AccountId: 011433970860
ContactId: 76d90bb9-b3c5-44be-9b30-43a1c9b47c91
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 563030 ms
Total Talk Time (AGENT): 310619 ms
Total Talk Time (CUSTOMER): 161051 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/76d90bb9-b3c5-44be-9b30-43a1c9b47c91_20250306T20:12_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, how are you? Um, my name is [PII]. So I'm calling, um, regarding, um, I have a bill for my OBGYN that when I went to the hospital, um, and uh how do I send you that bill so I could get the, you guys to pay for it?
[AGENT][NEUTRAL] OK, so you're the insured and you're wanting to find out how to file a claim with APL is that correct, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] Yes, ma'am. I can help you with that. And what is your last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And your policy number, please, [PII]?
[CUSTOMER][NEUTRAL] OK, one second let me let me.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I mean, I believe this is 102273057.
[AGENT][POSITIVE] OK, thank you. So give me a couple of moments please to get your information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. I will have to verify several things with you first for security. So if you could first please verify your date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Also your home mailing address, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you gave me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. And lastly your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, Ms. [PII], thank you for verifying all of your information with me. So, first off, have you ever set up your profile in our portal called the online service center?
[CUSTOMER][NEUTRAL] Yeah, I did.
[AGENT][NEUTRAL] OK, so I actually have a user guide if you have not already received that that I can email to you along with the claim form for this medlink policy because the claim form gives the instructions on what other documentation you would need to submit to us along with your claim form for review.
[AGENT][NEUTRAL] And if you're set up in the portal you can actually upload all of that information directly into the portal for us to review.
[AGENT][NEUTRAL] You can file your claim online. Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So would you like for me to send you that information?
[CUSTOMER][NEUTRAL] Let me see if I could
[CUSTOMER][NEUTRAL] Hold on, let me, let me see.
[CUSTOMER][NEUTRAL] Please send me.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Hold on, I think I put on my login. Hold on, let me, let me, let me try it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK then.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I think I got in, OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, I'm there.
[AGENT][NEUTRAL] OK, so you can actually get your claim form from our website, our public website, if you will open another tab and go to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'm there.
[CUSTOMER][NEUTRAL] Claim forms, OK.
[AGENT][NEUTRAL] OK, do you see where it's mhm, so click there, scroll down the page and you will see about middle ways down there's a small box that says filter by product and it has a little green drop down arrow in it.
[AGENT][NEUTRAL] If you'll click on that drop.
[CUSTOMER][NEUTRAL] Yeah, accident claim form, concept and change of.
[AGENT][NEUTRAL] You're looking for the med link, Med link.
[AGENT][NEUTRAL] You see the word meddling?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, I'm seeing a bunch of.
[AGENT][NEUTRAL] OK, so on the little.
[CUSTOMER][NEUTRAL] My account
[AGENT][NEUTRAL] No, on the where it says filter by product and it has a small green arrow.
[CUSTOMER][NEUTRAL] Let me check it now. OK, so res the filters, filter that product, OK, I see it.
[AGENT][NEUTRAL] It well, it says, it says filter by product. Uh-huh, if you'll just click the green arrow, uh-huh, and click on the word med link.
[CUSTOMER][NEUTRAL] Um, me link, OK.
[AGENT][NEUTRAL] Now you should see out to the right there's a blue button that says download form and if you will click that it's going to download your claim form.
[CUSTOMER][NEUTRAL] Yeah, on there.
[CUSTOMER][NEUTRAL] I know
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And the top section of that claim form gives instructions for you. It has like 4 bullet points.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I just use that as your checklist because that gives you, tells you how to complete the claim form and then again the additional documentation that you will need to present along with that.
[CUSTOMER][NEUTRAL] Yes, I see it.
[CUSTOMER][NEUTRAL] Complete the statement of insurer.
[CUSTOMER][NEUTRAL] Completing section D, is that how to.
[CUSTOMER][NEUTRAL] The documents be.
[CUSTOMER][NEUTRAL] OK, the explanation of benefits.
[AGENT][NEUTRAL] Yes, ma'am, and you.
[CUSTOMER][NEUTRAL] So then I will get that from the doctor, right?
[AGENT][NEUTRAL] The explanation of benefits will come from your primary insurance carrier.
[AGENT][NEUTRAL] And then your itemized bill with the diagnosis code will come from your provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now your provider, your provider may have a copy of your primary insurance company's explanation of benefits for the data service.
[CUSTOMER][NEUTRAL] I think I have it, let me see.
[AGENT][NEUTRAL] But if not, you know, you should be able to get that from your primary insurance.
[CUSTOMER][NEUTRAL] Yeah, like I have um
[CUSTOMER][NEUTRAL] The claims summary I guess is that what you need?
[AGENT][NEUTRAL] Yes, ma'am. It should show any amounts that were applied to your deductible, co-pay, or co-insurance amounts.
[CUSTOMER][NEUTRAL] OK, yeah. The insurance, for example, is 0.
[CUSTOMER][NEUTRAL] And then the deductible. OK, so you need that bill.
[AGENT][NEUTRAL] We need that explanation of benefits. Yes, ma'am. Uh-huh. Along with the itemized bill that includes the diagnosis code from your provider.
[CUSTOMER][NEUTRAL] From Humana.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And make sure that you sign your claim form as well. Now I am gonna go ahead and email you this user guide because it just gives you some information on like the type of files that you can upload and the size and.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Adding in, you know, direct deposit information, that type of thing. So I will send you that um in just a moment, [PII], and the email that you're gonna receive will come from care team at [PII].
[AGENT][NEUTRAL] And I will put APL online service center portal in your subject line.
[CUSTOMER][POSITIVE] OK, perfect. And then, for example, um with that form.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I go back to my regular thing that says upload documents or?
[CUSTOMER][NEUTRAL] Or
[AGENT][NEUTRAL] Yes. Once you have all of your information together and saved on your computer, you will log into your portal and you will upload that information.
[CUSTOMER][NEUTRAL] I put [PII] and applicant and then I put.
[CUSTOMER][NEUTRAL] Upload and and you guys would do like a claim.
[AGENT][NEUTRAL] And you
[AGENT][NEUTRAL] But you are gonna be submitting your documents to us for review by uploading all of this information once you have it together and you will receive a confirmation letting you know that your upload was successful and like I said you can opt in for text notification alerts and you can add in direct deposit information also into your portal and that user guide will give you that information on how to do that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. I'll do that. Thank you so much.
[AGENT][NEUTRAL] Mhm. Yes, ma'am.
[AGENT][POSITIVE] Well, you are certainly very welcome. Yes, ma'am. Is there anything else um that I can help you with today, [PII]?
[CUSTOMER][POSITIVE] Appreciate it.
[CUSTOMER][POSITIVE] Um, no, I think I'll call back if anything. Thank you.
[AGENT][POSITIVE] Well, absolutely. Well, you're very welcome. So thank you again for calling APL and I hope you have a nice afternoon.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You too. Bye, thanks.
[AGENT][POSITIVE] Thank you, bye bye.