AccountId: 011433970860
ContactId: 99986fb4-acc5-4b9b-8de7-6733239de8ae
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 304630 ms
Total Talk Time (AGENT): 145680 ms
Total Talk Time (CUSTOMER): 139199 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/99986fb4-acc5-4b9b-8de7-6733239de8ae_20250102T21:03_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]. My name is [PII], and I have um an APL gap uh plan that's tied with our um health insurance card, um with the um with UHC and I had a, um,
[CUSTOMER][NEUTRAL] I had a procedure done in November and I'm getting um a bill uh um out of pocket bill so I need to file a claim and this is the first time I, I do so.
[AGENT][NEUTRAL] OK, um, so I can definitely help you with filing the claim, and [PII], may I have a good contact number just in case we're disconnected and your policy number?
[CUSTOMER][NEUTRAL] Mhm, so the number is [PII].
[CUSTOMER][NEUTRAL] And then the group number is 23755.
[AGENT][NEUTRAL] Do you have your APL ID card with you?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Does it say in hospitals or outpatient policy cert number?
[CUSTOMER][NEUTRAL] Mm, let's see what it says. It says payer ID 60801 and then it has an in hospital benefits cert number and an outpatient benefit cert number. Um, which one do you need?
[AGENT][NEUTRAL] Um, it's OK. I actually just found it with the group number. I have you here. Can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] Uh, [PII], um, and then address should be [PII], and then what else did you need?
[AGENT][NEUTRAL] Um, your email address?
[CUSTOMER][NEUTRAL] Um, it should be my work email address [PII].
[AGENT][NEUTRAL] Yes, ma'am, and thank you so much for verifying your information. So you actually have two options. Um, if you wanted to, you can just give the provider your um policy number and our number if they need to verify benefits, um, and just let them know you have a secondary insurance and to bill us and they'll handle, you know, all the claims and stuff. But if you wanted to file it on your own, you would just need a copy of the Medli claim form, which can be found on our website.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] A like apple, M like Maryub.com.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, you also need the item the itemized bill from the provider that includes the diagnosis codes and procedure codes.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um, let me see what they have here.
[CUSTOMER][NEUTRAL] So what I have is a statement uh from the provider.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it has the date of the service, um, provider name and then charges and then payments and then patient balance that there's no uh you know they don't have codes on it or what have you so let me call them and it's United Health um through the University of Miami. So let me call them and see if I, so you're saying they should be able to file this um directly with APL.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am, they may, they may just, um, they may not have had us on file at the time, but yeah, you can let them know that you have the secondary insurance and just give them your policy number or, um, well, it will be over the phone, so just give them the policy number. Um, they may ask for our phone number to call and verify the benefits, but um I was gonna say something and it just slipped my mind when we were talking about.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The filing. What was I getting ready to tell you?
[AGENT][NEUTRAL] Oh, the last thing. So the itemized bill explanation of benefits and then um the claim form. So the explanation of benefits from your primary insurance is the last piece I was missing if you wanted to file.
[CUSTOMER][NEUTRAL] OK, well, let me find out with them.
[AGENT][NEUTRAL] But make sure
[AGENT][NEUTRAL] Make sure when you call them, um, you, you specify either an itemized bill or a universal bill, depending, it's the same form, just different uh locations call it different things, um, but just as long as it has diagnosis, procedure and all the charges.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it. Well, I'll, I'll find out first if they can go directly to you guys and just file it through a, you know, directly with APL. I don't have to worry about it, um, and then does this plan also cover the dental for out of pocket?
[AGENT][NEUTRAL] To us, OK.
[AGENT][NEUTRAL] No, ma'am, this is only for medical.
[CUSTOMER][NEUTRAL] OK, OK, just wanted to double check. OK, well thank you.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No, I think that's it.
[AGENT][POSITIVE] Alright, well, thank you so much for calling APL [PII], and I hope you have a great day and [PII].
[CUSTOMER][POSITIVE] Happy [PII]. Take care, bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.