AccountId: 011433970860
ContactId: 8eca6f63-29cb-4e2d-99b6-91a266ec0d1a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 401529 ms
Total Talk Time (AGENT): 160453 ms
Total Talk Time (CUSTOMER): 157598 ms
Interruptions: 4
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/8eca6f63-29cb-4e2d-99b6-91a266ec0d1a_20250604T15:57_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Um, hi, [PII]. This is [PII] in the Medli claims department. Um, I have a member on the line. He, he has a hospital indemnity policy, and he's calling about the status of his claim. Um, it's showing that it denied because there are no outpatient benefits, and he says that he has outpatient benefits. But the claim denied and there's another claim on file that also denied for him not having outpatient benefits. So could you further assist him?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] It is 230-1578 for [PII].
[AGENT][NEUTRAL] And did he give you a callback number?
[CUSTOMER][NEUTRAL] Um, it's the one in the system, the [PII], and he verified all his information.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] OK, here he is. Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hello, is this Mr. [PII]?
[CUSTOMER][NEUTRAL] It is.
[AGENT][NEUTRAL] OK, thank you. um, she transferred you said you had questions about your claims that were processed?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] See the process and a moment.
[CUSTOMER][NEGATIVE] He tells me that I'm not covered for outpatient yet. I have an outpatient cert number and I'm supposed to be covered. My company tells me by both in hospital and.
[CUSTOMER][NEUTRAL] Uh, outpatient, that's what I'm paying for.
[AGENT][NEUTRAL] OK, because I do show you have a Medlink policy.
[AGENT][NEUTRAL] It looks like the claim was under your HI plan which does not have any outpatient benefits but give me one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Let's see, this was for data service of [PII]?
[CUSTOMER][NEUTRAL] There are several of them. There's 5 of them total.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All done at my doctor's office.
[AGENT][NEUTRAL] Yeah, it looks like it was submitted by the provider but they placed it under the HR policy, uh, hospital indemnity plan you have with us that does not cover um outpatient, but let me see if they placed it under the Metlink. give me one moment.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, I have meddling select group.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And those two claims have been processed is not covered under the HI policy were processed under your Metlink plan.
[AGENT][NEUTRAL] Um, you said there was other data to service that means that the claim was placed, uh, placed under another policy you have with us, and those were processed and benefits were paid to the provider.
[CUSTOMER][NEUTRAL] Uh-huh. What does that mean?
[CUSTOMER][NEUTRAL] Yeah, I
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So how do I get that rectified?
[AGENT][NEUTRAL] Get what rectify the claims to be repriced or reprocessed?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well, they've already been reprocessed under your.
[CUSTOMER][NEUTRAL] The ones that haven't been covered.
[AGENT][NEUTRAL] They have already been processed under your meddling plan and benefits were paid to the provider, so they have been reprocessed.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] All of the labs.
[AGENT][NEUTRAL] Yes, sir. There is one for lab, and I forgot the other one, but yes, sir, they have been processed and paid to the provider.
[CUSTOMER][NEUTRAL] From Labor
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Uh, for the lab that was 20952 was paid to the provider and that was on [PII] of this year.
[CUSTOMER][NEUTRAL] OK, then I'm gonna have to.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and there's, there was a total of 5, I think that I was told weren't paid.
[AGENT][NEUTRAL] I only saw 2, and those two I do show were processed.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] It was a total of $500 and some uh it was like $524 between all of them for Labor.
[CUSTOMER][NEUTRAL] I'm not at home. I'm at work.
[CUSTOMER][NEUTRAL] Just got this text so one of the.
[AGENT][NEUTRAL] And this claim was from Lakeland pathologist. I don't see any claims from LabCorp.
[CUSTOMER][NEUTRAL] See if anything is outstanding then.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, but the one go.
[CUSTOMER][NEUTRAL] OK, there are some, well, then Labor is probably not processing through you, which is I've been trying, I've been arguing with them about I keep giving them APL and I think they keep running it on my primary insurance.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Um, all right, so the one for the.
[CUSTOMER][NEUTRAL] Pathologist was covered. But uh now I've got to go back to them about the other 5 then that they're that they're saying.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] APL is denying but apparently they're not even attempting to put them through you.
[AGENT][NEUTRAL] And when you're giving them our information, are you, which policy number are you giving it to them?
[CUSTOMER][NEUTRAL] I'm giving them the 02493494ML8.
[AGENT][NEUTRAL] Uh, that is correct, yes sir, so I'm not sure why it was placed on the HR, but um, yes sir, and if you like I can give you our fax number and they can fax the claims to our office.
[CUSTOMER][NEUTRAL] Mm, I don't.
[CUSTOMER][NEUTRAL] OK, please, I'll call them.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me know when you're ready.
[CUSTOMER][POSITIVE] I am ready.
[AGENT][NEUTRAL] Uh, fax number [PII].
[CUSTOMER][NEUTRAL] 877
[CUSTOMER][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 14.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] All right cool I appreciate you've been very helpful.
[AGENT][POSITIVE] Alright, you're welcome and thank you so much for calling APL. You have a great day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Bye bye.