AccountId: 011433970860
ContactId: 705e295e-cb69-4b2e-b42c-0dd54496c855
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 541349 ms
Total Talk Time (AGENT): 282183 ms
Total Talk Time (CUSTOMER): 272094 ms
Interruptions: 9
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/705e295e-cb69-4b2e-b42c-0dd54496c855_20250319T21:05_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes. Hi, [PII]. Um, good afternoon. My name is [PII].
[CUSTOMER][NEUTRAL] And I needed to, I need help because I'm trying to file a claim and I'm not sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How to process it
[AGENT][NEUTRAL] OK, Ms. [PII], I can help you file a claim. Can you please give me your callback, I'm sorry, your policy number first so I can pull your policy in?
[CUSTOMER][NEUTRAL] The policy number, yes, it's 2607944.
[AGENT][NEUTRAL] OK, let me look that up.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] OK, Ms. [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you. And then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, so the address should be [PII].
[CUSTOMER][NEUTRAL] Um, what else do you need?
[AGENT][NEUTRAL] Your email address and your phone number.
[CUSTOMER][NEUTRAL] The phone number is [PII]. And the email, I'm not sure if it's got my work address or personal address, but either [PII].
[AGENT][POSITIVE] Looks like work.
[CUSTOMER][NEUTRAL] Or [PII].
[AGENT][NEUTRAL] OK, thank you very much and the phone number you just gave me and verified, is that a good call back number if our call gets disconnected?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Like that.
[AGENT][NEUTRAL] OK perfect. Alright, so you want to find a file a claim from Medlink. Are you signed up on the online service center?
[CUSTOMER][NEUTRAL] I think.
[CUSTOMER][NEUTRAL] I'm not.
[AGENT][NEUTRAL] OK, so if you sign up for our online service center you can file your claim online that way um let me give you the website to go to.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh, I do.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] It, it is secured.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Give me one second, secured.
[AGENT][NEUTRAL] AM
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes ma'am, once you get into that website and you'll have to do it from a laptop or or a regular computer you can't do it on your phone it doesn't support it so once you get in there you'll um sign up as a new user and then you're gonna choose the option that you're an individual with an APL policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] and
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the product type that you have is called Medlik M E D L I N K.
[CUSTOMER][NEUTRAL] So I have a phone number.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So you'll be able to file your claim through there and the documents that you're going to need is your claim form for Medlink you'll need.
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] Also, to get an explanation of benefits from your primary insurance carrier.
[CUSTOMER][NEUTRAL] I really.
[CUSTOMER][NEUTRAL] Uh, explanation of benefits.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] From my insurance, right?
[AGENT][NEUTRAL] And then you
[AGENT][NEUTRAL] Right, your primary major medical insurance. Yes, ma'am.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, so explanation of benefits and you said a form from Medland claim form.
[AGENT][NEUTRAL] And then you
[AGENT][NEUTRAL] Yes, the claim form.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And they'll also need to get an itemized statement.
[CUSTOMER][NEUTRAL] This.
[AGENT][NEUTRAL] And you can get that from the facility, the doctor that you went to, and it should include your diagnosis code and your procedure codes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Diagnosis code and procedure code. OK.
[AGENT][NEUTRAL] Yes ma'am, so all 3 documents will need to be sent in with your claim.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] OK. And um where can I find out what um
[CUSTOMER][NEUTRAL] What things are covered. So I know I have some, um, what I wanted to submit was a um
[CUSTOMER][NEUTRAL] couple of tests. So one was a part of uh endoscopy that didn't get um covered. Also some lab work that didn't get covered.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so your policy, um,
[AGENT][POSITIVE] I, as you know, a supplemental to your primary, but it helps with deductible co-pay and co-insurance.
[CUSTOMER][NEUTRAL] I said.
[CUSTOMER][POSITIVE] It helps, OK.
[CUSTOMER][NEUTRAL] So if it's not covered in the explanation from my insurance, then you'll pick it up. So, so there's no list necessary from you on what you'll cover or not.
[AGENT][NEUTRAL] Right, there's no list, it's based on what the uh primary insurance pays. If it's noncovered by the primary insurance, then it's not something that we pick up because this policy only helps with deductible, co-pay and co-insurance for accident or sickness.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] $80.
[CUSTOMER][NEUTRAL] Deductible.
[CUSTOMER][NEUTRAL] Deductible, co-pay, or co-insurance. Um, OK, so I think these are co-pays. OK, for coinsurance. OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And it, and it needs to be for accident or sickness.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so accident or sickness only, um, OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So, our sickness.
[CUSTOMER][NEUTRAL] Not diagnosis.
[CUSTOMER][POSITIVE] Wow
[AGENT][NEUTRAL] No, the diagnosis code will be on the um I'm sorry, the itemized statement to show.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The diagnosis is, mhm.
[CUSTOMER][NEUTRAL] I know, but if these were tests to diagnose something, but it's not covered in full.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Go ahead and send it in, go ahead and send it in and and see because any little bit helps so yeah I would go ahead and send in what you can.
[CUSTOMER][NEUTRAL] Will that be covered?
[CUSTOMER][NEUTRAL] OK. Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if it gets denied because it might be, you know, not in the correct facility or something like that, um, then at least you know you tried.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, I'm trying to log in creating a new user and it's asking me for my last name. It says social security number.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, or member ID. So I put my social security number and it didn't take it.
[AGENT][NEUTRAL] You'll need you to use your
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Let's verify your information.
[AGENT][NEUTRAL] Again to make make sure that we've got all the everything that we need to have matches, it has to match completely. OK, so can you spell your last name for me?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][NEUTRAL] OK, and then spell your first name.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you. And then,
[AGENT][NEUTRAL] Let's verify your date of birth, make sure that was entered correctly.
[CUSTOMER][NEUTRAL] OK, so [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then go ahead and let's verify that social security number too.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] But in the meantime.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] Oh, I see why.
[CUSTOMER][NEUTRAL] And then, mhm.
[AGENT][NEUTRAL] Your policy
[CUSTOMER][NEUTRAL] I will try to get at.
[AGENT][NEUTRAL] Your policy has
[AGENT][NEUTRAL] OK, so did you ask for a card recently or make some changes recently?
[CUSTOMER][NEUTRAL] Um, I didn't make any changes, but I did ask for a card because I never got one.
[AGENT][NEUTRAL] OK, that's why, that's why so right now you're you're gonna have to sign up tomorrow and let this process overnight to be able to order your card for you. The policy status that it's in right now is so that a card can be issued overnight and it'll change and go back tomorrow to where it should be for you to be able to sign up for that.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so I have to wait till tomorrow and do the same thing I'm trying to do right now.
[AGENT][POSITIVE] Yes, ma'am. I'm sorry.
[CUSTOMER][NEUTRAL] OK, no problem. And then I'll upload my documents or whatever. Um, OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, that's what I needed. Thank you so much.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] That's it thank you so much.
[AGENT][POSITIVE] OK, well, you have a wonderful night and thanks for calling APL.
[CUSTOMER][POSITIVE] You too. Thank you. Bye-bye.
[AGENT][NEUTRAL] Bye bye, ma'am.