AccountId: 011433970860
ContactId: 4a158709-873c-472c-8abc-a1a0ee9c7a0d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 421399 ms
Total Talk Time (AGENT): 254154 ms
Total Talk Time (CUSTOMER): 144507 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/4a158709-873c-472c-8abc-a1a0ee9c7a0d_20250102T22:28_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, hi, um, good evening. I have this insurance through my employer and I actually totally forgot that I even had it and found the packet, so I wanted to see exactly what it is. I thought it was only employer employee life insurance while you're working at the company, but then the thing said something about dental and whatever, so I need somebody to tell me exactly what insurance I actually do have.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, um, do you have a policy number on that package?
[CUSTOMER][NEUTRAL] I do it's 02440127.
[AGENT][POSITIVE] Thank you. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, area code [PII].
[AGENT][POSITIVE] Thank you. And may I have your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh, thank you, Ms. [PII] and I need to verify the date of birth, mailing address, and email address.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It's um my birthday is [PII] um the home address is [PII] and the email I guess you have the company email which would be [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Mm, perfect. Thank you.
[AGENT][NEUTRAL] OK, so this one right here is the secondary supplemental plan that you have uh to help with the high deductible from your major medical.
[CUSTOMER][NEUTRAL] OK, so what does that mean exactly? So it's a supplement, but when was it effective and who's on my policy?
[CUSTOMER][NEUTRAL] And what amount does the supplement cover?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And the effective date on this policy is [PII].
[AGENT][NEUTRAL] Um, you're the only one listed on the policy. It's an individual policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me go ahead and go over the benefits. This is not a guarantee of payment, just a verification of coverage. Um, with this one, you have an inpatient benefit which is if you're in the hospital, 18 hours or more is inpatient. Um, we cover up to 3500 for inpatient.
[CUSTOMER][NEUTRAL] Alright, go ahead.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Hi
[AGENT][NEUTRAL] And that's uh for the calendar year. And then you have outpatient service. The outpatient service is for urgent care, ER is going to be for um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see. Surgery in an outpatient facility or surgery in a hospital, um, diagnostic testing in a hospital or outpatient facility, and that one covers $250 per day.
[AGENT][NEUTRAL] Um, you, you also have a physician rider which is a covered at $25 per visit, maximum of 4 visits per covered person per calendar year. This is an individual policy, so it will be just for you. And let's see, and it looks like that's all the coverage you have with this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, and then I'm this is through the company though, correct? Because I've never gotten a bill for this.
[AGENT][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] Correct, um, this is through your employer. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so this was from [PII]. So what if I, you said 250 per day for diagnostics, so I did have.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um, an MRI and I did have an X-ray, um, so the MRI was done at an MRI place out, you know, outpatient like a free standing facility, and then the X-ray was done inside of a doctor's office. So are those covered through this or?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] The X-ray may be under the physician writer which it only covers the $25 because it was in office. Um, now, the MRI is part of the outpatient benefits, which, that one will cover up to $250 per day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So all you need to do is send us the claim or if you still owe that amount, you can have the provider of service send in the claim for you and we'll pay them directly.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How do I send in a claim? Is there like a fax or?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. Um, yeah, if you're gonna send it, there is, um, 3 ways that you can send the claim. Now, there is a claim form that you can get through our website at [PII] and it's gonna be uh called the Metlink claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And then uh to submit that claim, you have again 3 options. The first one will be if you register online, which you can go to the same website, click on sign in, and it will take you to the page to register and you can send it electronically. That is the fastest and easiest way because it will come here automatically and it will be put in place to be processed, um, or you can fax it. The fax number is in the fax in the form, sorry, the, the number is in the form.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and that will take 24 hours to get to the fax, and then from there it will be imaged to the account and then it will be put in line to be processed. So it will be a couple of days before it goes to the line to be processed and then um you can mail it, which that's the.
[AGENT][NEUTRAL] Longest option if you mail it in, and the address is also on the form. Um, all claims are processed within 7 to 10 business days of the receipt day.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] So, um, with the, uh, MRI that I had, so I paid already, you know, whatever I owed, so I would be reimbursed, correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Correct, it will be a reimbursement. Um, on the claim form, you're gonna see uh the first page which has instructions of what you need to send. But for all claims, we need 3 documents that are is a must to have. Um, the first one is an itemized bill with the diagnosis code, you get that through the provider of service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The second document is the explanation of benefits from the primary insurance indicating how much they apply towards the deductible co-payment and co-insurance, and the third one is the claim form. So those 3 are a must to have a complete claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, and the to register, um, I mean to get the claim form you said it was [PII], M [PII].
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][POSITIVE] OK all right great thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today, Miss [PII]?
[CUSTOMER][POSITIVE] Yeah, that's it thanks.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Have a good afternoon.
[CUSTOMER][POSITIVE] You too take care bye.
[AGENT][POSITIVE] Thank you.