AccountId: 011433970860
ContactId: 6c9309e2-6f22-49f7-98ca-23257054fcba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 253360 ms
Total Talk Time (AGENT): 137339 ms
Total Talk Time (CUSTOMER): 96150 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/6c9309e2-6f22-49f7-98ca-23257054fcba_20250117T19:40_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APO. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I was just calling because I had recently had carpal tunnel surgery, and I know whenever I had presented my card at the hospital, they wasn't sure if they were supposed to submit the the claims to you guys or if I was supposed to go online and submit the claims. I was just trying to call to see how it all works. This is my first time having gap insurance, so I wasn't sure what I needed to do.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I can check and see if we received anything. Um, may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII] and my phone number is [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes, 02553277.
[AGENT][NEUTRAL] Thank you. And for security, may I have your date of birth, mailing address and email address on file?
[CUSTOMER][NEUTRAL] Yes, my date of birth is [PII]. My address is [PII], and the email should be [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, and what is the date of service?
[CUSTOMER][NEUTRAL] Like the effective date or the date that the surgeries were?
[AGENT][NEUTRAL] And the day that the surgery took place.
[CUSTOMER][NEUTRAL] My first one was [PII] and the second was [PII].
[AGENT][NEUTRAL] Alright, let me see if I received anything for those days. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] That answer that.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm. No, no, we have not received any claims. OK, um, so, OK, so at this point, um, you have two options. Either you can call the provider of service and let them know that we have not received the claim, that if they can please send us the claim so we can process the claim and pay directly to them.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or if you want to send a claim for reimbursement, you can. You still need to contact them. You still need to call them to get an itemized bill. The itemized bill needs to have the diagnosis codes and the procedure codes.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Cause I did receive one bill from the hospital that I believe had everything on there. So I will double look, I'll double check that and make sure everything is on there. I'll try to go online and do the claim myself. If not, then I will contact my provider and see if they would be able to do it on my behalf.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, OK, yeah, that would be the easiest way is if they can do it because they will send all the information we need. Um, if not, again, um, you just need that itemized bill and you also need two more documents. So the other two documents is the claim form.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In the claim form you can find it in our website at [PII]. It's gonna be the multiplan claim, not multiplan, the Metlink. I do apologize, Metlink claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] And the first page is gonna give you instructions on what to send, which is the same information that I'm asking for and we also need the copy of the explanation of benefits from the primary insurance showing how much they apply towards the deductible co-payment and co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] All right, I will get that all taken care of.
[AGENT][NEUTRAL] All right. Uh, is there anything else I might help you with today? Do you have any other questions, concerns?
[CUSTOMER][POSITIVE] No, I just that's all I needed.
[AGENT][POSITIVE] Anything else? OK. Well, if you have any, if you think of any, just give us a call back. We'll be happy to assist you and you have a good afternoon. Thank you for calling APL.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] You're welcome. Bye-bye.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.