AccountId: 011433970860
ContactId: 59cfc5e6-4387-4bf2-bccd-3cb80804c89b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 719140 ms
Total Talk Time (AGENT): 288943 ms
Total Talk Time (CUSTOMER): 246521 ms
Interruptions: 2
Overall Sentiment: AGENT=1.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/59cfc5e6-4387-4bf2-bccd-3cb80804c89b_20250106T17:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, my name is [PII], and I'm just calling because I have a couple of um claims to make. Um, I'm calling through Food for the Poor, which is, um, the organization we are associated with. Do you, can I ask for it to be emailed to me or how do I go about getting a form?
[AGENT][NEUTRAL] OK, so you just need assistance in filing claims, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, OK, I can definitely have a form sent to you. Um, let's get your the policy pulled up and see what kind it is, and we go from there. Really quick, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] OK. It's [PII].
[AGENT][NEUTRAL] OK, thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Um, it says group number here.
[CUSTOMER][NEUTRAL] Let me see if there's a policy. I only have a group number which is 24141.
[AGENT][NEUTRAL] OK, is this for your policy, [PII] through this group?
[CUSTOMER][NEUTRAL] Yes, uh-huh.
[AGENT][NEUTRAL] OK, OK, what's your last name please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII], OK, give me just a moment, let me try to find you this way.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] There we are. Food for the Poor incorporated.
[AGENT][NEUTRAL] see
[AGENT][NEUTRAL] OK, do you believe I found you, um, let, if I just gonna verify some information really quick, can I get your date of birth please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you and then uh can I get your mailing address please?
[CUSTOMER][NEUTRAL] It's [PII], and that's [PII].
[AGENT][POSITIVE] Perfect. The last thing I need is the email address we've got on file for you looks like it is through your organization.
[CUSTOMER][NEUTRAL] OK. It's [PII].
[AGENT][NEUTRAL] Uh, the email we've got is different. It looks like it might be actually through your organization.
[CUSTOMER][NEUTRAL] Oh, it's [PII]. We have the older one, which is [PII].
[AGENT][NEUTRAL] That's it.
[AGENT][NEUTRAL] OK, yes, it it's the [PII]. Does that need to be changed or is that OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's OK. The [PII]. [PII] is the new one. Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Gotcha. OK. All right. So this is a secondary medical policy, that's called Medlik. Bear with me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so you've got a couple of different options for filing claims, Monique. I will say, uh, generally the quickest and easiest way to get claim information to us is going to be through our online portal. Do you have access to a desktop or a laptop computer?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, I do.
[AGENT][NEUTRAL] OK, the reason I ask is our website doesn't have support for mobile devices, so it would have to be on an actual computer um let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] So from there um I can give you that web address you would create an account using all of that information that we just verified including that same email it does have to match what we have in our system and then there will be a spot there where you can upload documents and all the claim forms will be there as well. It gets to us very quick, so it'll just be that much faster process for you.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. So, uh, is it ww.
[CUSTOMER][NEUTRAL] Is it APL or?
[AGENT][NEUTRAL] No, let me know when you're ready for it, um.
[CUSTOMER][POSITIVE] OK. All right. I'm ready.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it's the word [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Dot
[AGENT][NEUTRAL] AM public.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I can see from here there's a login option.
[AGENT][NEUTRAL] So if you've uh not created an account before you would just go to uh create a new account it would be the top option that says an individual.
[CUSTOMER][NEUTRAL] Our new user.
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] I'm an individual, OK, and then go on.
[CUSTOMER][NEUTRAL] Um, to do the last name and all that good jazz.
[AGENT][NEUTRAL] Mhm and when there's gonna be a spot that asks.
[CUSTOMER][NEUTRAL] And the number I've used would be on the card. Uh-huh, sorry.
[AGENT][NEUTRAL] Sorry, no, that's OK um I think we're talking about the same thing where it asks for a member ID or a social security number, go ahead and put in your social security number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] and use the company email on file.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And create a username.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Almost there.
[CUSTOMER][NEUTRAL] Alright, so it's submitting, just waiting for it to be created.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] And if you ever forget your username, uh, you can always give us a call we'll be able to uh recover that for you easily.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So I'm in, so right where it says my claims, wait, it's asking me to verify.
[CUSTOMER][NEUTRAL] Next text message notification.
[CUSTOMER][NEUTRAL] If I I one text message, I could just do that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 5431 9.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] That that's my number. Let's put that verification in.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, alright, so my claims upload documents. OK, so I can do the claims from here.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Absolutely, um, and I'm not sure if you've been told already but I can go ahead and let you know the required information that we do need for claims.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so for this kind of policy, we would need the itemized statements that shows diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then we would need the explanation of benefits from your primary insurance, essentially showing what they did pay or that they did contribute and you can get all of that information from the provider you went to for treatment.
[AGENT][NEUTRAL] They will have all of that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so they can give me both, both um documents, OK.
[AGENT][POSITIVE] Absolutely, absolutely.
[AGENT][NEUTRAL] And then the claim form you would find one this policy is called Medin.
[AGENT][NEUTRAL] And so you would find that claim form that shows that if you can't I'll go ahead and email you um a copy of the form so you've got it I know uh some people have a bit of difficulty locating claim forms on the website I think it went through some changes lately um would you like me to go ahead and email that to you just for good measure?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Yes, please, at least I'll, I'll have something to refer to if I'm on the correct document because I do see Medin here and it's check marked with a number, but um yeah, it's better so I know I'm on the right track.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] Absolutely, um,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Of course. OK, did you want me to send it to the um the at [PII] email or did you?
[CUSTOMER][POSITIVE] You can send, yeah, the food for the more uh food for the poor email, yes, thank you.
[AGENT][NEUTRAL] OK, OK, perfect, yes, I will get that sent to you. Um, if you have any questions at all feel free to give us a call back. Um, it can be a bit confusing generally though, again, those get to us very quick. It can still take about 7 to 10 business days for claim information to process. You should be able to see the status through the website, but again if it's not quite sure you understand or anything like that, feel free to give us a call. Did you have any other questions for me at the moment?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I just wanted to know because I did get an EOB in the mail from UMR which is the insurance that covers us. Um, can I also attach a copy of that or do I request separately one from my doctor's office, or is that fine?
[AGENT][NEUTRAL] Oh yeah.
[AGENT][POSITIVE] Oh that's fine as long as you've got that um for as long as it's the same treatment it's yeah that's perfectly fine as long as it shows what they contributed to that so yeah that's perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm, mhm. OK. And that also has the details of like the surgery and all that, so, but I still would have to get that itemized bill from the doctor's office in addition.
[AGENT][POSITIVE] Correct, um, the itemized bill.
[CUSTOMER][NEUTRAL] If, if, if this one has it, mhm.
[AGENT][POSITIVE] Mhm the itemized bill that shows those diagnosis and procedure codes we absolutely do need that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right. I'll do that. Thank you.
[AGENT][POSITIVE] Yeah, of course. Was there anything else I can help you with?
[CUSTOMER][POSITIVE] All right, that will be all you're so helpful and you have a great day.
[AGENT][POSITIVE] All right. Well, happy to help. Absolutely, you too. Thank you, [PII]. Thank you. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. OK, you're welcome. Bye. Uh-huh.