AccountId: 011433970860
ContactId: 7298cfcd-6ed3-4dc2-ae53-57657b70c941
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 668719 ms
Total Talk Time (AGENT): 332964 ms
Total Talk Time (CUSTOMER): 260699 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/7298cfcd-6ed3-4dc2-ae53-57657b70c941_20250217T15:03_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um, yes, I'm calling because, um, we have a policy through my husband's work and I don't know exactly how this, um, I don't know how this works exactly so on his um on his Oasis.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, website or port is Oasis portal. It's got the, we're enrolled in the, um, the American Public Life gap enhanced 1500 to 500.
[CUSTOMER][NEUTRAL] Um, plan
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But I don't know how it works to file claims or anything like that. Can you help me?
[AGENT][NEUTRAL] Oh sure, yes. um, let me have your name and a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] OK, my name is [PII] and my number is [PII].
[AGENT][NEUTRAL] OK, thank you, Ms. [PII]. And may I have the policy number if you have it?
[CUSTOMER][NEUTRAL] Um, it's not listed on his portal, and I don't know where to go to find out because we didn't get like a card in the mail or anything.
[CUSTOMER][NEUTRAL] We have, uh, uh, we only got like our regular health insurance card. Should we have gotten a card?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, um, let me have the spelling of the last name.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII] [PII]
[AGENT][NEUTRAL] In the spelling of the first name?
[CUSTOMER][NEUTRAL] Is [PII] is his name.
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] OK. May I have your date of birth for security?
[CUSTOMER][NEUTRAL] Uh, you want my husband since it's his employer is [PII].
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, I need yours for security since I'm speaking to you. Mhm.
[CUSTOMER][NEUTRAL] Oh, mine is, yeah, mine is is uh [PII].
[AGENT][NEUTRAL] OK, thank you. And I need to verify the mailing address.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] OK. And that was [PII], correct?
[CUSTOMER][NEUTRAL] Uh-huh, [PII].
[AGENT][NEUTRAL] OK. And there's no um
[AGENT][NEUTRAL] Apartment or anything like that?
[CUSTOMER][NEUTRAL] No, it's a house.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, so let me go ahead I'm gonna go ahead and order that card um to be sent out.
[AGENT][NEUTRAL] And, and let me give you the policy number for your records. Let me know when you're ready.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK, the policy number is 02.
[AGENT][NEUTRAL] 55
[AGENT][NEUTRAL] 51
[AGENT][NEUTRAL] 26.
[CUSTOMER][NEUTRAL] So I got 02555126.
[AGENT][POSITIVE] That is correct, yes. Mhm. We have an effective date. Go ahead.
[CUSTOMER][NEUTRAL] OK, is there um
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] The effective date is [PII] and it is active at the moment.
[CUSTOMER][NEUTRAL] Is there like a member number or anything else I'll need to go do I file the claims on a web on because this has um like in the portal here it's got a carrier website that it sends me to.
[CUSTOMER][NEUTRAL] Um, and, OK, wait, OK, it's uh, it wants a member ID. Is there a member ID number?
[AGENT][NEUTRAL] The member ID is the same as the policy number.
[CUSTOMER][NEUTRAL] Oh, OK, because it says let's see, it says member ID not policy number but I'll try this and see if it works.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Are you trying to register? is that what you're trying to do or what are you trying to do exactly?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, I was trying to, well, the portal takes me to the website and then it wants to know and it says.
[CUSTOMER][NEUTRAL] Uh, to set up, I guess it's a new user. Am I doing the wrong thing? I was trying to see how to file a claim.
[AGENT][NEUTRAL] Yeah, that
[AGENT][NEUTRAL] OK, yeah, that's how you file a claim electronically if you wanna file a claim, you have to just create the account, um, through the website and now the information that is asking you on that portal for you to register is the Social Security is it's not an ID or it's not the policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I'll have to put his social there OK and then um and put his date his date of birth since it's under his employer, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Mhm, correct, yes.
[AGENT][NEUTRAL] It's gonna be all his information, so he will need to register. Mhm, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, now, um, with the email address, does it matter like if I put mine instead of his he doesn't not, he's not very good at checking his email. Did y'all have, will y'all have an email on file that we have to match that up to?
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] Correct. Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, uh, see, I don't know if it's under mine or under his email address.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Are you able to see that on your end?
[AGENT][NEUTRAL] Um, well, in in this case, mhm, mhm, OK, Miss [PII], in this case we do not have an email, but it has to be his information. We cannot update any information without having the member in the line. Um, the changes needs to be done by the insured. It cannot be done by the spouse or dependent.
[CUSTOMER][NEUTRAL] Cause mine is.
[CUSTOMER][NEUTRAL] Oh that's why I'm not trying to change anything. I just don't know if I, if we have it listed under my email or his email. Um, sometimes he uses his and yeah, there's no email listed. OK, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's not less than.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No. Mm.
[CUSTOMER][NEUTRAL] OK, that's fine. Um, so then, so once I set up as a new user, is it pretty easy? I just, I just like upload the bill, the bill from the doctor, is that what I do?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Simple, yeah.
[AGENT][NEUTRAL] Not the bills, no, um, if you go, if you, um, right now since you're on the website, if you just go ahead and click on the link on the APL bold letters, it's gonna take you to the home page. Um, if you go to the home page you're gonna see where where it says claims and forms you're gonna click on that.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and there you're gonna look for the Metlink claim form.
[CUSTOMER][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] So, oh I gotta mail it in.
[AGENT][POSITIVE] I believe it's impatience.
[AGENT][NEUTRAL] No, you don't have to mail it. You have 3 options either, um, you can send it by mail, by fax, or you can upload it into your policy once you create the online account. So there's 3 options, but you're still gonna need that claim form to be filled out either electronically or either by, you know, just handwriting, but in.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Needs to be filled out. Um, the first page of that uh form is gonna give you instructions on what you need to send in with it, um, which is two more documents that we're gonna need. Um, the first one is an itemized bill with the diagnosis code.
[AGENT][NEUTRAL] And the second document is the copy of the explanation of benefits from the primary insurance. So those two documents need to be sent in together with the form. We do not take receipts of as a documents for claim, OK?
[CUSTOMER][NEUTRAL] Oh, so yeah, well, I mean I have the actual bill with the codes and all that, but I need to wait until I get the EO I need to wait for the EOB and then send that with it, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Primary
[AGENT][NEUTRAL] Mm, yes, mhm.
[CUSTOMER][NEUTRAL] OK, alright, well I will get this set up, um, and so it's gonna, OK, so I guess it'll, well, uh, OK, hopefully Aetna has EOB's a little quicker because I don't want the bill sitting around. So this, so this policy basically covers like because the our uh Aetna has a big.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. Yes, sir.
[CUSTOMER][NEUTRAL] Uh, has a high deductible, so this will help pay for the bills like that we have to pay out of pocket and coinsurance until that's met, is that what this does?
[AGENT][NEUTRAL] Um, let me give you the benefits, um, so you have an idea about what it covers and what to send in, and this is not a guarantee of payment, just a verification of coverage, and that's just a disclaimer. And with this one, you have two benefits. One is for inpatient, which is if you're in the hospital, 18 hours or more, either observation or admitted. Um, we cover 1500 and this is to help with the deductibles, co-payment, and co-insurance from the inpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] And then you have outpatient service. Outpatient is like for an urgent care, and ER visit, um, diagnostic centers, surgery centers, um, those are the ones considered under the outpatient benefit. Uh, it does not cover office or office procedures, it's just for outpatient facilities. And this one covers $500 per occurrence. So it's um.
[AGENT][NEUTRAL] Her occurrence means that if it's related to the same treatment or condition, it needs to be separated by 90 days. So if it's the same treatment or condition, we pay every 90 days. If it's different condition or um or diagnosis, then it's gonna be $500 every time you need to use it for outpatient service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So an example, if you go to an urgent care like for a headache, um, and then you go again for a um back pain, those are 22 services and two different diagnoses. So it's gonna be 500 each. But if you go both of the times to the urgent care with the same back pain, if it's not separated by 90 days, it will only pay 1, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Gotcha. OK, yes, OK, that makes sense.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right.
[CUSTOMER][POSITIVE] OK, well, I'm gonna, this is a whole new concept for me so I got a lot to learn about it. Um, all right, well, you've been very, very helpful and I will um get, get set up on the portal and if I have any issues then I'll give a call back.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, no problem. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] Mm, I don't think so.
[AGENT][POSITIVE] OK, well thank you for calling APL. You have a good day.
[CUSTOMER][POSITIVE] All right you too thank you bye.
[AGENT][POSITIVE] You're welcome. Bye bye.