AccountId: 011433970860
ContactId: 5ca74efb-d334-49fa-ba9a-8f17a5e31721
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 844799 ms
Total Talk Time (AGENT): 430615 ms
Total Talk Time (CUSTOMER): 375519 ms
Interruptions: 8
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/5ca74efb-d334-49fa-ba9a-8f17a5e31721_20250213T21:12_UTC.wav
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[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII]. Um, my name is [PII] is my husband. He works at Morgan's and he has APL.
[CUSTOMER][NEUTRAL] And I called about 10 or 15 minutes early and I was speaking to a young lady and I told her that um
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] You know, they changed insurance to Allon, but evidently the old insurance I'm looking at the EOB statements their last day that they um.
[CUSTOMER][NEUTRAL] Uh, from January, uh, the last day that they, um, serviced his policy was on the [PII], United Healthcare.
[CUSTOMER][NEUTRAL] And um he's got something from Quest lab work.
[CUSTOMER][NEUTRAL] Um, so
[CUSTOMER][NEGATIVE] I needed to know where I need to send this because evidently Quest isn't sending they're sending me a paper statement, but I went on UnitedHealthcare and I printed the EOBs.
[AGENT][NEUTRAL] OK, Ms. [PII], so you're calling on behalf of your husband. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, you can, uh, I have the form, um, signed. You need the account number, baby?
[AGENT][NEUTRAL] Uh, first off, let's, um,
[AGENT][NEUTRAL] OK, so you're trying to find out about where to submit a claim for your husband, is that correct?
[CUSTOMER][NEGATIVE] No, what happened was he's with, he's with Allied now. They told us it started on the [PII], it didn't start on the [PII], it started on the [PII]. Um, and we have some claims left over from United Healthcare for Quest Diagnostics, that evidently Quest didn't send to y'all. They're sending them to us. I don't know why, but, uh, the young lady I was talking to said that I need to send y'all the explanation of benefits that showed the deductible and everything else.
[AGENT][NEUTRAL] OK, Ms. [PII]. So what is your last, I can help you. What is your last name, please?
[CUSTOMER][NEUTRAL] [PII], [PII]
[AGENT][NEUTRAL] Thank you. And what is the
[CUSTOMER][NEUTRAL] My husband's name is [PII].
[AGENT][POSITIVE] OK, thank you. And then what is a good callback number for you please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and the policy number, please?
[CUSTOMER][NEUTRAL] Let see, let's see, 2321217.
[AGENT][NEUTRAL] OK, thank you. So give me a moment please to get the policy information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Just one moment please, Ms. [PII]. Thank you.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so first off, Mr. [PII], I will need to verify several things with you for security and also any information that is provided will be a verification of benefits and not a guarantee of payment. So if you could first verify Mr. [PII]'s date of birth with me.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. Also the home mailing address.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you and the phone number that we would have on file for him while we show your number, go ahead, yeah, we have 2 numbers.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] You you have [PII], that's his number.
[AGENT][NEUTRAL] OK, thank you. And then, uh, do you, well, you don't have to verify that with me, that's OK. Thank you. OK, so just, so you're wanting to verify what how to submit your information to us, is that correct? The primary.
[CUSTOMER][NEUTRAL] Well, I went on UnitedHealthcare. I didn't, I didn't see anything where it was submitted on Allied, but I do see where the last day of service was the [PII] that United paid claims.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um, because they paid several other claims too, um, but the data service, the young lady asked me for the data service, and I am looking for that. Um, let me see if I can find it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I can check to see if we have, right, so I can check to verify if we.
[CUSTOMER][NEUTRAL] You don't. She said you didn't, she said you didn't uh see anything.
[AGENT][NEUTRAL] OK. I don't see.
[CUSTOMER][NEUTRAL] OK, this is what it's got on the plane for [PII]. It's got uh [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Looks like all of them were done on the [PII].
[AGENT][NEUTRAL] OK, so just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so yes ma'am, we do not have any, that is correct. We do not have anything on file for him for [PII].
[CUSTOMER][NEUTRAL] Yeah, I didn't think so. Uh, like I said, um, I have something that says, let's see, I got the thing from what claims paid. I got claim details for [PII]. I have explanation of benefits. She said that was what you needed, but I'm gonna send everything, just to make sure we got everything.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, good
[AGENT][NEUTRAL] Yes, ma'am, we
[AGENT][NEUTRAL] Yes ma'am and did she tell you where to get the claim form that you will need to, he will need to complete to submit along with those documents?
[CUSTOMER][NEUTRAL] OK, if they send it to y'all, I don't need to do this?
[AGENT][NEUTRAL] If they go, yes, ma'am. But if you're gonna be filing it, there is a claim form, a Medlink claim form, which is the type of plan he has Medlik.
[CUSTOMER][NEGATIVE] OK, let me ask you a question. Who sends this? United Healthcare sends it or does Quest send it? Because Quest sends it to United Healthcare. Then United Healthcare is supposed to send it to y'all? What?
[AGENT][NEUTRAL] It will need to be.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] No, ma'am. Typically, the provider wants to, it, I mean.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It depends. Some providers do not file the supplemental insurance and some do. So if the provider doesn't file it, then, then you can file it. The insured can file them themselves.
[CUSTOMER][NEUTRAL] Yeah, they have throughout the year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so where do I get the claim form?
[AGENT][NEUTRAL] OK, so our website is where you're gonna go, and that's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah, I know what it is.
[AGENT][NEUTRAL] [PII]. OK, you do have our website. OK, so when that page comes up, Ms. [PII], at the top, you're gonna see a link that says claims and forms.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you would click on that link and then scroll down the page and about middle ways down you're gonna see a small box more to the left of the screen that says filter by product and it has a green drop down arrow in it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Filter byproduct.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And you would click on that little arrow, the little green arrow, and it's gonna list out, it's gonna give you.
[CUSTOMER][NEUTRAL] I'm gonna put green arrows so on that.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, click on the green arrow.
[AGENT][NEUTRAL] Correct. And you will look for the word medlink, M E D L I N K.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Click on that word.
[CUSTOMER][NEUTRAL] Click on midli? OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And then you should see out to the right on your screen a blue button that says download form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Blue button.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I don't know how to do all that. Can I just put in the mail?
[AGENT][NEUTRAL] You can, but you're still gonna have to have the claim form.
[CUSTOMER][NEUTRAL] Oh, if I could bring these people's neck, I would. OK, blue button that says download.
[AGENT][NEUTRAL] I'm sorry. Yes, download form.
[CUSTOMER][NEUTRAL] Oh no, it's not your fault.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you would just click on that and it will open up the claim form, Ms. [PII], and the instructions are at the top of page one. It gives you the instructions on completing the claim form and then you can use the other little bullet points as your checklist for making sure you have all the required documentation that we need.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. All right.
[AGENT][POSITIVE] It lists out everything that we need on there.
[CUSTOMER][NEUTRAL] And then I print that out and I mail it to y'all.
[AGENT][NEUTRAL] Yes, ma'am, and make sure that Mr. [PII] signs it.
[AGENT][NEUTRAL] He does have to sign it, but that's in, that's part of those instructions as well.
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] OK, let me ask you a question, baby, because we don't understand. It's the same as last year. I'm, I'm assuming the meddling policy 6000 and 6000, 6000 in hospital care, 6000 outpatient hospitals here, is that right?
[AGENT][NEUTRAL] Uh, let me look at the benefits.
[AGENT][NEUTRAL] Yes, ma'am, that is correct. For covered outpatient services and there is an outpatient deductible of $100 for covered person per calendar year for.
[AGENT][NEUTRAL] Also.
[CUSTOMER][NEUTRAL] OK, so, so let me ask you a question.
[CUSTOMER][NEUTRAL] According to this new insurance, he's already met his deductible. So if he goes into the hospital, then what's covered?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I'm not sure that I understand your question. This policy that he currently.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That he currently has now and we show his in his primary insurance with this policy is United Healthcare.
[CUSTOMER][NEUTRAL] No, it's allied.
[AGENT][NEUTRAL] We have United, it may have changed. I, I can see that this group is.
[CUSTOMER][NEGATIVE] It did. It changed on on the [PII]. OK, I'm gonna have to call more. This, this is all screwed up.
[AGENT][NEUTRAL] Yes, ma'am. As of right now, his policy.
[AGENT][NEUTRAL] Yes, his policy is active.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Because he's got a card that says APL on one side and Allied on the other.
[AGENT][NEUTRAL] I
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] OK. I don't, I don't see that.
[CUSTOMER][NEGATIVE] I'm so confused.
[AGENT][NEUTRAL] Yes, ma'am. I'm sorry. I don't, let me.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, ma'am, our ID cards wouldn't have.
[CUSTOMER][NEUTRAL] Yeah, cause I think the first, I think the first girl that I talked to see it a lot.
[AGENT][NEUTRAL] OK, our ID cards would not have their primary, yes ma'am, but our ID cards here at APL do not have the primary insurance company's information on it, so I'm not sure where that ID came.
[CUSTOMER][NEUTRAL] And I don't remember her name.
[CUSTOMER][NEUTRAL] Well, the card, yeah, the card that they gave him, the card that they gave him has allied on the one side and APO on the other side. It says secondary insurance.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK. So that must be provided by the primary insurance. It's not, I'm looking at his APL ID card and it has none of that information.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah, so as far as y'all know, he's still with United Healthcare.
[AGENT][NEUTRAL] As of as of right now, just for their group information, but I can see that, you know, their group is also in the enrollment process, so I mean renewal process, Mr. [PII], so it may just be that that part has not changed over in our system. I can't speak to that. I can just let you know that his policy is active with APL at this time.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][POSITIVE] And yes ma'am, you are correct in those benefit amounts.
[CUSTOMER][NEUTRAL] Yeah, I know that.
[CUSTOMER][NEUTRAL] OK, so let me ask you a question. If, if he, um, if he submits something from Allied, y'all not gonna pay it because y'all don't show him what Allied on the system.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] I, I can't, I can't answer that for you at this point since there no since the group is in their renewal process, we'll just have to receive all of the required information, Ms. [PII] for review.
[CUSTOMER][NEUTRAL] You can't answer that. OK, alright.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right then. Well you, thank you for your help, [PII], and I'll try and do that for you tonight, OK?
[AGENT][NEUTRAL] Now,
[AGENT][POSITIVE] Oh, you're welcome.
[AGENT][NEUTRAL] Now, let me ask you something. Do you know what Mr. [PII]'s work email address is?
[CUSTOMER][NEUTRAL] Um, hold on, [PII].
[CUSTOMER][NEUTRAL] [PII] is it [PII] or [PII]. I can't. I have to ask him. It's [PII], but I don't know if it's .[PII]. I wanna say it'[PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, we don't have it as .net. Yes, ma'am, would you verify that? Because what I can do for you, if he's able, if I can email him this claim form, yeah, if I can email him this claim form, Ms. [PII].
[CUSTOMER][NEUTRAL] I can call and ask him.
[CUSTOMER][NEUTRAL] I'm gonna call him right now.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And he could print it out, but you know, if that would make it easier for you than you having to.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To do all of that, I could just email it. I can, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, can you hold on for a minute? OK, bye.
[CUSTOMER][NEUTRAL] Uh, you, you need to talk to him, [PII]?
[AGENT][NEUTRAL] Uh, yes, if I can.
[CUSTOMER][NEUTRAL] Hey babe, [PII] at APO wants to know what your um email address is. Is it [PII]?
[CUSTOMER][NEUTRAL] [PII]. [PII].
[AGENT][NEUTRAL] OK, so if I email him this claim form, Mr. [PII], can he print that out?
[CUSTOMER][NEUTRAL] OK, she's she's gonna.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, he can print it, babe if she sends you a claim form, can you print it?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, she can print it.
[AGENT][NEUTRAL] OK, so let him know that the email I'm gonna send it in just a few minutes when we're finished with our call, Ms. [PII], but it's going to come from [PII] [PII] at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh huh.
[CUSTOMER][NEUTRAL] It's gonna come from care team at American Public.
[AGENT][NEUTRAL] Uh huh and then I will put APL and the medin claim form in the subject line so that he can recognize that.
[CUSTOMER][NEUTRAL] OK, and she's gonna put the me claim form on there.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] OK. Well, is there anything else that I can help you with, Miss [PII] at the moment?
[CUSTOMER][POSITIVE] That's it, [PII]. I thank you for your help. OK, baby.
[AGENT][POSITIVE] Well, you are certainly very welcome. It's my pleasure and thank you again for calling. I hope you have a wonderful evening.
[CUSTOMER][POSITIVE] All right. Thank you.
[CUSTOMER][POSITIVE] OK thank you OK bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] OK