AccountId: 011433970860
ContactId: 845898fa-32f4-4ce0-950e-3891d5605fdf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 621080 ms
Total Talk Time (AGENT): 242144 ms
Total Talk Time (CUSTOMER): 307309 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/845898fa-32f4-4ce0-950e-3891d5605fdf_20250414T17:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII], and this is my first time reaching out to you, and I just wanted to check and see what the procedure is for filing a claim for the gap insurance. And I've got my policy number, my group number.
[AGENT][NEUTRAL] OK. May I have your policy number?
[CUSTOMER][NEUTRAL] Sure, it's 025.
[CUSTOMER][NEUTRAL] 86751
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And [PII], could you please verify your date of birth and mailing address, please?
[CUSTOMER][NEUTRAL] Sure, it's [PII], and our mailing address is [PII].
[AGENT][NEUTRAL] Thank you and may I have a callback number just in case this call is disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And it does look like we have an email address on file. Could you verify that for me?
[CUSTOMER][NEUTRAL] Yeah, well, you may have two of them because we were in the process of changing, uh, the company was purchased by Questco is the new company, so my new Questco email address is [PII], and the one that we had last month was
[CUSTOMER][NEUTRAL] A [PII] and both of them go to my house or go to me, so I get both of them.
[AGENT][NEUTRAL] OK, so is it OK to keep it at the [PII]?
[CUSTOMER][NEUTRAL] Yes, because they're gonna keep that forwarding to the to the new one, so it's that'll stay forwarding.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, and thank you so much [PII] for verifying your policy. You were calling in to see how to submit claims. You do have three options, that is the secured portal.
[AGENT][NEUTRAL] Mail and fax.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I guess I've got the.
[CUSTOMER][NEUTRAL] I'm on the, on the website right now, um.
[CUSTOMER][NEUTRAL] Is that where you just go to claim submission?
[AGENT][NEUTRAL] Yes, you're on [PII]?
[CUSTOMER][NEUTRAL] Uh, let's see, uh, well, bear with me a second, it's in uh.
[CUSTOMER][NEUTRAL] Uh, let's see, I am at [PII] right now.
[CUSTOMER][NEUTRAL] Uh, claims and forms.
[AGENT][NEUTRAL] OK, so the, the website that you actually go to is what's listed on the card which is secured.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Oh, OK, let me try that.
[CUSTOMER][POSITIVE] Secure.
[AGENT][NEUTRAL] A [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] And have you ever set up a username or anything listed?
[CUSTOMER][NEUTRAL] Oh yes I did. OK, so I'm clicking on it right now. OK, I'm in there now I'm in the portal, yep.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And so there, there you will be able to check your claim status, submit claims online also you will be able to check your benefit plan and download your ID card if need be.
[CUSTOMER][NEUTRAL] OK, got you, and I've got the, I got the ID card. I think that was the reason I've been into the, into the site before just to get that. So can you explain to me exactly what the procedure is? What, what do you need for, I've, I've got a balance bill from my, um, medical provider. So I just send a copy of just upload a copy of that for the form for the claim?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, now what, what is needed in order for us to review the claim, it, it can be the an itemized bill, a statement with the date of service and total bill, but we will need the primary insurance explanation of benefit.
[AGENT][NEUTRAL] That says that you do have a patient's responsibility, which was applied to your deductible, co-insurance, or co-pay.
[CUSTOMER][NEUTRAL] Yeah, I got
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yep, I got that this morning. That's exactly what I got. That's what it said. It said this is, you know, you're been applied to your deductible, your max out of it was MOP, so I it took me a minute to figure out what that was. That was max out of pocket, it looks like, and here's your balance bill for for the patient. So that's the, that's the piece you need, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It does say that it was applied to the deductible, co-insurance or co-pay.
[CUSTOMER][NEUTRAL] Correct, it did say that on the portal. I had to go into the portal to get it, so I'm gonna try to log back into the portal and then print off a copy of it because it just, it asked me if I want to pay it over the portal, but it's like they don't show a copy of it as the total and it said it's been applied, but I don't have, I don't see the actual invoice. I gotta go in there and find where the invoice is. I'm sure I can find it, but I assume I can find it.
[AGENT][NEUTRAL] OK. So did they come from the provider or did they come from your primary insurance?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Nope, that came from the, from the hospital after the procedure.
[AGENT][NEUTRAL] OK, so what
[CUSTOMER][NEUTRAL] And so they've already applied to insurance.
[AGENT][NEUTRAL] What we need is from your primary insurance that is the explanation of benefit. So whoever you have as your primary, you should be able to go on to their website as well and pull that data service and download that EOB.
[CUSTOMER][NEUTRAL] OK, so be better to get it from the.
[CUSTOMER][NEUTRAL] And it's an EOB I need explanation of benefits.
[AGENT][POSITIVE] Yes, it's an explanation of benefit.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Got you. And can you tell me, I, because I can't, I.
[CUSTOMER][NEUTRAL] I clicked on the med link with benefit assignment and I click on it. It says getting your file, but it's
[CUSTOMER][NEUTRAL] I'm not seeing the
[CUSTOMER][NEUTRAL] Oh, there it is. OK, I just, I wasn't patient enough. It finally just downloaded.
[CUSTOMER][NEUTRAL] I just downloaded the copy of the policy. That's what I was looking for. I couldn't find it couldn't seem to find a copy of it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] That is there an amount that this covers, or is there a percentage that it covers? How does that Medlink 6 policy work?
[AGENT][NEUTRAL] Let me check that for you.
[AGENT][NEUTRAL] Was this services, it was rendered within an office setting or outpatient facility?
[CUSTOMER][NEUTRAL] Um this was rendered in
[CUSTOMER][NEUTRAL] A surgical center or from the hospital owns it, but it's a surgical center off from the main hospital.
[AGENT][POSITIVE] OK, I'm pulling that up for you now.
[AGENT][NEUTRAL] And also, before I forget, when you submit in the documentation, you do need to make sure that it does have the diagnosis code listed. And I'm not sure if that's gonna be on that invoice, but if not, you may need to contact that provider and ask them for the reason of the visit.
[CUSTOMER][NEUTRAL] Oh yeah, it's, yeah, I had just had to have a hernia repair, just a small surgical thing.
[AGENT][NEUTRAL] OK, so see we're still gonna have to have something showing that that's why we need it from the provider for that date of service indicating.
[CUSTOMER][NEUTRAL] Um yeah
[CUSTOMER][NEUTRAL] So description
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] But description plus the code.
[CUSTOMER][NEUTRAL] You need, you need bolted.
[AGENT][NEUTRAL] It's gonna have, do you, is the description on there, listed on there?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, good question. I'll have to look. I'll pull it up on that, um, portal, but it's, I can only get into the portal on my phone. So if I, I can't get into it while I'm on the phone with you, unfortunately I have to do that after.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, no problem. Yes, as long as it shows the description.
[CUSTOMER][NEUTRAL] So diagnosis so we will be.
[AGENT][NEUTRAL] Yes, if it shows the description, we would be able to, you know, figure out what that code would be, but it just has to show what the reason for that visit was. If it's not listed on there, you may have to contact them and it will have to be with something with their letterhead on it indicating that that is for that date of service.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Goodbye.
[CUSTOMER][POSITIVE] You got it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] OK, and in regards to your outpatient benefits, verification of coverage does not guarantee the payment of the claim. It does show that you have $1000 that would apply to your primary insurance deductible, co-insurance, or co-pay for that calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got you and
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And that's, that's the, that's the full that's the, that's the policy, right? That's what it covers.
[AGENT][NEUTRAL] Yes, that's the maximum benefit for outpatient.
[CUSTOMER][NEUTRAL] OK, got you, and that would be considered outpatient?
[AGENT][NEUTRAL] Yes, you stated it was in a surgical facility.
[CUSTOMER][NEUTRAL] Where it was done in the surgical.
[CUSTOMER][NEUTRAL] Yes, yeah.
[CUSTOMER][NEUTRAL] Yeah, it's owned by the hospital, but it's still, they still call it.
[CUSTOMER][NEUTRAL] You know, main med, the same as the name as the hospital, but it's not on there. It's just a different location. It's, it's there. It's not like a, it's not a third party. It's not like a physician's office or that type of thing. It's, it's there, it's part of the hospital, but it's just, it's at a different address than the main, the primary hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, as long as it's for the it rendered within an out outpatient facility, then that is the maximum amount that we will pay out for the calendar year.
[CUSTOMER][NEUTRAL] OK. Is it different, is it different for in, in a hospital setting?
[AGENT][NEUTRAL] Let me pull that up for you.
[CUSTOMER][NEUTRAL] If it was done internally.
[AGENT][NEUTRAL] If you stayed or was confined within a hospital that is covered up under your inpatient, and for your inpatient, you do have up to $3000 per calendar year.
[CUSTOMER][NEUTRAL] Got it. OK. And the difference probably staying overnight in the hospital would eat up that that extra $2000 anyways, so OK.
[AGENT][NEUTRAL] Yes, it is, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, I will look for that. I'll see if I can get in and get that uh EOB and then the diagnosis code and the description and I'll get that uploaded and get, get to work on that.
[AGENT][NEUTRAL] OK, is there anything else that I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] No, I think that'll do it. Thank you very much for the help.
[AGENT][POSITIVE] You're welcome and thank you for calling American Public Life. Have a great rest of your day.
[CUSTOMER][NEUTRAL] You too. OK, bye bye.
[AGENT][POSITIVE] Thank you bye.