AccountId: 011433970860
ContactId: 9aab7f23-77e2-4448-b9e4-ca7dcb03817d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 292959 ms
Total Talk Time (AGENT): 160213 ms
Total Talk Time (CUSTOMER): 77067 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/9aab7f23-77e2-4448-b9e4-ca7dcb03817d_20250211T22:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Er, how you doing? Um, I have a quick question. My name is [PII]. Um, I have a procedure being done tomorrow. It's gonna be a colonoscopy, endoscopy.
[CUSTOMER][NEUTRAL] And I wanna know after the procedure what form do I gotta ask for the hospital for so I could fax it over to you guys.
[AGENT][NEUTRAL] OK, for the claim itself.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, I would need, do you know what type of policy you have? If not, I would need the policy number to check it.
[CUSTOMER][NEUTRAL] Um, can you check it by my name?
[AGENT][NEUTRAL] Yeah, I can look by your name or social if you don't have your policy number.
[CUSTOMER][NEUTRAL] OK. My social is [PII].
[CUSTOMER][NEUTRAL] 499877
[AGENT][POSITIVE] Alright, thank you so much. Give me just a second, let me take a look here.
[AGENT][NEUTRAL] All right, [PII], and then let me just verify please your date of birth and address.
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] All right, so you have a med link um policy with us, the secondary policy, so that's a claim form that is needed.
[AGENT][NEUTRAL] When you submit that claim, um, if you're gonna do it yourself, you will need explanation of benefits from your primary insurance, just showing what they paid and what your responsibility was.
[CUSTOMER][NEUTRAL] OK, so ask for what form the explanationary benefit form?
[AGENT][NEUTRAL] Mm. You need the med link form and then you need your explanation of benefits from your primary insurance also.
[CUSTOMER][NEUTRAL] OK, the meddling form. How do I get the meddling form?
[AGENT][NEUTRAL] So you can get that from our website um if you'd like I can email it to you.
[CUSTOMER][NEUTRAL] Yes, please email me that.
[AGENT][NEUTRAL] OK, um, you also have the option, [PII], to let the provider, and when I say provider, I mean the doctor or facility you're going to, you can let them know that you have a secondary insurance and give them your insurance card. They can also file the claim on your behalf.
[CUSTOMER][NEUTRAL] Which one, the, the APL insurance card?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Give them that card?
[AGENT][NEUTRAL] Yeah, yeah, if you give them that card, they can file the claims with your primary and your secondary.
[CUSTOMER][NEUTRAL] OK, I'll let him do that then.
[AGENT][NEUTRAL] Yeah, so, um, I'll send you the claim form just in case, but that's usually the easiest way if they can do it for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And then so whatever the the.
[CUSTOMER][POSITIVE] Benefit. All they're gonna do is just get the difference out of it, right?
[AGENT][NEUTRAL] Mhm, yeah, so they would bill your primary insurance first.
[AGENT][NEUTRAL] And then if you have any like deductible, co-pay, coinsurance that's not covered, then they send that to us.
[AGENT][NEUTRAL] And your outpatient benefit max on this plan is $1000 so that's the most it's gonna pay out in a calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So then we would submit the payment for the difference.
[CUSTOMER][NEUTRAL] OK. What if they have a remainder? Does it go what?
[AGENT][NEUTRAL] Um, any remainder is up to the facility or the provider to bill you. We don't advise them as far as like what your responsibility is. So if there's a portion that it's not covered, um, that's up to them to bill you for that if you wanna collect that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, appreciate that then.
[AGENT][POSITIVE] Yeah, no worries. Claim forms on its way. Do you have any other questions or concerns?
[CUSTOMER][NEUTRAL] Um, no, that's it, and you already sent the claim form, right?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Mhm I'm emailing that to you, yep.
[CUSTOMER][POSITIVE] Appreciate that.
[AGENT][POSITIVE] Not a problem, [PII]. Have a good night.
[CUSTOMER][POSITIVE] Alright thank you bye you too