AccountId: 011433970860
ContactId: 8a4c9b19-00b1-45a6-a833-b6f6144de8a9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 858989 ms
Total Talk Time (AGENT): 291068 ms
Total Talk Time (CUSTOMER): 340100 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/8a4c9b19-00b1-45a6-a833-b6f6144de8a9_20250613T20:46_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] Hi, [PII], good afternoon. This is [PII]. I just wanted to have your assistance with uh filing a claim. I recently went to, uh, an urgent care, and I, again, I was in so much pain that I forgot that, uh, those visits, uh,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We included in my plan, I ended up paying for it so now I just wanted to, you know, submit the request for reimbursement.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, I can help you with filing the claim, um, and Mr. [PII], may I have a good contact number in case we're disconnected and your policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, it's uh [PII].
[AGENT][POSITIVE] Thank you for that and your policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Uh, the policy number, where do I see it? I have the group number, payer ID in hospital and outpatient number.
[AGENT][NEUTRAL] On
[AGENT][NEUTRAL] Yes, the in-hospital and outpatient policy, sir, the, the um numbers are the same, the ML 7 or 8 at the end is different. I just need those numbers.
[CUSTOMER][NEUTRAL] Where do I
[AGENT][NEUTRAL] That's your policy number.
[CUSTOMER][NEUTRAL] Uh, OK, so the one that ends with ML 7 is 0244.
[CUSTOMER][NEUTRAL] 3504 ML 7
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] And can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] Sure, uh, [PII]. Mailing address is [PII]. And what else did you say that you need?
[AGENT][NEUTRAL] Yeah, email.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Um, this may be your work email?
[CUSTOMER][NEUTRAL] No, that's my personal. Uh, the work email uh is [PII].
[AGENT][NEUTRAL] Yes, and thank you so much for verifying your information and all your information provided is a verification of benefits, not a guarantee of payment. Um, did you want to make your email your personal email or you're OK with it being your work email?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] My work email is fine.
[AGENT][NEUTRAL] OK, um, so you can either mail the claim.
[CUSTOMER][NEUTRAL] Is that, is that what you have is, is that what you have in, in, in, in your files?
[AGENT][NEUTRAL] Yes, your work email.
[CUSTOMER][NEUTRAL] [PII]. OK, yeah, so let's just keep it.
[AGENT][NEUTRAL] OK, so you can fax the claim, you can mail it, or you can send it electronically. Um, which of the three would you prefer?
[CUSTOMER][POSITIVE] Good
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, electronically by email, right?
[AGENT][NEUTRAL] not email, um, on the online portal. Are you near a computer now?
[CUSTOMER][NEUTRAL] Yes, I am.
[AGENT][NEUTRAL] OK, um, I can walk you through if you don't have one set up already, and then um you can file the claims from there.
[CUSTOMER][POSITIVE] OK, I'd appreciate it.
[AGENT][NEUTRAL] OK. Um, let me know when you're ready. Hold on one second.
[CUSTOMER][NEUTRAL] So where where do I go?
[AGENT][NEUTRAL] So you're gonna go to um [PII].
[CUSTOMER][NEUTRAL] Oh OK. Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] So, to file the claim, you're gonna need the Medlink claim form. So um to the top right, you'll see where it says claims and forms.
[CUSTOMER][NEUTRAL] Yes, I see it. So click on it.
[AGENT][NEUTRAL] Alright, go ahead and click on that, uh-huh, and scroll down until you see claims forms and policy change documents.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Uh, OK.
[AGENT][NEUTRAL] And then keep scrolling until you see the 123 and click the second or the number 2.
[CUSTOMER][NEUTRAL] Number 2.
[CUSTOMER][NEUTRAL] Is that authorization to disclose information?
[AGENT][NEUTRAL] Uh, scroll down, continue scrolling till you see the actual number 2.
[CUSTOMER][NEUTRAL] 00, for the page number 2?
[AGENT][NEUTRAL] Yes, it'll be 123, click on the number 2.
[CUSTOMER][NEUTRAL] OK, yes, OK.
[AGENT][NEUTRAL] And then you're um looking for the Medlink claim form. It should be the 3rd form on the list.
[CUSTOMER][POSITIVE] I, yes, I found it.
[AGENT][NEUTRAL] Alright, so go ahead and download that form, so you'll fill that out, um, you can fill it out electronically. Anytime you file the claim, that will be needed.
[CUSTOMER][NEUTRAL] Down
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, OK.
[AGENT][NEUTRAL] Uh, so once you download that and save it.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me know when you're finished.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Let me download it.
[CUSTOMER][NEUTRAL] But I guess that I need to complete this before downloading it, right?
[AGENT][NEUTRAL] Um, no, you should download it and save it, and then, um,
[CUSTOMER][NEGATIVE] Oh no.
[AGENT][NEUTRAL] If you say it
[CUSTOMER][NEUTRAL] Right, but so then how do I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I can't complete it online, right?
[AGENT][NEUTRAL] No, so when you download it and save it, you're taking it off the internet and putting it onto your computer. You're saving it to your computer.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][POSITIVE] Got it. OK. Yeah. OK. OK. Understood. So, OK, I saved it.
[AGENT][NEUTRAL] All right, so you said you saved it?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Yes, I do.
[AGENT][NEUTRAL] OK, so then you're going to scroll back up to the top and click sign in.
[CUSTOMER][NEUTRAL] Sign in, sign up or log in, right?
[AGENT][NEUTRAL] Um, it should say sign in.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. And then it should say welcome to online service center.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, go ahead and click create your OSC account.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you're the insured?
[CUSTOMER][NEUTRAL] Then I guess that I insured. OK, next.
[AGENT][NEUTRAL] And then you would enter that information there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] What's my member ID?
[AGENT][NEUTRAL] Um, there's no member ID for, um, this type of policy, so that would be your full social.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, complete your account set up, continue.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] A verification is necessary, please.
[CUSTOMER][NEUTRAL] Click send the button.
[CUSTOMER][NEUTRAL] So, OK.
[CUSTOMER][NEUTRAL] OK, I just got a cold.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Verify code. The code has been verified, so now I need to create a password, right?
[CUSTOMER][NEUTRAL] Displaying name.
[CUSTOMER][NEUTRAL] OK, continue. I agree in terms of your privacy policy.
[CUSTOMER][NEUTRAL] OK, it looks like I created my account. Should I log into it now?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] I'm sorry, I just had a whole conversation on mute. Yes, sir, you can um go ahead and log into it.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] Verification code again.
[CUSTOMER][NEUTRAL] All right, looks like I'm in.
[AGENT][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] I can see my dashboard.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then to the top right it should say um
[AGENT][NEUTRAL] It should be, it should ask about submitting a claim.
[AGENT][NEUTRAL] I should say
[CUSTOMER][NEUTRAL] Hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know, well, because now this is asking me for um.
[CUSTOMER][NEUTRAL] Or another code. OK, that I just received.
[CUSTOMER][NEUTRAL] Got it. OK. So now, OK, so where do I go? I'm in, I'm in my dashboard. So I can see dashboard my policy resource center and then help to the left.
[AGENT][NEUTRAL] OK, my policy?
[CUSTOMER][NEUTRAL] My policy, OK.
[AGENT][NEUTRAL] And then it should say my details and claims.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] It may take a minute to come, you see it?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, I see.
[AGENT][NEUTRAL] OK, and then do you see to the right need to file a wellness or traditional claim?
[CUSTOMER][POSITIVE] Yes, I do, yeah.
[AGENT][NEUTRAL] All right, and then you'll click on start your claim, and that's how, that's where you'll go um once you fill out your claim form and have your documents and um you'll be able to upload it there.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK. So this is a traditional claim, right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, so next.
[CUSTOMER][NEUTRAL] What do you need, policy information, supporting documents, claim form?
[CUSTOMER][NEUTRAL] Next step, select the claimant, which is me and then I have two options here Medin SFS.
[CUSTOMER][NEUTRAL] Oh my [PII]. Uh, what's the difference between those things?
[AGENT][NEUTRAL] Um, hold on one moment. What's the, what's the other option that it's giving you?
[CUSTOMER][NEUTRAL] Uh, I have to select select coverage slash policy type.
[CUSTOMER][NEUTRAL] That I have a number here, 1869601 Matin SFS.
[CUSTOMER][NEUTRAL] And then another option with number 2443504 dash Medlink SFS.
[AGENT][NEUTRAL] So, the first policy.
[CUSTOMER][NEUTRAL] I don't know. I mean, other than
[CUSTOMER][NEUTRAL] That's what
[AGENT][NEUTRAL] The first policy number 1869601. That was the very first policy you had with us from [PII].
[AGENT][NEUTRAL] To [PII]. So if there's any claims that you need to file within those dates, you would file it under that 186 number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, the 24 244 number became effective on [PII]. So anything [PII] and to now would be the 244 number.
[CUSTOMER][NEUTRAL] Oh got it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I'm OK, clicking on that one and then next step, I guess.
[CUSTOMER][NEUTRAL] And then upload files.
[CUSTOMER][NEUTRAL] Is it here that I upload that uh the claim form?
[AGENT][NEUTRAL] Right, so you'll upload the claim form and then any of the documents that you have, your itemized bills, your, um, I don't know, um.
[AGENT][NEUTRAL] What are you're filing for, but
[CUSTOMER][NEUTRAL] Yeah, I, I, I, I, I have a, uh, uh, a receipt for the copay that I paid, uh.
[AGENT][NEUTRAL] Uh, explanation of benefits from primary insurance, yes.
[CUSTOMER][NEUTRAL] But that's about it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, all right.
[CUSTOMER][NEUTRAL] So I guess I mean
[CUSTOMER][NEUTRAL] It's just a matter of me following, you know, all the steps here and, and that's it.
[AGENT][NEUTRAL] Mhm. And then once you submit it, you, you'll get a confirmation number letting you know it came through to us successfully. And then once it's um finished processing, you'll receive a text message letting you know it's completed and you can come online to see the decision.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, understood.
[CUSTOMER][NEUTRAL] All righty, so I guess that I'll, I'll, I'll print, uh, and, and fill this uh form out and then I'll, I'll upload everything to the portal here.
[AGENT][NEUTRAL] All righty. Well, was there anything else I can assist you with today, Mr. [PII]?
[CUSTOMER][POSITIVE] No, no, no, that was all. I really appreciate your help, OK?
[AGENT][POSITIVE] Well, you're very welcome and thanks for calling APL. I hope you have a great weekend.
[CUSTOMER][POSITIVE] You too. Bye. Thank you.
[AGENT][POSITIVE] Thank you. You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] Bye.