AccountId: 011433970860
ContactId: 394dc8cd-b24d-493c-9639-c4d84659b723
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 244979 ms
Total Talk Time (AGENT): 135829 ms
Total Talk Time (CUSTOMER): 99637 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/394dc8cd-b24d-493c-9639-c4d84659b723_20250612T17:52_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi. So, yes, um, I have a question. Um, can I still submit a claim if, um, I have a receipt that I paid um out of my pocket? Um, I don't think it went through my, my health insurance.
[CUSTOMER][NEUTRAL] Um, and I just, I would have a receipt from my, from my, from my, um, healthcare provider.
[AGENT][NEUTRAL] Mm, I can check and see what type of policy you have and what are the instructions to submit claims, and I can go ahead and give you those. Um, may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, my name is [PII]. My callback number is [PII].
[AGENT][NEUTRAL] Mm, OK. And do you have the policy number on it?
[CUSTOMER][NEUTRAL] Yes, I do, uh, inpatient or outpatient?
[AGENT][NEUTRAL] You are.
[CUSTOMER][NEUTRAL] OK, 02476599 ML 7.
[AGENT][NEUTRAL] OK, thank you. For security, may I have your date of birth, mailing address and email address on file?
[CUSTOMER][NEUTRAL] Sure. It's [PII]. Mailing address is [PII]. Email address is [PII].
[AGENT][POSITIVE] OK, thank you. All right, thank you. And
[AGENT][NEUTRAL] OK, so you have one of our secondary supplemental plans. Um, with this one you can submit a claim yourself for reimbursement if we have not received a claim from the provider. Um, you're gonna need a little bit more than just the receipt. Um, for this one you need 3 documents. Uh, the first document is our claim form and you can find the claim form in our website at [PII].
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Again, that's [PII]. You will go on claims and forms and you will select the Metin claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The first page is gonna give you instruction on what's needed to be submitted with the form which is uh two documents. The first one is the itemized bill with the diagnosis code. You will get that from the provider of service.
[AGENT][NEUTRAL] And the second document is the copy of the explanation of benefits from the primary insurance indicating the amount applied towards the deductible co-payment or co-insurance.
[CUSTOMER][NEUTRAL] OK, so, um, the second page you said that, uh, I'm gonna need that from my insurance.
[AGENT][NEUTRAL] Yes, from your primary insurance.
[CUSTOMER][NEGATIVE] Now if I didn't submit it, they won't have anything.
[AGENT][NEUTRAL] If they don't pay, we don't pay we're secondary we follow primary.
[CUSTOMER][NEUTRAL] OK, so, so I have to go through them first.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so I'll do that. I'll, I'll go them first and then I'll submit it and then uh once I go through them, they would submit um explanation of benefits and then um then I can submit that to you.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Correct. Once they send you the copy of the explanation of benefits showing where they apply those, uh, benefits, if they applied it towards the deductible co-payment and coinsurance, then that's what we're gonna take place and process because that's what we help with. We help with the deductibles co-payment and coinsurance, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct, correct.
[CUSTOMER][POSITIVE] OK, great. OK, thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're welcome and you can submit that through uh the website if you want to register or you can send it by fax or mail. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Isn't it?
[CUSTOMER][POSITIVE] No, you've been very helpful. Thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling APO. Have a good afternoon.
[CUSTOMER][NEUTRAL] You do the same thing.
[AGENT][POSITIVE] Thank you. You're welcome. Bye bye.