AccountId: 011433970860
ContactId: 60757a31-a0ac-4d30-b2e1-8122cc6f2faa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 372000 ms
Total Talk Time (AGENT): 155460 ms
Total Talk Time (CUSTOMER): 154316 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/60757a31-a0ac-4d30-b2e1-8122cc6f2faa_20250213T22:21_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yes, I have or or have had coverage.
[CUSTOMER][NEUTRAL] Let me give you my name [PII].
[CUSTOMER][NEUTRAL] And the policy number.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] I was here in front of me until a moment ago.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I got 11 moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] Uh, I was told to go to make a claim to go to to the website and then find Medlink, but I don't find Medlink.
[AGENT][NEUTRAL] Oh you're on the [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Under claims and forms, um, it may be on.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The 2nd row of claim forms.
[AGENT][NEUTRAL] The kind of alphabetical order.
[CUSTOMER][NEUTRAL] 2nd row, OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Says uh
[CUSTOMER][NEUTRAL] OK, it starts with accidental claim authorization is closed, cancer claim change and request form, critical illness.
[AGENT][NEUTRAL] If you go all the way down to the bottom, it should say 1 and then it should be highlighted and it has 2 and 3. It should be in the 2nd 1. Yeah, it should be in the 2nd 1.
[CUSTOMER][NEUTRAL] Oh, number 2. OK.
[CUSTOMER][NEUTRAL] Medlink there it is.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Alright, meddling, it's pretty straightforward looks like.
[CUSTOMER][NEUTRAL] Let me see if it needs anything from a doctor.
[CUSTOMER][NEUTRAL] Hm, just ensure it has to sign it that's it, OK.
[AGENT][NEUTRAL] Yeah, um, the claim, uh, with that claim form with Metli policies, we would need the billing, showing diagnosis and procedure codes and the primary EOB.
[CUSTOMER][NEUTRAL] Oh, wait a minute.
[CUSTOMER][NEUTRAL] In the primary what?
[AGENT][NEUTRAL] EOB explanation of benefits.
[CUSTOMER][NEUTRAL] And that's coming from where? From your insurance policy?
[AGENT][NEUTRAL] From your insurance company, it will show um what EOB or X.
[CUSTOMER][NEUTRAL] Like I had Humana. I had Humana for my main policy. You want the you want the policy for Humana?
[AGENT][NEUTRAL] Not the policy, the EOB. The explanation of benefits is what our insurance company would send, showing how they process the claim.
[CUSTOMER][NEUTRAL] On that particular claim?
[AGENT][NEUTRAL] For that particular data service, yes, sir. So, um,
[CUSTOMER][NEUTRAL] OK, what if the what if the hospital has already has an information? It has the insurance and it has the, the total amount, everything like that, is that OK or not?
[AGENT][NEUTRAL] Oh, no, we still need the primary EOB, uh, with our Metlink policies anytime whether the provider insured files a claim, we always need that EOB for the data service you're filing for.
[CUSTOMER][NEUTRAL] OK, who do you get the EOB from?
[AGENT][NEUTRAL] Your insurance company, your primary insurance company.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] And then another question.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Uh, how, how far back do you go on claims?
[AGENT][NEUTRAL] Um, as far back as your effective date, what's your policy number?
[CUSTOMER][NEUTRAL] OK, it's, let's see.
[CUSTOMER][NEUTRAL] Do you want the group or the individual?
[AGENT][NEUTRAL] It should be a policy start number start with 01 or 02.
[CUSTOMER][NEUTRAL] Yes. OK, 01.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 986-454
[CUSTOMER][NEUTRAL] M as in Minnesota, L as in Louisiana, #7.
[AGENT][NEUTRAL] Uh, OK. Um, let's see, and verify your date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK. And I show your policy became effective [PII]. So anything uh after [PII], you can file claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then um
[CUSTOMER][NEUTRAL] The other question is.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] My, I couldn't go online because my policy expired on the [PII].
[CUSTOMER][NEUTRAL] Right?
[AGENT][NEUTRAL] Yes, cause I show your policy would terminate [PII]. Yeah.
[CUSTOMER][NEUTRAL] No, it will actually, it actually goes to the end of the month.
[CUSTOMER][NEUTRAL] [PII], OK. Now I got some, well, I was looking through these forms. There's a COR form. Is it possible to extend this policy?
[AGENT][NEUTRAL] Uh, you have to contact your group administrator since this is a group, um, issued policy.
[AGENT][NEUTRAL] And they can verify if you can get on COBR, especially if you are with your major medical as well for your group.
[CUSTOMER][NEUTRAL] Yes, I have, I've already extended, but it didn't say anything about this policy. Everything else got extended.
[AGENT][NEUTRAL] Yeah, I would say you contact your group administrator and they can verify if uh COBR is offered and then they will send those documents into us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Then one other thing. So on the first page of this, these forms, there's a way to fax stuff. Is it, is it better for me to fax or to, to mail?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Since I can't do it online.
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] It is a lot quicker, uh, so I would say to fax it to us.
[AGENT][NEUTRAL] If you can.
[CUSTOMER][NEUTRAL] OK, I got a fax.
[CUSTOMER][NEUTRAL] Alright, use the fax number that's on there I guess.
[AGENT][NEUTRAL] Mhm. It should be [PII]. No, wait, did I give you the right one? [PII]. I apologize.
[CUSTOMER][NEUTRAL] Wait, wait, one moment, [PII] again?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you much man I appreciate it.
[AGENT][POSITIVE] You are welcome and you have a great day, Mr. [PII].
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.