AccountId: 011433970860
ContactId: 765b3fbb-a04c-4883-8437-1a43b59781ae
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 437679 ms
Total Talk Time (AGENT): 186685 ms
Total Talk Time (CUSTOMER): 167177 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/765b3fbb-a04c-4883-8437-1a43b59781ae_20250408T21:22_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, and, um, I was just chatting with y'all earlier about the gap insurance stuff but I completely forgot a question.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] I have some like claims that came through before I had the gap insurance card. Is there any way to go back and process that through after the fact? Could the doctors do that, or is that something you guys would need like the paper billing from us after we already paid that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It depends.
[AGENT][NEUTRAL] So it depends. Um, well, first, let me pull your, um, let me pull your policy up so I can know exactly for sure, but, um, may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, of course, um, [PII].
[CUSTOMER][NEUTRAL] And then [PII], the last name.
[CUSTOMER][NEUTRAL] And for my contact number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And your policy number?
[CUSTOMER][NEUTRAL] Let me get my card. Um, I thought I had a picture of it, but I do not. I need to go grab it really fast. Sorry.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh no, you're fine. Take your time.
[CUSTOMER][MIXED] Appreciate it. I I just leave my wallet in like the most inconvenient place, I feel like.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] All right, um, let's see.
[CUSTOMER][NEUTRAL] It has
[CUSTOMER][NEUTRAL] A coverage and a group number, oh, pay ID there it is. uh 60801.
[AGENT][NEUTRAL] Oh, so not the payer ID. You're looking for a policy cert number. It might say in hospital or outpatient.
[CUSTOMER][NEUTRAL] Oh, yeah, exactly. Um, so, in hospitals is 02604221.
[CUSTOMER][NEUTRAL] ML 7
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] And then the outpatient is just ML 8 instead.
[AGENT][NEUTRAL] Alright, hold on one moment.
[AGENT][NEUTRAL] And what's the name on the policy?
[CUSTOMER][NEUTRAL] Um [PII] and then [PII] [PII] [PII]
[AGENT][NEUTRAL] Wait a minute, I must have typed something wrong. Can you repeat that um inpatient policy number?
[CUSTOMER][NEUTRAL] Yeah, um 0260.
[CUSTOMER][NEUTRAL] 4221
[CUSTOMER][NEUTRAL] ML 7.
[AGENT][NEUTRAL] I see what happened. I missed it too. Sorry about that. And um in your policy, I just need you to verify your date of birth, mailing, and email address on file.
[CUSTOMER][NEUTRAL] No, you good.
[CUSTOMER][NEUTRAL] Yeah, [PII], uh, email, uh, I think it's gonna be [PII]. Could also be my work email. I don't know.
[CUSTOMER][NEUTRAL] Um, and address is [PII]
[AGENT][NEUTRAL] Thank you, and all the information provided is a verification of benefits, not a guarantee of payment.
[AGENT][NEUTRAL] And so, as long as the policy was active on your dates of service, you can file the claim at any time. Um, so this policy became effective on [PII] of this year, [PII]. So anything from then on, anything before then, you wouldn't be able to file on this policy because it wasn't active.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Perfect. Um, and how would I like process those claims retroactively? Is that something that like I would submit a document to the website for you guys? or do you know that like if doctors just kind of do that when we give them an updated policy?
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] So that's really up to your preference. If it, if it was active, you can just give the um either your ID card or just call them and give them the policy number and let them know like, hey, I have a secondary insurance, here's the policy number. Um, it's been effective since [PII]. Um you can bill them.
[AGENT][NEUTRAL] Or you can file a claim if you like to.
[CUSTOMER][NEUTRAL] OK, cause they did already.
[CUSTOMER][NEUTRAL] Yeah, I was gonna say I did already pay for some of the claims, so I'm curious um if like going back.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Well, no, if
[CUSTOMER][NEUTRAL] Like what makes the most sense.
[AGENT][NEUTRAL] If you've already paid, like you got the bills and you paid for them.
[AGENT][NEUTRAL] And you're just trying to be reimbursed. OK. So then, no, I, so in that case, no, I, I would file a claim on my own. So, to file a claim, you'll need 3 things.
[CUSTOMER][NEUTRAL] Yeah, because I didn't realize how this worked.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You're going to need the Medlink claim form, M E D L I N K.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim form and that can be found on our website. Our website is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And you'll click on claims and forms to the top right.
[AGENT][NEUTRAL] And then you'll just search for the Metlink form. It's in alphabetical order.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Alright, so the
[CUSTOMER][NEUTRAL] And I just mail that in with.
[AGENT][NEUTRAL] Well, no, you need two more things. So the claim form, the explanation of benefits from your primary insurance?
[CUSTOMER][NEUTRAL] Oh sorry, go ahead.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the itemized bill from the provider. On the itemized bill, um, some places might call it a universal bill, but it just needs to, you need to stress not the patient itemized bill, their, their version, and it needs to have the diagnosis codes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Procedure codes and all the charges.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] OK, amazing. This is so helpful. Thank you so much.
[AGENT][POSITIVE] You're very welcome. Well, was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Um, I don't think so. I think that's it for now.
[AGENT][POSITIVE] Alrighty well thank you so much. You're welcome for calling APL [PII]. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] You too, bye.
[AGENT][POSITIVE] Thank you. Bye bye.