AccountId: 011433970860
ContactId: 4bcccd82-daf5-4b66-a378-e51c94ec2dc4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 450670 ms
Total Talk Time (AGENT): 197453 ms
Total Talk Time (CUSTOMER): 193347 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/4bcccd82-daf5-4b66-a378-e51c94ec2dc4_20250206T19:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII]. Uh, my name is [PII], and I'm calling because I need um to file a claim, but I was gonna ask you about my insurance.
[CUSTOMER][NEUTRAL] I need to file a claim because I was in, I was in the emergency room and all, and that was in, uh, let's see, in November and then in December, I had surgery of my thyroid, which I don't know if they will cover.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I was in the hospital one day.
[CUSTOMER][NEUTRAL] Uh, but I don't know if they consider it, uh, impatient because I was there for recovery.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Um, let me look at your plan. Do you have your policy number?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes, uh, well, there's two numbers. One is in the hospital, which is 02473403 ML 7.
[CUSTOMER][NEUTRAL] And the outpatient is the same number but with an 8 at the at the end.
[AGENT][NEUTRAL] OK. And if I could just verify your first, last name, date of birth, please?
[CUSTOMER][NEUTRAL] [PII]. My name is [PII].
[AGENT][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] And my data, what else do you need? OK.
[AGENT][NEUTRAL] Um, and then just if you could verify the address we should have on file for you just sell it.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you so much. OK.
[AGENT][NEUTRAL] Um, usually, inpatient is defined as being in the hospital for at least 18 hours or longer. So, anything that you've had done, um, if you were in the hospital for at least 18 consecutive hours, the plan would pay towards that um from your inpatient benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so what do I have to submit? I have to upload the files here says, do you have documents to upload for a claim?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What, what do I have to upload there?
[AGENT][NEUTRAL] So the first thing that you're gonna need, which I can either send to you via email or you can get from our site, um, you have a you have a Medlink plan so you need the medlink claim form.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you can get that from our website under the claims and forms.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, let's see. They have several. Do I do the hospital or the Meli? Oh Meli. OK, Meli.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] It doesn't show it doesn't let's see, OK, my link claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You should be able to uh download the form and then uh print it out if you need to or fill it out.
[CUSTOMER][NEUTRAL] Yeah, but they have so many, they have.
[CUSTOMER][NEUTRAL] Um, do you know the name of it, specifically, the name of the form?
[AGENT][NEUTRAL] It's the Medlink claim form. It's gonna be on page 2.
[CUSTOMER][NEUTRAL] 20.
[AGENT][NEUTRAL] Yeah, all the forms should be in alphabetical order.
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][POSITIVE] OK, here it is OK perfect mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, um, page one is complete instructions as far as.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] What to do.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] As far as what you'll need to fill out with the claim, you need the explanation of benefits from the primary insurance carrier.
[AGENT][NEUTRAL] We need to be able to see what exactly was paid um from your primary.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You'll need an
[CUSTOMER][NEUTRAL] Oh, so the EOB, right? The EOB?
[AGENT][NEUTRAL] Mhm. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then you need an itemized bill with diagnosis codes from the provider.
[CUSTOMER][NEUTRAL] Diagnosis code, OK.
[AGENT][NEUTRAL] Um, and then you'll just need to have that form completely filled out and submitted with all the documentation.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Let me see if I could get the bill and that's the thing. I don't know, like, I know for the emergency room, it will be the outpatient. But for the surgery, I don't know.
[CUSTOMER][NEUTRAL] Um, if it's in, in the hospital or outpatient. Because like I said, the hours.
[CUSTOMER][NEUTRAL] Um, I don't remember if it was 12 or 18 hours that I, well, actually, I had surgery and I stayed over a night.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, I mean, your plan has outpatient and inpatient benefits both, so you should be able, whether or not it was inpatient or outpatient, you should still be able to submit it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So where it says APL policy, I I put both numbers?
[AGENT][NEUTRAL] You can put either one it honestly doesn't matter because it pulls your benefits for inpatient and outpatient both so it's all under the same plan.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. And how would I get the funds?
[CUSTOMER][NEUTRAL] When the, the, the claim is processed.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Once the claim is processed, it, it would be sent to you, um, a paper check. If you want, you can online there is direct deposit that you can sign up for if you want the direct deposit um option, the claims to be paid that way.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] OK. I see it. I found it. OK, perfect.
[AGENT][NEUTRAL] All right, is there anything else that I can help you with here today?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How long do I have to submit after?
[CUSTOMER][NEUTRAL] Uh, it happened. How long do they give me to submit?
[AGENT][NEUTRAL] Oh yeah, there's no time frame so you can submit when you know uh whenever you have everything together.
[CUSTOMER][NEUTRAL] Oh perfect. Yeah, because I don't, I have to get the EOB and then I have to get the itemized bill.
[AGENT][NEUTRAL] Yeah absolutely so yeah once you have it all together then you can submit it. There's no sort of like time frame it has to be submitted by.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect. Thank you so much. I really appreciate it.
[AGENT][POSITIVE] Yeah, you're welcome. You have a good rest of your day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] I