye.