AccountId: 011433970860
ContactId: 4ff5287f-785e-4be1-a6e0-f2008063a7c1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 448899 ms
Total Talk Time (AGENT): 211453 ms
Total Talk Time (CUSTOMER): 176880 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/4ff5287f-785e-4be1-a6e0-f2008063a7c1_20250416T19:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Hi, [PII], this is [PII] and I don't think I have a bad one today.
[AGENT][POSITIVE] Yay!
[CUSTOMER][POSITIVE] Yeah, I know, right? You answered. I went, oh [PII], and I went, oh no, he's real nice. Every everything, he's just, he just, he just got his online service center set up, wants to know how to do claims and he's got stuff he never filed. He didn't know he could.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And can you help with that? Is that a claims thing? I don't even know who to send anything to anymore.
[AGENT][NEUTRAL] No, that's me. That's me. I can help him file a claim.
[CUSTOMER][POSITIVE] Oh bless you.
[CUSTOMER][POSITIVE] OK, he's very nice. Um, the policy is 246.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 5411.
[AGENT][NEUTRAL] OK. 246-541-1.
[CUSTOMER][NEUTRAL] We have verified his information and updated his address.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The number he is calling from is the number we have on file and I can still give that to you.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] I got it. [PII].
[CUSTOMER][NEUTRAL] Yes ma'am, and he's that's what we have for him in the system.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, alrighty, you can go ahead and put him through, [PII]. I am.
[CUSTOMER][NEUTRAL] Are you ready?
[CUSTOMER][POSITIVE] OK, thank you, dear. Thank you. Bye.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Hi, [PII], this is [PII]. I'm in the care team. So I understand you need a little bit of help filing a claim.
[CUSTOMER][POSITIVE] Uh, yes, I just wanna know how to do it exactly.
[AGENT][NEUTRAL] OK, alright, um, we have several different ways to do it, but the best way to do it is through our online service center. uh have you signed up for that yet?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I just, uh, signed into my online accounts for the first time, um, so that's where I'm at.
[AGENT][NEUTRAL] OK, good. OK, so um when you go into the online service center to file a claim, you're gonna click on your policy which is the Medlink policy, and then you're gonna choose claims and forms.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hi
[AGENT][NEUTRAL] And when you, when you choose the claims and forms, you're gonna fill out the Medlink claim form and then you'll need to attach your explanation of benefits and your itemized statement from the date of service that you're filing the claim on. The explanation of benefits comes from your primary insurance carrier and the itemized statement will come from the facility that you went to to have your.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Data service done.
[CUSTOMER][NEUTRAL] Oh, that it has to come from both?
[AGENT][NEUTRAL] So I'll
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, one comes from the insurance company and the other one comes from the doctor's office, clinic, hospital, wherever you went to, um.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] To be seen.
[CUSTOMER][POSITIVE] Well that's gonna be fun tracking down so and what about receipts?
[AGENT][NEGATIVE] Receipts don't work. We'll have to have those two things, the explanation of benefits because that shows what your primary insurance paid on their part of the claim, and then the itemized statement shows your diagnosis codes and procedure codes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it doesn't matter like I'm doing this for past claims I've already paid out of uh some out of pocket for, so it doesn't matter what the amount I've paid that you just need the explanation of benefits and the itemized statement from the provider.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Let's see what you said go to. I didn't I go to the right place. It's not letting me click on my policy when I'm uh.
[CUSTOMER][NEUTRAL] Online, let's see, policy contact information.
[CUSTOMER][NEUTRAL] Maybe it's there.
[CUSTOMER][NEUTRAL] Uh, that's not it.
[CUSTOMER][NEUTRAL] Because when I'm on the home page, it, it says my coverage Medley group medical supplier or whatever the S SUP is for that's not clickable but the policy number is clickable but that's just a download for I guess probably the policy. I don't have anything that's clickable.
[AGENT][NEUTRAL] It should say claims and forms.
[CUSTOMER][NEUTRAL] Uh, let's see at the top there's a one that says claim claim forms.
[AGENT][POSITIVE] Yes, click on that please.
[AGENT][NEUTRAL] And you should see
[CUSTOMER][NEUTRAL] It takes me to another.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Separate page.
[AGENT][NEUTRAL] Yes, and you'll choose the.
[CUSTOMER][NEUTRAL] Claim and
[AGENT][NEUTRAL] Yes, sir. You would choose the Medlink M E D L I N K claim form.
[AGENT][NEUTRAL] That's the form you'll need to download.
[CUSTOMER][NEUTRAL] Let me just make
[AGENT][NEUTRAL] And then your other information, once you get it um and it's downloaded in your computer then you just upload everything into the claim.
[AGENT][NEUTRAL] Into the online service center.
[AGENT][NEUTRAL] And then submit your claim.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh, I am not finding the med link one that you had said.
[AGENT][NEUTRAL] OK, um, let me look and see if I can tell you what page it is on.
[AGENT][NEUTRAL] OK, when you're in the claims and forms, if you kind of scroll to the bottom you'll see page 12, and 3, you're gonna click on page 2.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then the Medlink claim form is going to be the 3rd 1 down.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Yes ma'am, I looked right over it as per usual.
[AGENT][POSITIVE] That's OK, it's easy to do.
[CUSTOMER][NEUTRAL] Alright, so I'll just.
[CUSTOMER][NEUTRAL] Fill it out and then I I submit this form and the EOB and the itemized receipt to the uh to the main page where it says upload files.
[AGENT][NEUTRAL] Yes sir.
[AGENT][POSITIVE] Yes, sir, that's correct.
[CUSTOMER][POSITIVE] OK perfect I can do that.
[AGENT][POSITIVE] OK. And if you find yourself getting stuck or you need further help while you're in the process of doing it, just call us and we'll help you, OK?
[CUSTOMER][POSITIVE] Absolutely I do appreciate it.
[AGENT][POSITIVE] You're very welcome, Mr. [PII]. Is there anything else I can help you with or any other questions you may have?
[CUSTOMER][NEUTRAL] So how would it work once I submit everything and stuff that I've already paid for? Would I just get reimbursed for it?
[AGENT][NEUTRAL] Right, um, they would send the check to you rather than the facility that you went to because you're the one filing the claim.
[CUSTOMER][POSITIVE] OK perfect just wanted to make sure OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Any other questions you may have, Mr. [PII]?
[CUSTOMER][POSITIVE] No ma'am, that is it. I appreciate it.
[AGENT][POSITIVE] Well, you're very welcome. I hope you have a wonderful [PII] and we thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you you as well.
[AGENT][POSITIVE] Thank you sir bye bye.
[CUSTOMER][NEUTRAL] Bye bye.