AccountId: 011433970860
ContactId: 372210f1-3372-4387-92ce-14c258355a86
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 808440 ms
Total Talk Time (AGENT): 361529 ms
Total Talk Time (CUSTOMER): 443553 ms
Interruptions: 8
Overall Sentiment: AGENT=2, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/372210f1-3372-4387-92ce-14c258355a86_20250328T12:41_UTC.wav
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[AGENT][POSITIVE] Morning thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII]. I am a, um, I have gap insurance through my employer, and I am trying to see if somebody can help me, uh, figure out how to file a claim online.
[AGENT][POSITIVE] Well, it would be my pleasure to assist you. Do you happen to have your policy number available?
[CUSTOMER][NEUTRAL] Uh, yes, it would be 02478709 ML 7.
[AGENT][POSITIVE] All right, thank you. Ms. Yay, what is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And what is your date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right, thank you. And what is your current mailing address, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you. And then finally, what is your email address?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][POSITIVE] All right, thank you. I appreciate that verification.
[AGENT][NEUTRAL] Now I do see that you have an active online account.
[AGENT][NEUTRAL] On our portal.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So, anytime that you.
[CUSTOMER][NEUTRAL] Yes, I just recently opened it up.
[AGENT][NEUTRAL] OK, thank you. And just to let you know your policy has been active since [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] In order to file a claim, there is a claim form. If you go to the form sections for Medlink.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So, um, that, that's where I'm having a difficulty. Um, so up on top of my screen, I see contact us and claim forms and help. Do I go to claim forms?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, because I just, I, I, I actually feel dumb right now, um, and then I scroll down and it it says mail paper form or fax documents I continue to go down and then there's different, um, I guess claim forms, accident claim form, authorization.
[AGENT][NEGATIVE] No, no, no.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] To disclose information, cancer claim form, change in request, continuation of COBR, um, critical illness form, dental.
[AGENT][NEUTRAL] It's on page 2.
[CUSTOMER][NEUTRAL] So it, I'm sorry, which one?
[AGENT][NEUTRAL] It's on page 2 of those list of forms.
[CUSTOMER][NEUTRAL] It's on page 2, OK.
[CUSTOMER][NEUTRAL] Hospital loss of claim, med link Medlink claim form, would that be it?
[AGENT][NEUTRAL] That's it. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, um, I guess while I have you on the line, and I don't know if it's gonna be asking me for this or not. Well, let me, let me just take a quick look and sure it.
[AGENT][NEUTRAL] Yeah, and there's instructions at the top of the page. It's a quick form, but it does, uh, give the documents needed to process a claim.
[AGENT][NEUTRAL] What's required
[CUSTOMER][NEUTRAL] OK. I mean, I, honestly, I think this is what I, uh, like I said, I felt, I knew I was gonna feel them. I didn't go to page 2. I just stayed on page one.
[AGENT][NEUTRAL] I would have done the same thing, to be honest.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] I'd be like, where is it?
[CUSTOMER][POSITIVE] [PII], you've been very helpful. I'm gonna work through this document.
[AGENT][NEUTRAL] And that's not a problem. Listen, um, and also if you want to view your policy benefits online, all you do is click on the policy number.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And your policy certificate will download and in the certificate there's a page called the Schedule of benefits page, and you can see exactly what's covered on your policy, and there's no claims on file, so if you had something last year after [PII], be sure to file for that as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's exactly what I'm trying to do. I, I had an incident, um, specifically [PII], and that's what I'm trying to file a claim for.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Oh, good. I mean, not good.
[AGENT][NEUTRAL] I didn't mean good. I meant good. It, it, it was after your policy was effective. I'm sorry.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And
[CUSTOMER][NEGATIVE] I didn't, I honestly didn't even know I had gap insurance until I fill until I did my taxes this year and I see additional insurance gap and I said, wait, what do you, what, what does this mean gap? I go into my, yes, and I'm like I've been paying for gap this entire time and I, and, and I didn't even realize it.
[AGENT][NEUTRAL] What is that? Right.
[AGENT][NEUTRAL] Well, so always show your APL card with your primary insurance card when you go for medical attention outside of a doctor's office. Services are not covered in a doctor's office, but if you go for, say, um, urgent care.
[CUSTOMER][NEUTRAL] So, here we are.
[AGENT][NEUTRAL] If you go to the emergency room, outpatient surgery, physical therapy, anything that's covered, always show your APL card with your primary card, and then the providers can file the claims for you and we can pay them direct.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][POSITIVE] OK, sounds good. Thank you so much. That is very helpful.
[AGENT][NEUTRAL] And then one other quick tidbit if there's an option for direct deposit, you know, the mail's a little wonky right now.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] So for payment.
[CUSTOMER][POSITIVE] Yes, I've actually filled that out while waiting to get serviced by you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, good.
[CUSTOMER][POSITIVE] But thank you for pointing that out, but yes, I, I got ahead on that one.
[AGENT][NEUTRAL] It just takes.
[AGENT][POSITIVE] Good deal. See you, see you're doing good. Most people don't see that.
[CUSTOMER][NEUTRAL] I'm doing, I'm, I'm, I'm not that dumb. I'm not, I'm, I'm not that slow. It's, it's Friday, the body knows it. It's been a long week.
[AGENT][NEGATIVE] You're not at all.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] For sure.
[AGENT][POSITIVE] But listen, if you need anything along the way, Ms. [PII], never hesitate to give us a call. We're here for you.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. You have been very helpful, like I mentioned. I hope you have a great Friday and a great weekend.
[AGENT][POSITIVE] Oh, I hope the same for you, Ms. Yay, and again, don't ever hesitate to give us a call. Oh, and make sure that we get the diagnosis code on one of those documents. That's, we can't process a claim without that.
[CUSTOMER][NEUTRAL] No, well, I, if, if there's, uh, this is my first time doing something like this, if I'm missing any documentation or uh any specificity on the documentation that I submit, will I get a phone call so that I could to give me the opportunity before the claim gets denied?
[AGENT][NEUTRAL] No, ma'am. We, um, you would get a letter in the mail called an EOB from us that will, in detail, explain what is missing. Let me ask you, so it might be easier for you. What type of service was it? Was it inpatient hospital, emergency room, urgent care, outpatient surgery?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have to go, I had to go into the emergency room. I went into preterm labor. Um, they're not considering it a, a, an inpatient, like they, they're not considering it as a hospitalization because I was there under 24 hours. But it was the diagnosis that I went into preterm labor at 16 weeks, so I gave birth to a stillborn.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh, I am so sorry.
[AGENT][NEUTRAL] It just breaks my heart. Sorry. So, let me tell you a form to request from the hospital and make it a lot easier and all the information will be there.
[CUSTOMER][POSITIVE] Thank you. Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The form is called a U as in umbrella, B as in Bravo, 04. So just call the hospital billing department and request that you be 04 for that data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And let me ask you, maybe you, you know this, maybe not. As a part of my expenses.
[CUSTOMER][NEUTRAL] Um, because I was in labor, my doctor was called out, and um, this happened overnight, in the middle of the night. So he, he came to the emergency room and helped me deliver. I was also charged for that. Um.
[CUSTOMER][NEUTRAL] But um I was charged by him by my OB's office. Would that be something that I also submit or is, or would it not qualify because it is more of an inpatient doctor office?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now, um, so that could qualify now your benefit amount that we can pay per calendar day for outpatient services is $300. Now that's a verification coverage on your policy, not a guarantee of payment simply means we can't process the claim over the phone, but um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Understood.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So that hospital, do you know what your primary insurance applied to your deductible for the hospital for the emergency room?
[CUSTOMER][NEUTRAL] For the emergency room, it paid it paid mostly everything with the exception of that $337 charged by the doctor and my $500 co-pay for the emergency room.
[AGENT][NEUTRAL] OK. So if you submit that UBO4 from the hospital, if there was a $500 co-pay, that's probably gonna max out that benefit for that day.
[AGENT][NEUTRAL] Because we can only pay up to $300.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But it, yes, if you have benefits, you could file for the doctor's fees as well.
[CUSTOMER][NEUTRAL] OK. And so, uh.
[CUSTOMER][NEGATIVE] OK. Um, and then I guess, cause I'm hearing it's up to a $300 per day. I am newly pregnant and I'm about to pop. Um, so now I'm gonna be hospitalized. Thank you.
[AGENT][POSITIVE] Well, congratulations on that.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] I it, it was a quick boom boom. I can't, I, I'm, listen, I'm [PII]. I didn't, I, I, I, I could, I was grieving. I'm still going through it, and I also recognize my age. I need to get moving. So, um, I got pregnant again and I'm being induced at the end of this month, um, which means more than likely I'll be hospitalized for a couple of days.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um, so with regards to the pregnancy and what it relates to deductibles, what the insurance covers or doesn't cover, does that also max out at 300?
[AGENT][NEUTRAL] That benefit amount for your inpatient services is $3000.
[CUSTOMER][NEUTRAL] I see. OK, so it changes when it's in when it's inpatient, OK.
[AGENT][POSITIVE] That's right.
[CUSTOMER][POSITIVE] OK, that is helpful to know. Thank you so much.
[AGENT][NEUTRAL] So be sure, be sure to give them your APL card.
[AGENT][NEUTRAL] To the hospital.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] When it's time, make sure that they have your APL policy on file.
[CUSTOMER][NEUTRAL] Yes, what I'm gonna do is my, in my new, um, our open enrollment, uh, the new year starts [PII]. I go to my doctor's office. I'm actually going to ask them to update all my insurance information, and then moving forward, now that I know that I have this benefits, I will begin to put this as a secondary insurance.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That's right. That's right. I'm so excited for you.
[CUSTOMER][POSITIVE] Thank you. Thank you. I'm excited and scared at the same time, so I'm just trying to like clean house and, you know, just do uh uh uh kind of start brand new and, and I'm trying to, yeah, close close out the last chapter, open up a new one, hopefully clean slate and, and I'm, I'm just trying to figure stuff out and that's why I'm, I'm here on something that happened last year.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Get everything ready, right? Keep busy.
[AGENT][POSITIVE] Oh, absolutely. Well, I'm glad that you realized you had this policy because it is a valuable policy.
[AGENT][POSITIVE] It does help.
[CUSTOMER][NEUTRAL] Yes, I see that.
[AGENT][NEUTRAL] And
[CUSTOMER][POSITIVE] So, thank you very much.
[AGENT][POSITIVE] My pleasure. And I'm sorry, I didn't mean to keep you, but I just wanted you to be aware.
[CUSTOMER][NEUTRAL] No, you're fine. You're fine. I was feeling the same way on my. She doesn't want to hear my boring story. I mean, it's, it's, it's medical stuff.
[AGENT][NEUTRAL] And the
[AGENT][POSITIVE] No, I'm here for you.
[AGENT][NEUTRAL] You know, if it's, if it's 15 minute call or 30 minutes, I'm here for you, so.
[AGENT][POSITIVE] That's why I love working with this company. They give us time to take care of our clients, so.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Nothing rush, we just want to get to be taken care of.
[CUSTOMER][POSITIVE] Thank you so much. So I am gonna wish you a great rest of your day and um if I have any further questions, I will give a call back.
[AGENT][POSITIVE] My pleasure.
[AGENT][NEUTRAL] You too.
[AGENT][POSITIVE] It's been my pleasure, and I know everything's gonna go well for you. It's gonna be fine.
[CUSTOMER][POSITIVE] Thank you. I hope so. I'm, I'm hoping for that.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am, and call us if you need it, OK?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Sounds good. Be well.
[AGENT][POSITIVE] Thank you, Ms. [PII]. You too, and have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] But it's