AccountId: 011433970860
ContactId: 49f40d21-7cba-4b2c-acf3-97aced7ce25c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 381170 ms
Total Talk Time (AGENT): 241644 ms
Total Talk Time (CUSTOMER): 111143 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/49f40d21-7cba-4b2c-acf3-97aced7ce25c_20250114T19:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, yes, my name is [PII], and I believe I am, I have coverage under you, and I had a procedure at the end of last year, um, where I had to pay a deductible and so I wanted to see if I could submit that.
[AGENT][NEUTRAL] OK, absolutely so claims can be submitted either um online in the mail or they can be faxed. Have you ever logged in online to our service center?
[CUSTOMER][NEUTRAL] No, I have not, no.
[AGENT][NEUTRAL] OK, um, so that's probably the easiest way to do it is online if you're OK with that versus like sending in the mail or faxing.
[CUSTOMER][NEUTRAL] OK and so um.
[CUSTOMER][POSITIVE] Yeah, so can you tell me how to, can you just walk me through that? That'd be great.
[AGENT][NEUTRAL] Yeah, absolutely, so the website that you're gonna go to is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] When you get to the home page on the top right hand side you are going to see an option there that says sign in.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If you click there it'll then take you to the secured login page you're gonna wanna click on I'm a new user and then I'm an individual with an APL insurance policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, you'll need to put in your last name, social, zip code and email and date of birth.
[CUSTOMER][NEUTRAL] Now this is through my work, so what I can I put my personal or does it matter or what would you have on? I need to put what's on file?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] You're gonna need to put what's on file and if you're not sure I'm happy to check on that for you.
[CUSTOMER][POSITIVE] Yeah that'd be great that would be great.
[AGENT][POSITIVE] Yeah, absolutely. Do you by chance have your policy number?
[CUSTOMER][NEUTRAL] I don't.
[AGENT][NEUTRAL] OK, so I can do a look by your name.
[CUSTOMER][NEUTRAL] I can have to give you my social too.
[AGENT][NEUTRAL] OK. If you're OK with social, that's usually easiest. Um, I can take that when you're ready.
[CUSTOMER][NEUTRAL] Uh-huh [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Alright, thank you [PII]. And then let me just verify please your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so email address we have on file looks like is a work one. It's [PII] and the zip code on here is [PII].
[CUSTOMER][NEUTRAL] It's a food for report? OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I have that yeah.
[CUSTOMER][NEGATIVE] I'm in [PII] so we're dealing with all these fires right now. It's like a nightmare.
[AGENT][POSITIVE] Oh, bless your heart. Yes, that is. I've been watching it. I'm in [PII], so, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Yeah, I've never seen anything like this. Uh, I've been here like 20 years and not seen anything comparable ever. It's really bad. Like I have friends who've lost everything. It's just so sad, so.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm.
[AGENT][NEGATIVE] Oh that is sad.
[CUSTOMER][NEUTRAL] Yeah, OK, so now I'm gonna create your account, so then I just go ahead and fill everything in.
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] And once you get in there um it's gonna have your policy type and you're gonna see my claims and then you're gonna see a green button that says upload files um and that's where you would when you click that green upload files that's where you're gonna start downloading your information for your claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So just basically be the bill right that I received I guess.
[AGENT][NEUTRAL] So I was gonna say that we yeah what you'll need for the claim itself is now the page that you're on right now is the secured login page. It opened a new a new tab. So if you go to the other tab over where you were originally um if you pan left on that to where you click sign in, there is a link there that says claims and forms. You need the claim form also, yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I remember that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you want the uh Medin claim form because that's the plan that you have. It's gonna be on the 2nd page. Everything's in alphabetical order.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so once you have the claim form, you'll need to fill that out in its entirety. You will need to submit the itemized bill, um, with diagnosis codes from your provider and then you also need to submit the explanation of benefits from your primary insurance. Uh this basically shows us what your primary paid and then what's left remaining.
[CUSTOMER][NEUTRAL] OK, so the, the bill I have currently, it just has, um, the patient payment I had to pay $400. It was like an endoscopy, colonoscopy, then they show the primary billing with the insurance paid and then it says insurance payment and then patient responsibility so I still have like another $76. So in total I would have paid out of pocket for $7644. So do you need something more in depth than that? Is that kind of what I'm hearing you say?
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] So it sounds like you have a receipt from the provider just showing what you owe, but yeah, we need something with diagnosis codes on it um for the actual procedures being done.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so I have to call and then get so it'd be more like a line item type of situation, OK.
[AGENT][POSITIVE] Yeah, and they should, they should definitely be able to provide you that no, no issue whatsoever.
[CUSTOMER][NEUTRAL] OK, and then if they said you said you need something for my primary insurance as well?
[AGENT][NEUTRAL] So your primary insurance should have um on file an explanation of benefits for that date of service uh that usually can be gathered either directly from them or if you have a portal for your primary, you usually can download them there um so yeah it it's basically just showing whoever your primary is it shows us, you know, again what they paid and what the residual remaining is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, all right, thank you so much I appreciate that so I'll go ahead and make some calls and.
[AGENT][POSITIVE] You're wel
[AGENT][POSITIVE] If you have any other questions or concerns feel free to give us a call [PII] that's what we're here for.
[CUSTOMER][POSITIVE] OK, thanks so much I appreciate it.
[AGENT][POSITIVE] You're welcome. Have a good one.
[CUSTOMER][NEUTRAL] OK bye bye.
[AGENT][NEUTRAL] OK.