AccountId: 011433970860
ContactId: 9df224c7-831a-43c3-af70-b5c69e15e61a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 482890 ms
Total Talk Time (AGENT): 294756 ms
Total Talk Time (CUSTOMER): 104661 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/9df224c7-831a-43c3-af70-b5c69e15e61a_20250102T18:58_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, I'm just calling to get an update on um.
[CUSTOMER][POSITIVE] High submission.
[CUSTOMER][NEUTRAL] For a claim.
[AGENT][NEUTRAL] OK. You're the insured and you filed a claim that you're wanting to check status on?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, and [PII], what is your callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you. And your policy number, please?
[CUSTOMER][NEUTRAL] It is 02389041.
[AGENT][NEUTRAL] OK, thank you. Give me one moment to get your information pulled up. I will have to verify several things with you first for security, and then also [PII], any information that I do provide will be a verification of benefits and not a guarantee of payment. So first off, if you could please verify the primary insured's name and date of birth, and then your date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. Your home mailing address, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm. Zip code?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And the phone number for Mr. [PII]?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Well, actually, OK. I was gonna say actually what we have on file is the same one you gave me.
[CUSTOMER][NEUTRAL] OK, that's mine.
[AGENT][NEUTRAL] OK. And that'll be, um, that's all the, well, go ahead and verify the email address.
[CUSTOMER][NEUTRAL] Um, mine is [PII].
[AGENT][NEUTRAL] And that is what is on file for you all. OK. So I do see that there was a claim processed on the [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] of [PII] and that benefit, there was a $2000 benefit issued.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To you all, and that would be that was issued in the form of a check. Now for future reference, since you all are signed up on the portal and it's your email and everything that's affiliated with that log in, you can add in direct deposit information so that then in the future if there's a claim that we pay benefits, you know, that we're able to pay benefits to you, it could go direct deposit instead of having to have a paper check.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Physically males.
[CUSTOMER][NEUTRAL] So the check went to me and not to [PII], is that correct?
[AGENT][NEUTRAL] That is what this shows. Give me just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Cause it shows that you filed the claim.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, let's
[AGENT][NEUTRAL] Yes, it was actually, the check is issued to your husband.
[AGENT][NEUTRAL] That's what it shows.
[CUSTOMER][NEUTRAL] OK. All right. And it was [PII]?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] The check, the pro the issue date is the [PII], so we're given the holidays and all of that. Um, it would have had to have gone through our nightly processing.
[AGENT][NEUTRAL] So, that would have been on Thursday. So the check wouldn't have been mailed until [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or possibly even [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so we should be getting in the next few days then.
[AGENT][NEUTRAL] Should be we usually say up to 10 business days and this time of the year, the mail can be, you know.
[AGENT][NEUTRAL] A little more lengthy as well, but yes, ma'am, that was issued to you all. And you can log in to your portal also to see the explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For that claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and my next question is I um this is a yearly so I can file again.
[CUSTOMER][NEUTRAL] Is that correct?
[AGENT][NEUTRAL] Uh, now there were
[AGENT][NEGATIVE] This was not.
[AGENT][NEUTRAL] OK, give me just, when you say that a yearly, what do you mean?
[CUSTOMER][NEUTRAL] Um, cause I'm going through, uh, cancer treatment, so can I, I'll be having to redo my, um,
[CUSTOMER][NEUTRAL] Uh, you know how the first of the year starts and sorry I have 2.
[AGENT][NEUTRAL] The deductible and all of that. That's OK. OK. So on here, let me look at your remarks.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So this 1014 data service on this one claim that was paid.
[AGENT][NEUTRAL] It states with the payment of this check, the policy maximum for this benefit has been met.
[AGENT][NEUTRAL] One second. OK.
[AGENT][NEUTRAL] There were some other charges also.
[AGENT][NEUTRAL] On there that were denied just stating that the outpatient benefit for this calendar year has been met.
[AGENT][NEUTRAL] So on here, it does, this is a calendar year plan that you all have.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it does start over.
[CUSTOMER][NEUTRAL] In [PII].
[AGENT][NEUTRAL] Let me double check your husband's employer to make sure that it's not a plan that it's not their plan year, that it's actually a calendar year. I see it as calendar year, but I'm I wanna double check that for you.
[CUSTOMER][NEUTRAL] So, um,
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Thank you for your patience while pulling the information up.
[CUSTOMER][NEUTRAL] You're fine.
[AGENT][NEUTRAL] OK, so yes, on your outpatient benefits, it is a calendar year [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, so when I start getting um bills for this year, then I can just send them to you and make a claim.
[AGENT][NEUTRAL] Correct. You can upload, you can upload that into the portal, uh-huh, just like you did before and make sure to include your primary insurance company's explanation of benefits cause we always have to have that. But on the, the Medlink claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, there's, the instructions are on page one, and it tells you that the documents that you need to submit each time you submit a claim.
[AGENT][NEUTRAL] If that makes it a little easier for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, and then I can do um I can put in my check my routing number and just be direct deposited right on the next one, OK.
[AGENT][NEUTRAL] Correct. Now, if you want me to, I can um I can email the user guide for the online service center in addition to giving the instructions for setting it up. It also explains the different things of, you know, uploading claims and that type of thing. So I'll just go ahead and send that in a moment. The email you'll receive, Charlie is gonna come from [PII] team [PII] [PII] and I will put a PO online service center in the subject line for you.
[CUSTOMER][NEUTRAL] Oh yes.
[CUSTOMER][POSITIVE] That'd be great.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] All right. Well, you're certainly very welcome. So is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] No ma'am, that is it.
[AGENT][POSITIVE] OK. Well, thank you so much for calling APL. I hope you have a nice afternoon and happy [PII] Year.
[CUSTOMER][POSITIVE] All right. You too. Thank you.
[AGENT][POSITIVE] Thank you. Yes, ma'am. Thank you as well.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye-bye.