AccountId: 011433970860
ContactId: 9bd97abc-2011-4dd6-ab70-c6bcbb5dd1af
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 658500 ms
Total Talk Time (AGENT): 231048 ms
Total Talk Time (CUSTOMER): 206029 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/2025/01/13/9bd97abc-2011-4dd6-ab70-c6bcbb5dd1af_20250113T19:11_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, [PII]. My name is [PII]. I'm calling from Warlaw Group on a recorded line. How are you?
[AGENT][NEUTRAL] Fine, how are you?
[CUSTOMER][POSITIVE] I'm good, thanks for uh asking. I appreciate it. I'm calling on behalf of my client [PII]. Uh, can I give you a, maybe a group number?
[AGENT][NEUTRAL] Yes, and can I get the spelling of your name, please?
[CUSTOMER][POSITIVE] Yes, no worries. It's [PII]
[AGENT][NEUTRAL] And just in case this call is disconnected, may I have your call back number?
[CUSTOMER][NEUTRAL] No worries, [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you, so you're calling from the group?
[CUSTOMER][NEUTRAL] Yes, Ward Law group, we represent him for an accident he had.
[AGENT][NEUTRAL] OK, so you're calling from War Law Group?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have his policy number?
[CUSTOMER][NEUTRAL] Um, I have a picture of the card. I have a group number. I don't see anything about policy number here.
[AGENT][NEUTRAL] If you have their card, it should be listed as policy 3 or certificate number.
[AGENT][NEUTRAL] What's the group number?
[CUSTOMER][NEUTRAL] Mhm. Yeah, thank you. It's 18635.
[AGENT][NEUTRAL] And that was 18635?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the name of the group?
[CUSTOMER][NEUTRAL] Um, the plan says med link select group med sub.
[AGENT][NEUTRAL] So the number that you gave me was 18635 and what is the name of the group? Not the coverage.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I'm not sure. I'm sorry. Does it say a group name on his, on his.
[CUSTOMER][NEUTRAL] They, I mean, I see his insured as [PII], the coverage as individual.
[AGENT][NEUTRAL] OK, you said the last name is [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] You said first name was [PII]?
[CUSTOMER][NEUTRAL] Uh [PII]
[AGENT][NEUTRAL] And [PII], he's who you're calling in regards to?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Do you have the date of birth?
[CUSTOMER][NEUTRAL] Yes, I do. It is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you're calling in regards to a claim?
[CUSTOMER][NEUTRAL] Uh, yeah, I, I actually need to see if there was even a claim open. Um, my client told me he had this insurance that they probably paid. this is what he explained to me, so you can tell me if I'm, if I'm wrong or if I understood it wrong. He says he has this coverage that helps him pay for the deductibles that his health insurance doesn't pay, and he said that it seems like you guys paid that for the hospital. So I need to, do you guys subrogate for that? Was there any payments made or can you make any payments?
[AGENT][NEUTRAL] OK, so he had an auto accident?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And you're representing him with the warlaw group? OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Exactly, yes.
[AGENT][NEUTRAL] Give me one moment. I'm gonna put you on a brief hold.
[CUSTOMER][POSITIVE] Yeah. Take your time. I appreciate you helping me. I'm sorry.
[AGENT][POSITIVE] Mm. You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey, [PII], I just have a quick question. Well, if we get a call, I have an attorney's office calling regarding subrogation on an accident that they're representing one of our insured, but we don't have any claims. What do we usually do if we get a call from an attorney's office?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK. OK, so let them know we don't have any subrogation clause and that we do not request any reimbursement.
[AGENT][NEUTRAL] And if they need it in writing, then they need to submit it to us.
[AGENT][NEUTRAL] The request, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, we don't have no claims on file. Could we tell them that or we don't even tell them that? OK, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK dokey. I will.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, OK, I will let her know all right thank you.
[AGENT][NEUTRAL] Bye.
[AGENT][NEUTRAL] Thank you for holding, [PII]. I show under this particular coverage, I don't show any claims on file. However, when it comes to subrogation, there's no subrogation clause under the coverage, so we don't um seek any reimbursement or anything like that. If you're needing any information in writing, you can submit a request into us and I can give you our fax number or mailing address.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, but is that how, how this coverage works? Like you guys would essentially be as like a secondary coverage to his health insurance to cover the deductibles?
[AGENT][NEUTRAL] It would be secondary.
[CUSTOMER][NEUTRAL] OK, so he does have deductibles he needs to pay. So how do I get you guys those bills to pay those balances?
[AGENT][NEUTRAL] You can submit um claims to us since this coverage is secondary, we will need their major medical insurance explanation of benefits also along with any along with the itemized billing either the UB4 or CMS form.
[CUSTOMER][NEUTRAL] OK, yeah, I'll just tell the providers to go ahead and send that to you because like for example he went to [PII] and I know for sure he has a $1300 balance or something, um, so I'm gonna tell them to submit that claim to you with the explanation of benefits that they received and the itemized billing in a CMS form. Is that OK?
[AGENT][NEUTRAL] OK, sure. I can give you our claims address or fax. I can give you both. Our claims mailing address is [PII] [PII].
[CUSTOMER][POSITIVE] Perfect. I'm ready for it.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And our claims fax number is one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And if they wanted to submit it electronically, the payer ID number is 60801.
[CUSTOMER][NEUTRAL] Sorry, I missed that 60801, you said?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][POSITIVE] Awesome. And then do you, if let's say you guys paid out these balances, do you guys subrogate for that money paid?
[AGENT][NEUTRAL] No, we don't. We do, we don't, there's no subrogation clause within the coverage, so we do not seek any reimbursement.
[CUSTOMER][POSITIVE] Awesome, so can I get that in writing that you guys do not subrogate whatever is paid?
[AGENT][NEUTRAL] So you'll need to submit a request that you want that in writing, and you can send it to that, that number, that, that fax number and or mailing address that I provided to you.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Cool, the [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Awesome, awesome alrighty I'm gonna go ahead and then with that same information is that OK for them to send to you the group number like does does it need anything else because I don't have like a policy number or anything like that just the group number.
[AGENT][NEUTRAL] Yeah, you just wanna make sure you reference their first and last name.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And their date of birth.
[CUSTOMER][NEUTRAL] OK, yeah, those are all on the bills for sure. And then once they send that over, is there gonna be like a specific adjuster assigned or something that I can follow up with?
[AGENT][NEUTRAL] Once that is submitted to us, uh, it, it will be assigned to an examiner um to process the claim, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Depending on the claim, so yes, it will be have uh someone that will process the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Awesome, so I'm gonna go through our regular process to quote unquote like open segregation to basically just get a denial from you guys saying hey we haven't paid anything yet, but even if we do pay we're not gonna surgate, um, and then I'll just follow up with the providers to send you the bill and essentially reach out to you for anything further. Is there a number that they should be calling to follow up on their bill payments?
[AGENT][NEUTRAL] Our claim number which is 1-800256-8606.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Awesome alrighty I appreciate your help today. Thank you so much.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. You have a good day.
[CUSTOMER][POSITIVE] Likewise, ma'am. Thank you. Bye-bye.
[AGENT][NEUTRAL] You