AccountId: 011433970860
ContactId: 437e1e41-7005-4a58-a8af-962b40e15938
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 406010 ms
Total Talk Time (AGENT): 197152 ms
Total Talk Time (CUSTOMER): 149825 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/437e1e41-7005-4a58-a8af-962b40e15938_20250110T21:52_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Hi, um, I have coverage to my, to my employers for, uh, gap insurance, and I, uh, last month I, I went to the emergency room and I have a kind of a deductible or co-pay of like $300 which I understand is covered by my gap insurance. How do I go about like
[CUSTOMER][NEUTRAL] Getting that reimbursed or actually paid.
[AGENT][NEUTRAL] OK sir um I can help you with filing a claim can you uh please give me your name and your callback number just in case our call is disconnected.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] And the number is [PII].
[AGENT][NEUTRAL] OK, thank you for giving me that information and what is your policy number, [PII]?
[CUSTOMER][NEGATIVE] I do not know. I don't think I got a new card in now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, well, give me a second. Let, let, let, let me look at my wallet. I might have an old one and I don't think the policy number would have changed.
[AGENT][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] Right. OK.
[CUSTOMER][NEUTRAL] Let's see
[CUSTOMER][NEUTRAL] That's not it.
[CUSTOMER][NEUTRAL] OK, no, I don't have a card.
[AGENT][NEUTRAL] OK that's fine I can look it up if you would like to give me your social security number it'll pull in that way for us.
[CUSTOMER][NEUTRAL] Yeah, that's fine. It's uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, sir. Let me look it up real quick.
[CUSTOMER][POSITIVE] Good
[AGENT][NEUTRAL] OK, [PII], I have you pulled up. I'll need for you to verify your policy for me for security reasons can you please give me your date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you. And then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Oh, I don't know if you, if you should have my new address. It's uh [PII].
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] And then the phone number that you gave me to call you back on if we get disconnected, is that your cell phone number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is
[AGENT][NEUTRAL] OK, and then also, I'll need for you to verify your email address, sir.
[CUSTOMER][NEUTRAL] Uh, it could be one of three, but let's try it's [PII] or [PII].
[AGENT][NEUTRAL] I've got [PII].
[CUSTOMER][NEUTRAL] Is it one of those?
[CUSTOMER][NEUTRAL] OK, so [PII].
[AGENT][NEUTRAL] OK, thank you. I appreciate you verifying your policy for me. OK, so you want to file a claim because you went to the ER and you need to be reimbursed for your money that you spent on your deductible, is that correct?
[CUSTOMER][NEUTRAL] That's trucks.
[AGENT][NEUTRAL] OK, so, uh, the way that it works is, first there's 3 things you're going to need. You're going to need the explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You'll need the itemized statement from the ER that has the procedure codes. OK, good. has procedure codes and diagnosis codes.
[CUSTOMER][NEUTRAL] Which I have.
[CUSTOMER][NEUTRAL] 00 wait, the the the.
[CUSTOMER][NEUTRAL] Uh, no, there are no codes. It just says diagnostic X-ray, EKG, ECG, emergency room lab.
[AGENT][NEUTRAL] OK, so you may want to ask them for a detailed itemized statement.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, detail with codes.
[AGENT][NEUTRAL] And then you'll need to.
[AGENT][NEUTRAL] Yes, with procedure and diagnosis codes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you'll need to um send in the claim form. The claim form is available to you at our website. Let me give you that website.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright and let me know when you're ready.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Like [PII].
[CUSTOMER][NEUTRAL] Yep, OK, claims and forms.
[AGENT][NEUTRAL] OK, when you, yes, go to the 2nd page and on page 2 of claims and forms it's a 2nd 1 down it's medlink.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I'm on claims and forms. I see other ways to submit your claim. Second one.
[AGENT][NEUTRAL] Yeah, you'll need to go to page 2.
[CUSTOMER][NEUTRAL] Oh, paper too, yep, OK, I see med link claim form, see it. OK, download.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, also on that claim form at the very top it also tells you what you need to send in in case you get stuck at any time you need to refer back to it.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] Great.
[AGENT][NEUTRAL] OK, and then if you sign up for the, if you sign up for the online service center you can file your claim online.
[CUSTOMER][NEUTRAL] OK, so once I, yep.
[AGENT][NEUTRAL] And let me give you that website.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] It's it's secured.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, [PII] probably.
[CUSTOMER][NEUTRAL] Uh, it says can't be found.
[AGENT][NEUTRAL] OK, it's [PII]
[AGENT][NEUTRAL] [PII]. Yeah.
[CUSTOMER][NEUTRAL] Oh, sure.
[AGENT][NEUTRAL] Secured. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] OK good and then um if you choose not to do it that way you can fax it in or you can mail it in. Would you like the fax number and the mailing address?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I, I, I'll do it online.
[AGENT][POSITIVE] OK, alright, good deal.
[AGENT][NEUTRAL] All right, Mr. [PII], is there anything else that I can help you with before we go?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] No, that's all. Thank you.
[AGENT][POSITIVE] You're welcome you have a good weekend and thank you for calling APL.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye-bye, sir.