AccountId: 011433970860
ContactId: 6bf2a602-59d7-4ab9-b992-2fed49fb9724
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 498100 ms
Total Talk Time (AGENT): 177312 ms
Total Talk Time (CUSTOMER): 270069 ms
Interruptions: 0
Overall Sentiment: AGENT=2.3, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/6bf2a602-59d7-4ab9-b992-2fed49fb9724_20250505T15:21_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] This money
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, this is [PII] with Broker Resources. Is this claims?
[AGENT][NEUTRAL] Yes, this is [PII].
[CUSTOMER][NEUTRAL] OK perfect. I have a broker um on the line and she was curious just like about our um submitting our claim process, you know what the claim numbers would be all of that so I was curious if you could speak with her.
[AGENT][NEUTRAL] OK, is she for meddling?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And what's her name?
[CUSTOMER][NEUTRAL] Alright. Her name is [PII] with town Benefits.
[CUSTOMER][NEUTRAL] And she's referring to group number 26113.
[AGENT][NEUTRAL] OK, do you have a good callback number for her?
[CUSTOMER][NEUTRAL] Um, it is gonna be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] OK, I'm gonna have her join the call, OK? OK, perfect.
[AGENT][POSITIVE] And I'm ready.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] [PII], are you still there?
[CUSTOMER][POSITIVE] I sure am. OK perfect I have someone from our claims department on here that can answer all of your questions, OK?
[CUSTOMER][POSITIVE] You're the best.
[CUSTOMER][POSITIVE] All [PII]. Have a good day.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] [PII], this is [PII], and I'll be happy to assist you with the claims information. How are you today?
[CUSTOMER][NEUTRAL] I'm good and what did you say your name was?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] Thank you. Uh, [PII], we, we have a mutual customer. It's the Western Tidewater Free Clinic, and one of their, uh, people, uh, went to the doctor's and presented her APL card and the doctor wouldn't file it for her. So she's like one of the first.
[CUSTOMER][NEUTRAL] Um, that I'm that I that I've handled, um, who's reached out to us about filing a claim and usually what I do is I just, you know, give him a little hand holding and tell them what to expect and you've got a great handout here on how to, uh, instructions on filing electronically and filing by mail and all that kind of stuff but there's other things like, um, do you.
[CUSTOMER][NEUTRAL] When the claim gets submitted, do you, uh, assign it a claim number or is it tracked by the data service?
[AGENT][NEUTRAL] Once the claim is received, we will put it in line for processing. The claim number does not get assigned until the claim is actually processed.
[AGENT][NEUTRAL] But if they register online their account once they submit the claims, they will receive the notification that we did receive a claim for them.
[CUSTOMER][NEUTRAL] Mm. Mhm.
[CUSTOMER][NEUTRAL] Oh, so they get a notification confirmation.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And then sometime later once it's really in in being processed they get a claim number is that is that correct? And then the claim number comes OK now once once it's submitted and they've got a claim number obviously it's it's somewhere in the process how do y'all communicate with the insured? I mean do you pick up the phone and call her? Is there a message center on on your portal? How do, how does that work?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] No ma'am, if they're in their portal online they can see every claim that was submitted by them or their provider but once we process the claim if she submitted it, it will send the email I mean I'm sorry, it will send the EOB to her.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If the provider submit submits the claim, she will still receive an EOB. So anytime someone submits on her behalf, she will get the EOB by mail.
[CUSTOMER][NEUTRAL] OK, and that's the one that you, that you, um.
[CUSTOMER][NEGATIVE] That you all submit that says you know this this is what we're paying on your claim and this is exactly what we're paying for is that what you mean by your EOB?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, um, but what if she doesn't submit everything that you need? How do you communicate with her to say, you know, we're missing this piece of information.
[AGENT][NEUTRAL] If there's
[CUSTOMER][NEUTRAL] I mean, you wouldn't deny the claim.
[AGENT][NEUTRAL] Yes, if the mail comes in, I'm sorry, if the mail comes in and she submitted an itemized bill. Well, when you filed the claim, we would need an itemized bill, the major medical EOB.
[CUSTOMER][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim form, in this case, they would need the Metlink claim form. So on that claim form, there's the information that she completes, address, policy number, information like that. We also would need a diagnosis code, which is the reason she went to the doctor hospital.
[AGENT][NEUTRAL] Urgent care, we would need that. For instance, if that's not on there, we may pick up the phone and call her and say, hey, [PII], we received your claim, but we need a diagnosis code. Just to let her know, we're processing the claim, but
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We need additional information and we will put it in the system requesting that information to kind of give her a heads up on what's coming.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][MIXED] Yeah yeah we we work with some carriers who like don't use email and they won't call on the phone they only send letters and that's just a very cumbersome process so I think she'll really appreciate it knowing that you'll pick up the phone and and call her if something is is missing um.
[CUSTOMER][NEUTRAL] Now she files.
[CUSTOMER][NEUTRAL] Electronically, does she have to do a medling claim form? Doesn't she just do that?
[CUSTOMER][NEUTRAL] As part of the electronic process.
[AGENT][NEUTRAL] Yes, normally with that electronic process the claim just comes over, we will not receive that claim form but if she uploads it or she mails it or she faxes it, we request the claim form.
[CUSTOMER][NEUTRAL] OK, you gotta have a claim form if you do it any other way than electronically that makes perfect sense, um.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] And I'm, I've got an, I've got a really nice uh instructional flyer here that y'all have, and that's really, really helpful. I'm gonna send that to her um is there anything else you'd want her to know as a first time claimant?
[AGENT][POSITIVE] She is more than welcome to give us a call and we will walk her through everything that she needs when submitting her plan. She can call us Monday through Friday. We'll be here to help her.
[CUSTOMER][NEUTRAL] OK, what are the hours Monday through Friday?
[AGENT][NEUTRAL] [PII] it's [PII].
[CUSTOMER][NEUTRAL] [PII] OK, that's good. OK, um.
[CUSTOMER][NEUTRAL] Well that's good. um [PII], I'm gonna um go ahead and, and share the flyer with her and I'm also gonna share your information and how you guys communicate with her should, should you need more information because you know first time claimant filing something it's.
[CUSTOMER][POSITIVE] You know they're they're overwhelmed with the process anyways regardless of how easy it may seem um so I'm I'm, I'm good to hear that you would the company would reach out to her if they needed something more so that's good. Alright, well [PII], thank you so much. I, I appreciate it. I'm gonna write this down for myself and, and for my other two or three teammates that do some of the same things that I do, so we'll all have it.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] And [PII], if you need additional information or assistance, just give us a call back. We'll be happy to assist you.
[CUSTOMER][POSITIVE] OK, OK, that's great news. OK, thank you.
[AGENT][POSITIVE] Honey, you're so welcome and thank you for calling American Public Life. Have a great rest of your day.
[CUSTOMER][POSITIVE] Yes, you too, and if you're a mother, have a wonderful Mother's Day.
[AGENT][POSITIVE] Thanks, you as well, [PII]. I appreciate that.
[CUSTOMER][NEUTRAL] All right, bye-bye.
[AGENT][POSITIVE] Have a great day, [PII]. Bye-bye.
[CUSTOMER][POSITIVE] Thanks. Bye-bye.