AccountId: 011433970860
ContactId: 63c5d30e-4c6b-4ce5-9001-599426e22bb9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 516090 ms
Total Talk Time (AGENT): 276931 ms
Total Talk Time (CUSTOMER): 156990 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/63c5d30e-4c6b-4ce5-9001-599426e22bb9_20250205T18:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] Can you hear me?
[AGENT][POSITIVE] Hi, yes ma'am, I can.
[CUSTOMER][NEUTRAL] OK. All right, thank you. Um, I was calling, um, I've had some medical claims go through and um we just got this new insurance with you guys, so I wasn't sure how it worked or if it was already applied to my bills or not. Could you help me with that?
[AGENT][NEUTRAL] Mhm. Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, I can look at your claims for you. Uh, can I please get your name and your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Uh, sure. My name is [PII].
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. And then what is your policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, is it you want the payer ID or the group number?
[AGENT][NEUTRAL] Uh, it may say inpatient or outpatient certification number.
[AGENT][NEUTRAL] Or member ID number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, patient certification.
[CUSTOMER][NEUTRAL] Yeah, so there's the in in hospital and outpatient. The in hospital is.
[CUSTOMER][NEUTRAL] 025.
[CUSTOMER][NEUTRAL] 664.
[CUSTOMER][NEUTRAL] 25 ML 7
[AGENT][POSITIVE] OK, thank you so much. Let me pull that policy up for us real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII], can you verify your date of birth for me, please?
[CUSTOMER][NEUTRAL] Um, mine is uh [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the address, phone number and email address that we have on the policy?
[CUSTOMER][NEUTRAL] Um, [PII], um, probably [PII].
[CUSTOMER][NEUTRAL] And the email would be.
[CUSTOMER][NEUTRAL] Um, I don't know if it's [PII].
[CUSTOMER][NEUTRAL] Um, is that the one?
[AGENT][NEUTRAL] Actually, I don't have his email address on the policy, so we'll have to wait for him to give us the one that he wants since he's the account holder. um. OK, so let me look at, and you're looking at claims. Are the claims for yourself?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, no, they're actually for my husband.
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] OK, is your, OK.
[AGENT][NEUTRAL] Is [PII] there um.
[AGENT][NEUTRAL] Where I can get his verbal consent to talk about the policy with you as far as claims go?
[CUSTOMER][NEUTRAL] Um, no, but I, I can give you like his birthday or um.
[CUSTOMER][NEUTRAL] Uh, any other information you might need.
[AGENT][NEUTRAL] Right, OK, so are you just needing in are you just needing information on how to file a claim?
[CUSTOMER][NEUTRAL] I also, I also
[CUSTOMER][NEUTRAL] Yeah, I don't know how this works. I don't know if, if when I get these bills they already processed or, or do I have to claim them myself or how does it work?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right. Yes, ma'am, I understand. OK, so when you guys go to the hospital or facility that you need to use, you give them your primary insurance card, but you also give them this card too, um, because this, this card helps with deductible, co-pay and co-insurance. So when you give them the card.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, they can help, they can file the claim for you all the information on the card for them if, if they're willing to file the claim for you. If not, then I'm gonna, then I'm gonna give you a website to go to.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You go to secured, [PII]
[CUSTOMER][NEUTRAL] Hold on one second, sorry, I have to grab a pen. OK.
[AGENT][POSITIVE] Yes ma'am, sure, that's fine. Take your time.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] All right. What is it? I'm sorry.
[AGENT][NEUTRAL] That's OK. um, so you would go to the secured SECU or ED.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You can file your own claim there through our online service center.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or if you choose to mail in a claim or fax in a claim, let me give you another website to go to.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you go to [PII].
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] It's the same website but without the secure, it's just [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you go there and you click on claims and forms.
[AGENT][NEUTRAL] You're going to choose the med link form. It's M E D L I N K.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on that first page of the meddling claim form, it'll give you everything that you need to send in with your claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You'll need your
[AGENT][NEUTRAL] Explanation of benefits from the primary insurance and you also need an itemized statement with your diagnosis and procedure codes, along with the claim form.
[AGENT][NEUTRAL] And then if you want to fax in a claim, let me give you the fax number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or you choose to mail in a claim, you will send it to [PII].
[AGENT][NEUTRAL] And that's going to be [PII].
[CUSTOMER][NEUTRAL] Oh I'm sorry, can you repeat that?
[AGENT][NEUTRAL] Yes, [PII] is the [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] And then the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It was Am claims.
[AGENT][NEUTRAL] APL claims.
[CUSTOMER][NEUTRAL] APL, OK.
[CUSTOMER][NEUTRAL] Alright, um, OK, is there any way that if you can tell me if um there have been any claims yet?
[AGENT][NEUTRAL] No, uh, we have not received any claims.
[CUSTOMER][NEUTRAL] OK, great. I know we gave them a card, so I guess they just didn't do it.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah. Now, uh, uh-huh.
[CUSTOMER][NEUTRAL] So I call, I would call.
[CUSTOMER][NEUTRAL] Do I call um like the hospital to do this or do I call United?
[AGENT][NEUTRAL] You'll call the hospital because the hospital is going to file your primary insurance first. Once your primary pays their part, then they'll file this insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh, I see. OK, yeah, so they already did the primary, so I guess I'll call them to see if they're gonna do the other one. OK.
[AGENT][POSITIVE] Correct and the easiest way for you if you have to do it yourself is to sign up on that online service center it's really cool because you guys will be able to get confirmation that we received it it'll also let you know um when it's in the process and where it as is in the process of being um taken care of for you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Um, all right, yes, thank you so much. I appreciate your help.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. I hope you have a wonderful rest of your day and we thank you for calling APL.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] You're welcome and if you get stuck or you need help when you're doing it, pick up the phone and we'll help you, OK?
[CUSTOMER][POSITIVE] All right sounds good thanks.
[AGENT][POSITIVE] OK. All right. You take care.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] You too bye.