AccountId: 011433970860
ContactId: 822a2f3f-9bc9-4d22-b757-091b5b93d5b8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 553729 ms
Total Talk Time (AGENT): 307948 ms
Total Talk Time (CUSTOMER): 205249 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=2.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/822a2f3f-9bc9-4d22-b757-091b5b93d5b8_20241230T21:47_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] Hey [PII], my name is [PII]. um, I, I know it's pretty late in the year, but um I was going to try to file a claim online. I don't know my username and password. um, I never got that information, but when I try to reset my password, it says I have an account when I try to create one, but then it says my username doesn't exist for the email I put in, um, so I was hoping you could help me either figure out how to file a claim.
[CUSTOMER][NEUTRAL] A different way or get logged in to file a claim.
[AGENT][POSITIVE] It would be my pleasure to assist you. Do you have your policy number available?
[CUSTOMER][NEUTRAL] Um, I don't actually, um, I don't know if you can look that up, um, I can.
[AGENT][POSITIVE] I certainly can. I can use your social if that's OK.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] And that number?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] All right, thank you. And what is your name?
[CUSTOMER][NEUTRAL] [PII] and last name is [PII]
[AGENT][NEUTRAL] Thank you. And Miss [PII], what is your date of birth and current mailing address?
[CUSTOMER][NEUTRAL] Yes, date of birth is [PII], um, and current current mailing address is [PII], and [PII] [PII].
[AGENT][POSITIVE] All right, perfect. Thank you. I appreciate that. And then what is your email that you're using?
[CUSTOMER][NEUTRAL] Um, so I was taking a work email. I don't know if it's connected maybe to my personal email, um, but my work email is [PII], um, but I don't know if that's the one that's on file.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That is the one that's on file. And what is a good callback number for you, please, ma'am?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] All right, thank you. OK, so I do see that you have an active account online and the username is all lowercase [PII].
[CUSTOMER][NEUTRAL] Oh yes, OK, that's my maiden name, um, that's.
[CUSTOMER][NEGATIVE] That's probably my problem. I was just using my email as my username.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I do the same thing. That's not a problem. That is why we are here so we can help you. But yeah, it's all user names and passwords, it's so hard to keep up with everything.
[CUSTOMER][POSITIVE] Amazing, thank you.
[CUSTOMER][NEUTRAL] Yes, it is.
[AGENT][NEUTRAL] But that's what it is.
[CUSTOMER][NEUTRAL] OK, yep, that seemed to work, um, and then as far as filing a claim, um, because I had an outpatient procedure back in, um, April, which I should not have procrastinated to file it up until this point, um, but, um, I guess is there any anything that I should be collecting now any documentation or anything that I'm assuming you guys will need?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Absolutely. um on the website, if you go to the claim forms, there is a claim form for Medlink M E D L I N K.
[CUSTOMER][NEUTRAL] OK let me.
[AGENT][NEUTRAL] On the front page there are instructions, but I can kinda go over that with you too to make sure. So you said.
[CUSTOMER][NEUTRAL] OK, yep I see that one.
[AGENT][NEUTRAL] OK, so we'll need that claim form completed to the best that you can complete it and then we'll need a copy of an itemized bill in the form you said it was an outpatient facility?
[CUSTOMER][NEUTRAL] Uh, yeah, it was a hospital outpatient, uh, hospital.
[AGENT][NEUTRAL] OK, so you can request from them a form called a U as in umbrella, B as in Bravo, 04. That's a UBO4.
[AGENT][NEUTRAL] That'll have all the procedure codes, the charges, the diagnostic codes. It'll tell us what place of service it was. So we need that UBO4 from the hospital.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then we will need a copy of the explanation of benefits from your primary insurance care.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that will show us what they applied to your deductible, co-pay or co-insurance.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Who's your primary insurance with?
[CUSTOMER][NEUTRAL] It's um [PII] I think they use Aetna um network it's like [PII] through Aetna.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, so you just go to their website and.
[AGENT][NEUTRAL] Look for that claim.
[AGENT][NEUTRAL] And uh you can print the detailed explanation of benefits, so we'll need something that shows what they apply to your deductible, co-pay, or co-insurance for that data service.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] It sounds like a lot, but it's not a lot once you see everything.
[CUSTOMER][NEUTRAL] Yes, yeah, I think once I get logged in I'm hoping that um and then I could just submit it online correct? the claim form with that information?
[AGENT][NEUTRAL] You just uploaded, yes ma'am, just uploaded directly online.
[CUSTOMER][POSITIVE] Amazing.
[AGENT][NEUTRAL] There will also be a direct deposit option if you would prefer benefits go directly to your bank account, so that option is available.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] When you submit it, it'll ask you if you want to do direct deposit.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] And that makes it easy. Now if you sign up for the text messaging for claim status, you'll receive a text message once it's processed. You may not be able to view it online until about 24 up to 24 hours after it for it to process and go through imaging and all that, um, but you can click on the claim number and view the claim decision once it's been processed.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] So that's an option as well. A lot of people get that text and they're like, I'm gonna go check on it now. And they say, oops, it's not there, what's going on?
[CUSTOMER][POSITIVE] Perfect
[AGENT][NEUTRAL] It just needs a few minutes to get it, you know, in the
[AGENT][NEUTRAL] Online.
[CUSTOMER][POSITIVE] Perfect, yeah, no that makes sense.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Once our claims are processed, the, the payments go out the following business day. So if you do direct deposit the next day after processing, then we'll send that to your bank and you should have that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In your account within 2 to 3 business days or if by check just depending on the mail when it gets there.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, direct deposit is usually way easier.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] But if you ever want to view your policy benefits, Ms. [PII], you can click on the policy number since you have that account online, and you can within the policy, there's a page called the Schedule of benefits page, and you can view the benefits payable.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] That's the easiest way to look at it on the schedule of benefits page.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Um, and then as far as, um, because I know it is close to the end of the year, um, if I get it all submitted by tomorrow, is it OK even if like some of the processing goes into the [PII]?
[AGENT][NEUTRAL] So there's no time frame to submit a claim, so you can bring.
[CUSTOMER][NEUTRAL] Oh, OK, I don't know why I thought I had to submit it by the end of the year.
[AGENT][NEUTRAL] Well, as long as your policy is active for the data service, it's fine.
[CUSTOMER][POSITIVE] Got you. OK, amazing.
[AGENT][NEUTRAL] But yeah, you can get it in and we'll get that processed for you and also if you have any medical services, you can just show your APL card and the providers can file the claims for you and we can pay them direct.
[CUSTOMER][NEUTRAL] Mm, OK, yeah, I'll definitely need to do that next time I think because I didn't have the card. I um I was just like oh I'll I'll file the claim after.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you need us to order some cards for you? Um, you can also print them from online.
[CUSTOMER][NEUTRAL] But that's probably easier.
[CUSTOMER][POSITIVE] Yeah, I'll do that once I once I get logged in. I think that would be perfect.
[AGENT][NEUTRAL] OK. Well, if you need us to mail you some, you just call back and let us know and we'll request the cards are mailed to you.
[CUSTOMER][POSITIVE] Perfect thank you so much.
[AGENT][POSITIVE] It's been such a pleasure. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] That's it thank you I really appreciate it.
[AGENT][POSITIVE] Oh, it's been such a pleasure to assist you. And if you need anything else, Ms. [PII], you give us a call and I hope you and your family have a very [PII].
[CUSTOMER][POSITIVE] Thank you so much, you too.
[AGENT][POSITIVE] Thank you. Take care.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye-bye.