AccountId: 011433970860
ContactId: 9470feae-7ef8-45cb-b1a1-be52073d7d3a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 757380 ms
Total Talk Time (AGENT): 491607 ms
Total Talk Time (CUSTOMER): 332860 ms
Interruptions: 12
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/9470feae-7ef8-45cb-b1a1-be52073d7d3a_20250603T17:24_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, good afternoon, [PII]. My name is [PII], and I have a plan with you guys. Um, I was wondering, how do I submit a bill?
[AGENT][NEUTRAL] I am.
[CUSTOMER][NEUTRAL] Or, you know, how do I go about, I've, I've been with you guys for over 2 years and I never submitted a claim.
[AGENT][NEUTRAL] OK, Mr. Cheers, so.
[CUSTOMER][NEGATIVE] And I'll have surgery.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] I had surgery, so they send me a bill here that I'm supposed to be responsible for.
[AGENT][NEUTRAL] OK, so you're wanting, you're the insured and you're wanting to find out how to file a claim. Your, your provider's not filing it for you and you need to file it, is that correct?
[CUSTOMER][NEUTRAL] Yeah, I guess I do, yes, because I gave them my um insurance information, my primary insurance. Um I gave them my secondary, which was, you know, APL, but I don't know what happened.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, well, I can help you with that. Um, what I'll need to do first off, um, what is a good callback number for you?
[CUSTOMER][NEUTRAL] My number is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, Ms. [PII]. Thank you. And what is your policy number?
[CUSTOMER][NEGATIVE] Uh, I don't have a policy number on this card. All it says group number. This is the problem. I just have coverage employees and spouse.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So you should have something that says maybe an in-hospital or outpatient number policy.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah. OK. OK. OK. So would that, is that the policy number that you guys calling?
[AGENT][NEUTRAL] Uh, yes, ma'am. The first, if you'll notice on your card, the first part of both of those numbers prior to the letters ML is exactly the same.
[AGENT][NEUTRAL] So that's your actual policy number. The rest of it just helps us to be able to determine if it was an inpatient or an outpatient admission.
[CUSTOMER][NEUTRAL] Impatient oil. Gotcha. OK, I have it, so it's 0022.
[AGENT][NEUTRAL] Uh-huh. So.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 68001. So you said that ML just needs to be able to identify whether it's inpatient or outpatient, is that correct?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right. So, yes, this one that has an ML 7 and one has an ML 8.
[CUSTOMER][NEUTRAL] And the MLA, OK, I'm glad I'm like you told me that because they had asked me for a policy number and I was oblivious to what I was looking at, to be honest.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Well, that's OK. I mean, it doesn't, uh, the way it's worded, but yes, ma'am, the first part of that number is your actual policy number, and then the rest of it, again, it's, it just helps us to differentiate if it's included on the claim, you know, what the service was.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So Mr.che I will have to verify several things with you first for security and then also any information that's provided would be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][POSITIVE] It's not a problem.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the next piece of information to verify will be your I'm sorry, your mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that is on file for you is the same as the one that you provided for me, so that is your best contact number, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, thank you and then the last piece of information to verify is going to be your email address.
[CUSTOMER][NEUTRAL] Mm, I don't know if you have my job or my personal, um.
[AGENT][NEUTRAL] This appears to be personal. It appears to be personal.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, ma'am, that is correct. OK. All right. So first question for you, Ms. [PII], did you ever set up your profile before in our portal called the online service center?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, so we have a portal and there have just recently been some updates to it so I can actually um send you a user guide that we had the set up process is essentially the same, yes ma'am. Now there will be some differences in how it looks now because this this new implementation just went in over the weekend, but the overall.
[CUSTOMER][POSITIVE] Oh, you can do that, that'd be great.
[CUSTOMER][NEUTRAL] I hope it's not complicated cause
[AGENT][NEUTRAL] It's, it's really, it's really not. I mean, it's gonna just ask you to fill in some blanks, click next, fill in some blanks, click next, um, and it will send you a passcode to your email that you'll have to enter two different times like a almost like a two-factor authentication type thing. Um, but, but once you get that portal set up, you can actually submit your claims to us through there.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It takesification, yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you have difficulty doing that or don't wanna do that, you can also fax them or mail them. We just cannot accept claims information via email.
[AGENT][NEUTRAL] So I can include
[CUSTOMER][NEUTRAL] OK. So, the fax number is [PII]?
[AGENT][NEUTRAL] That is correct, yes ma'am, it is, and you would just put attention claims department.
[CUSTOMER][NEUTRAL] You know, and I prefer email, yeah, like claims attention claims department. Attention.
[AGENT][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] The only reason I don't like uh facts unless this is an e-fax, cause anyone can see the faxes that are coming in versus
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, it's, that's our secured.
[CUSTOMER][NEUTRAL] Email unless again it's an e-fax.
[AGENT][NEUTRAL] Yes, that's a secured fax line for our claims division. I just always put, because it depends on if it's gonna be like a regular claim or if it's an appeal, but it's a secured fax. So, um, you could do that now but.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK. So no, we have that way I work.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, we have the we have the e-faxes that comes directly non-paper comes through the emails in a form of a fax. All right, so what's next? Thank you. Sorry to interrupt you.
[AGENT][NEUTRAL] OK. No, no, no, no, no. So what I can do is I can include, since you're gonna have filed the claim yourself.
[AGENT][NEUTRAL] The, I can attach the Medlink claim form. The Medlink is the type of policy you have with us. On the claim form, it does have the instructions for the additional documentation that you will also have to provide to us along with the claim form for review.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But those instructions again are on page, on page one in the top section, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I know I spoke to someone. They said something about I need to provide the EOB explanation of benefits. Oh, but I also have the bill, the bill here. Um, OK, I can do that, not a problem. I'm off from work today and I really wanna get this rectified before it gets too old because I had a bill that I had to pay that I never claimed last year and I, I guess I probably missed the deadline. I'm not sure. But anyways, um.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, actually, actually, with APL, Mr. [PII], we do not have a timely filing limit.
[AGENT][NEUTRAL] So you can, yes, yes, ma'am. Some insurance companies I know do, most do, but we do not, as long as your policy was active.
[CUSTOMER][NEUTRAL] Oh, OK, so maybe I should go look for, uh-huh.
[AGENT][NEUTRAL] For your data service, you can still submit your claims to us for reviews.
[CUSTOMER][POSITIVE] Not a problem. I can do that. What about for my husband?
[AGENT][NEUTRAL] Same thing. Uh-huh.
[CUSTOMER][NEGATIVE] Cause we got, I, I got a, I got a bill from uh Labor, and they're charging over 800 and something bucks. I'm gonna call my insurance first before I, I send this over to find out why.
[AGENT][NEUTRAL] Now, I will tell you that.
[AGENT][NEUTRAL] Oh, go ahead. That's what you were gonna say. I was just gonna to let you know that on this, this supplemental policy does not have benefits for lab work.
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEGATIVE] No, no, no, no, no, no.
[CUSTOMER][NEUTRAL] OK. OK. All right.
[AGENT][NEUTRAL] Mhm. So lab, yeah, that's, and one.
[CUSTOMER][NEGATIVE] So then I'll have to find out what my insurance, why I didn't pay it.
[AGENT][NEUTRAL] With your primary. Yes, ma'am. Um,
[CUSTOMER][NEUTRAL] In my primary, yeah.
[AGENT][NEUTRAL] Yes. Now, office visits, you know, there are certain things that are not covered under this supplemental policy. Um,
[AGENT][NEUTRAL] Give me just a moment and I'm, let me finish doing one thing and then I'll look.
[CUSTOMER][NEUTRAL] Can you send me, yeah, not a problem. Maybe you can send me, I mean, I have it within my paperwork, but if you have it handy on what my supplement covers and doesn't, um.
[AGENT][NEUTRAL] Actually, when you create your profile in this portal, there is a PDF version of your whole policy in there with all your benefit information. Yes, ma'am. Uh-huh. And your ID cards are there. So if you need more ID cards, you can also print them from there.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Perfect, perfect.
[CUSTOMER][POSITIVE] OK, perfect, perfect. OK great, great.
[CUSTOMER][POSITIVE] Need it. Beautiful. OK, great. So then I'm gonna do that.
[AGENT][NEUTRAL] Yes, ma'am. So let's see, so the email that I'm gonna send to you will come from [PII]. I have put APL in your subject line.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Care, what is it? [PII]?
[AGENT][NEUTRAL] Care team. Mhm.
[CUSTOMER][NEUTRAL] You said [PII] team? OK, care [PII]. I can, OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And I will put a pill.
[CUSTOMER][NEUTRAL] A
[AGENT][NEUTRAL] P L.
[CUSTOMER][NEUTRAL] A in public.
[AGENT][NEUTRAL] Yes, ma'am, but the email that you're gonna receive, yes, [PII] is the email that you're gonna get. That's who it's gonna be from.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then I did put in the subject line ATL online service center portal user guide, and meddling claim form and again the user guide will give you the website that you're gonna go to to set up your profile but the instructions on this particular user guide, you know, your screens are gonna look a little different once you start going through the steps.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][POSITIVE] But this gives you a good, you know, baseline. Again, it's, it's not hard to set up, but if you have any issues, you can call us back and we will be very happy to help you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I do appreciate it. Thank you so much.
[AGENT][POSITIVE] Oh, you're certainly very welcome. Yes, ma'am. So with technology changing, you know, we're just constantly evolving and so if you run into a bug.
[CUSTOMER][NEUTRAL] All right, well, great. Uh, no, not only that, I know.
[AGENT][POSITIVE] We'll be happy to
[CUSTOMER][NEUTRAL] OK, I will definitely go because I'm, I'm dealing with my works change and upgrades with the system. Then my husband has his own business, then I have to deal with the city.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Their website, because now the city doesn't allow anyone to walk in. You gotta do it through their portal. Mind you, it's like I gotta become a wizard with these, all these different portals. That's becomes a little frustrating, but anyway, we'll figure it out.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yes, ma'am. I understand. I struggle with trying to keep up with my own personal portals for all of my different medical things and insurances. So I, I do, it's just the world we live in. It's just the world we live in now, so.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I, I know.
[CUSTOMER][NEUTRAL] I know. All right, so then do I, I, do I, uh, yes, um, I need my explanation of benefits. Is that correct, along with that I have to pull up?
[AGENT][NEUTRAL] But is there anything else at the moment? No.
[AGENT][NEUTRAL] Your item I yes ma'am, you're gonna complete the claim form.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] You'll need your itemized bill from the provider that includes the diagnosis codes.
[AGENT][NEUTRAL] And then you're also gonna have to have your primary insurance company's explanation of benefits. But again, on page one of that claim form I sent you,
[CUSTOMER][NEUTRAL] And the me and uh
[CUSTOMER][POSITIVE] OK perfect I have it.
[AGENT][NEUTRAL] Just use those bullet points at the top under instructions as a checklist for what you will need to submit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] All right. Great. Thank you so much. I do appreciate all your information. I appreciate it. I'll be looking out for that email now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, you, you.
[AGENT][NEUTRAL] OK, Ms. [PII]. Well, I have sent it, so if you haven't seen that in your inbox very shortly, you might wanna check your junk or spam folder, but you should be receiving it.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] I should have already received it.
[CUSTOMER][POSITIVE] OK, thank you again so much. I appreciate your help.
[AGENT][NEUTRAL] Well
[AGENT][POSITIVE] Absolutely and thank you again for calling APL. I hope you have a wonderful afternoon.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][POSITIVE] Likewise, thank you. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.