AccountId: 011433970860
ContactId: 6e435614-7f21-4be1-9386-77c4c05bab9b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 674039 ms
Total Talk Time (AGENT): 205641 ms
Total Talk Time (CUSTOMER): 346240 ms
Interruptions: 5
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/6e435614-7f21-4be1-9386-77c4c05bab9b_20250205T20:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, yes, hi, [PII]. This is, uh, [PII], and I need uh assistance, um, I guess uploading receipts for care that, um, we got, um, and I've never done this before, so, um, they said that I, we could call to find out how to.
[CUSTOMER][NEUTRAL] Uh, you know, go through the process of uploading the receipts to see about getting refunded.
[AGENT][NEUTRAL] OK, and what's your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK. Is it your policy, [PII]?
[CUSTOMER][NEUTRAL] It's under my husband's name and we're all, um, all 4 of us are covered.
[AGENT][NEUTRAL] OK. And what
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] OK, it is.
[CUSTOMER][NEUTRAL] uh, uh, which one do I give you? There's in hospital and outpatient.
[AGENT][NEUTRAL] The number before the elm, so it should be the same for each, the number before the elm.
[CUSTOMER][NEUTRAL] Does it matter?
[CUSTOMER][NEUTRAL] The number before the M?
[AGENT][NEUTRAL] Before the letter M, so the policy number for the inpatient and outpatient should be the same.
[AGENT][NEUTRAL] So just give me all of the numbers before the letter L.
[CUSTOMER][NEUTRAL] Oh, I see what you're saying. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 02510864
[AGENT][POSITIVE] Thank you. And what's a good phone number, [PII], in case we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Of the number before the end. Mhm.
[CUSTOMER][NEUTRAL] My daughter [PII] on the phone with me, so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Both understand at the same time cause for her and then 4 for me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, OK. No worries. Verify your date of birth, [PII].
[CUSTOMER][NEUTRAL] Mine is [PII].
[AGENT][NEUTRAL] Hi, [PII].
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] OK, and so you're wanting assistance creating the online account?
[CUSTOMER][NEUTRAL] Um, I, I, I guess, I, I guess we have to do that. I, I, we've never done this before. This is all new to us.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, no worries.
[AGENT][NEUTRAL] I'm gonna see first if there is one created for this family or not.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Actually there is one already created.
[CUSTOMER][NEUTRAL] Maybe I did that.
[AGENT][NEUTRAL] Uh huh I can tell you what the user name is, but of course the the password is private.
[CUSTOMER][NEUTRAL] If anybody
[AGENT][POSITIVE] And maybe that'll bring your, you know, come back to your remembrance.
[AGENT][NEUTRAL] It's um [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, my husband, is it, is it his
[AGENT][NEUTRAL] Could be your spouse, you know, could be his.
[CUSTOMER][NEUTRAL] [PII] or is it his [PII]?
[AGENT][NEUTRAL] Uh, it's not an email at all. It's just a username that he that he has created.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Huh, OK, so he's gonna have to give us that information.
[AGENT][NEUTRAL] Right
[CUSTOMER][NEGATIVE] Yeah, yeah, he didn't give me that information.
[AGENT][NEUTRAL] Mhm, are you trying to upload documents claim documents?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, he told me that I would, I would need to do that, but um, yeah, because I needed to upload the, I guess the, the receipt from the doctor visit.
[CUSTOMER][NEUTRAL] Um, that, that, cause I'm seeing physical therapist and my daughter had um dental surgery, although we were told that the dental surgery would not be covered, but
[CUSTOMER][NEUTRAL] Um, the thing is, there was one item in that surgery that may be covered because it's not a typical.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] She had a tumor.
[AGENT][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] So it was a typical type of thing. So she had um her wisdom teeth removed, but she also had a tumor removed.
[AGENT][NEUTRAL] Who removed the tumor?
[CUSTOMER][NEUTRAL] So that
[CUSTOMER][NEUTRAL] Yeah, yeah, the tumor was also removed.
[AGENT][NEUTRAL] But who, who removed the tumor? Was it a?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] The, the same, the same surgeon, dental surgeon.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what caused the tumor?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] I, I don't know if it's a typical thing that happens with, with dental patients or if it was due to her, her um disease. She has neurofibromatosis. So that's where I don't know.
[CUSTOMER][NEUTRAL] That's what I couldn't tell you.
[AGENT][NEUTRAL] OK, because, of course, you know, this is a medical policy and dental is not covered under the policy.
[CUSTOMER][NEUTRAL] You gotta have
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] That's why I was asking who performed the surgery.
[CUSTOMER][NEUTRAL] Well, it was a, it was a dentist.
[CUSTOMER][NEUTRAL] But, and, and our Guardian dental insurance covered it, but because she has a medical condition,
[CUSTOMER][NEUTRAL] He removed the tumor.
[CUSTOMER][NEUTRAL] Along with the wisdom teeth. So that's what it.
[AGENT][NEUTRAL] But was the tumor as the result of the medical condition?
[CUSTOMER][NEUTRAL] That's where, that's where it kind of, you know,
[AGENT][NEUTRAL] A gray area.
[CUSTOMER][NEUTRAL] Yeah, it was, it was next to where the wisdom teeth were. So that's, that's where it kind of gets iffy where it's like, OK, is this covered?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] With APL because the dental insurance didn't cover it. How does this work? You know what I mean? Because the medical insurance didn't cover it, the dental insurance didn't cover it. So is this something that the APL would cover?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I do.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It paid out of pocket for that.
[AGENT][NEGATIVE] I don't believe so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, the, the, the, the last lady I spoke to from APL said, well, you can submit it and see if they'll we'll pay for it or not.
[AGENT][NEGATIVE] Yeah, you can always submit it for review if you would like, but I don't believe that it would be covered.
[CUSTOMER][NEUTRAL] So that's why.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You don't believe it would be, OK.
[AGENT][NEUTRAL] Yeah, the policy wording states that is it, if it's as a result of.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Like an accident or, um,
[AGENT][NEUTRAL] An anomaly like something that she was born with.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Other than that, I don't believe it will be covered, but you're, you are, that's correct. You're more than welcome to submit it for review.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it doesn't sound like it's going to be covered then.
[AGENT][NEUTRAL] Yeah, just based off of the policy wording under this Metlink policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so, um, since my husband created.
[CUSTOMER][NEUTRAL] The, whatever the the credentials.
[AGENT][NEUTRAL] Account, the, the online account. Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] He's the one who has to.
[CUSTOMER][NEUTRAL] Give us the credentials or do the submission of.
[CUSTOMER][NEUTRAL] Of the documents, correct?
[AGENT][POSITIVE] Mhm. Correct. That is correct.
[CUSTOMER][NEUTRAL] And so um where on this website would we be doing this?
[AGENT][NEUTRAL] So you can't get onto the website, um, it's might be a little hard for me to show you, but what I can do.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Email you um an individual user guide and it kinda helps you navigate um in the online service center um so if you want to submit a claim, it gives you instructions on how to do that without getting into his file because you need his username um I can't direct you like over the phone because you're not in there but I but there is a but there is a user guide that I can email.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, can you email or
[AGENT][NEUTRAL] I guess I could I could email it to his address. You do know what his email address is?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I don't know which one he's using for the account though. Uh, he either uses the [PII] or the or the [PII].
[AGENT][NEUTRAL] What's the [PII]?
[CUSTOMER][NEUTRAL] I prob
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK, that is the one that we have on file.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, yeah, typically he uses that one.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, uh, yeah, if you can send that one I can access that from my phone and then I'll I'll pick that up.
[CUSTOMER][NEUTRAL] And then I'll ask him for the credentials and then we can upload that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] With the instruction that'll help a lot.
[AGENT][NEUTRAL] OK, give me 1 2nd.
[AGENT][NEUTRAL] Alright I just sent him over.
[AGENT][NEUTRAL] You can verify that you did receive them.
[CUSTOMER][NEUTRAL] OK. Um.
[AGENT][NEUTRAL] It's coming from [PII].
[CUSTOMER][NEUTRAL] [PII]. Let me check it now.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh, actually, you know, I don't have access I have access to the private to the personal one. I don't I I I.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so he'll he'll, you may wanna let him know that it's coming.
[CUSTOMER][POSITIVE] Yeah, OK, I will. I'm texting him now. Thank you so much, [PII]. If anything, I'll have to call back again.
[AGENT][POSITIVE] OK, no worries.
[CUSTOMER][POSITIVE] But uh back with him. Thank you so much. You've been helpful.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Mhm, no other questions. Thanks for calling APL [PII]. Have a good day.
[CUSTOMER][POSITIVE] All right thank you you too bye bye.