AccountId: 011433970860
ContactId: a249418e-382e-42e5-9e75-603bbc6b5ef9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1007830 ms
Total Talk Time (AGENT): 524907 ms
Total Talk Time (CUSTOMER): 346355 ms
Interruptions: 7
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/a249418e-382e-42e5-9e75-603bbc6b5ef9_20250606T15:22_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, I'm [PII] I'm a patient of the APL or client, and I, I'm trying to log in and I, it doesn't let me and then I try to say change, uh, forgot my password and it says it's not, doesn't recognize my.
[CUSTOMER][NEUTRAL] Email
[AGENT][NEUTRAL] OK, so you're the insured and you're having some issues with the online service center and signing in, is that correct? Yes, ma'am. Well, I can help you with that and I, I can help you. Who am I speaking with?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Yes, yes, correct.
[CUSTOMER][NEUTRAL] Oh, OK, this is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And Mr. [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And your policy number, please?
[CUSTOMER][NEUTRAL] It is not the group number, no, the end.
[CUSTOMER][NEUTRAL] Hospital or outpatient benefit certain number?
[AGENT][POSITIVE] Either one. Yes, ma'am. Either one will be fine.
[CUSTOMER][NEUTRAL] The group, well, the group number, the group number is 22, no, the uh the other one.
[AGENT][NEUTRAL] Not the group number. No, ma'am, not the group number.
[CUSTOMER][NEUTRAL] OK, 02595724 ML 7.
[AGENT][POSITIVE] OK, thank you very much. If you'll give me just a couple of moments to get your information pulled up please.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and [PII], I will need to verify several things with you first for security purposes. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And also your home 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 gave me, so that is the best number that we should have, is that correct?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, thank you and the last piece of information to verify is going to be your email address.
[CUSTOMER][NEUTRAL] Um, I, my personal one is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, actually, this does appear to be your work. Now, ma'am, they have your work email on file. Uh-huh.
[CUSTOMER][NEUTRAL] But now I'm not sure.
[CUSTOMER][NEUTRAL] Oh, my work number is [PII].
[AGENT][NEUTRAL] OK, thank you so yes ma'am [PII], there was some changes made to the portal so anyone who already had a profile created will need to create a new profile, OK? So instead of doing your log in right below the log in button on that front screen first screen you should see where it says create an OSC account.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, I see it. OK. And then I put insured.
[AGENT][POSITIVE] So yes ma'am, you would select.
[AGENT][NEUTRAL] Correct. And then on the next screen, only fill in the boxes that have the red asterisk.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] The red asterisk, OK, my email.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And my date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Complete
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Your account set up, OK, continue.
[AGENT][NEUTRAL] Mhm and then I'm, I've also just emailed you the uh new user guide for how the new portal looks just so that you'll have it.
[CUSTOMER][NEUTRAL] OK, oh great, thank you, so now I just log in.
[AGENT][POSITIVE] Oh, you're welcome.
[CUSTOMER][NEUTRAL] Put my email again.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Yes, it should email you a verification code.
[CUSTOMER][NEUTRAL] That's verification code, OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And actually you will want, you're gonna receive two different verification codes you'll have, so it's like a two-factor authentication. So you'll get that first one and then you'll enter that and then it'll prompt you again in a couple of more steps.
[CUSTOMER][NEUTRAL] OK, now it says change email address. I know change email.
[AGENT][NEGATIVE] No, you're not gonna do that.
[CUSTOMER][NEUTRAL] OK then continue a new password that I put all that in now.
[AGENT][NEUTRAL] Yes, you're not gonna do anything with the email but and then you can even try um [PII] to use the password that you had on your other profile.
[CUSTOMER][NEUTRAL] Yes, can I use the same one?
[AGENT][POSITIVE] I think you can. I think you can, but we're kind of learning, we're kind of learning together this week.
[CUSTOMER][NEUTRAL] OK, let me try it.
[CUSTOMER][NEUTRAL] OK, let's see if it works.
[CUSTOMER][NEUTRAL] Confirm your password.
[CUSTOMER][NEUTRAL] Display name.
[AGENT][NEUTRAL] And yeah, I mean, that can be whatever. Yeah, that can be ever how you just want it, if your first name, I mean, it, yeah.
[CUSTOMER][NEUTRAL] Just any name.
[CUSTOMER][NEUTRAL] And then given name? What is that?
[AGENT][NEUTRAL] So you can put.
[AGENT][NEUTRAL] And the surname, you can put your last name. I don't even think you have to actually fill that in if you choose not to. I don't think those are marked with red asterisks.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK, let's see.
[CUSTOMER][POSITIVE] OK, I agree to the terms.
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] to polic[PII]
[CUSTOMER][POSITIVE] OK, the account has been successfully created. Go to dashboards.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And now I can log in.
[AGENT][NEUTRAL] Right, and I believe that this is where it's going to also send you another code.
[CUSTOMER][NEUTRAL] Oh yeah, that's it.
[CUSTOMER][POSITIVE] Another very good, yeah, so very.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Welcome to the online.
[CUSTOMER][NEUTRAL] OK, start it clean.
[CUSTOMER][NEUTRAL] OK, so I just, I needed to uh to start a claim that uh I guess the comp the um the imaging company didn't send to my APL.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have the the uh the I have the EOB from that claim.
[CUSTOMER][NEUTRAL] So now I just start to file a claim next and this is.
[AGENT][NEUTRAL] Yes, ma'am. And do you already have the, do you have the claim form since you're gonna be submitting it, [PII], there's a claim form with the instructions of what all you do have to submit because it's gonna be your itemized bill including the diagnosis code.
[AGENT][NEUTRAL] And any information provided on benefits would be a verification of benefits and not a guarantee of payment, but you, there is a specific claim form for the meddling policies.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And you can get
[CUSTOMER][NEUTRAL] OK, where do I get that?
[AGENT][NEUTRAL] OK, so if you will just open another tab on your
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Browser and go to [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Just let me know when that opens up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, it's open.
[AGENT][NEUTRAL] Because I don't want you to click anything yet. I just wanna show you that on the screen at the top you see where it says claims and forms and then to the right of that it says sign in. Don't click anything but if you do click sign in right there it's gonna take you to that online service center login page, OK? I just wanted to show that to you so to get your meddling claim form you're gonna click on claims and forms.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then just scroll down the page.
[AGENT][NEUTRAL] And you're gonna see a little box that says filter by product and it has a green drop down arrow.
[CUSTOMER][NEUTRAL] So like.
[CUSTOMER][NEUTRAL] Filter by product, OK.
[AGENT][NEUTRAL] Mhm so just click the green arrow and then it's gonna give you a list of different.
[AGENT][NEUTRAL] Products you're gonna select the one that says Medlink.
[CUSTOMER][NEUTRAL] Man, OK.
[AGENT][NEUTRAL] Mhm just click on that word and now out to the right on your screen you should see it where it says download form.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And click that and it should open up your claim form and again the instructions are at the top section of that first page.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So you can just use that as a checklist to make sure you have everything that's needed. Once you have all of your documents together, you can save them on your computer and then yes ma'am, you would just log into your portal and go through the uh start your claim process to upload everything.
[CUSTOMER][NEUTRAL] And then I have to like upload it, the, the claim form.
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh, uh-huh. The claim form with those other required documents that are listed under those bullet points.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Right, so I, I can send the invoice from the um the diagnostic place and then the other the EOBs, right? for that claim.
[AGENT][NEUTRAL] Yes, now, the
[AGENT][NEUTRAL] The detailed itemized bill, if you will um in those instructions it says an itemized bill with diagnosis from the provider so just it needs to make you because we do have to have the diagnosis code.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It should be on the invoice?
[AGENT][NEUTRAL] It wouldn't be on just uh an invoice. You're gonna have to request an itemized bill, including the diagnosis.
[CUSTOMER][NEUTRAL] Shouldn't they have done this because I gave them my card?
[AGENT][POSITIVE] I will be happy to check to see if that we have received anything for you. Most providers will follow because it's a lot easier.
[CUSTOMER][NEUTRAL] Because I gave them when I, when I, when I got, when I went to do my diagnos the imaging, I gave them both cards. But now they're billing me for this, which they apparently they didn't go to the APL but should they have done that themselves?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Well, they're not required to do that. Most, most of them will do it, but in the event that they don't, then the insured can submit. So let me, what's the date of service that you
[CUSTOMER][NEUTRAL] Data service is [PII].
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Wait, wait for it.
[CUSTOMER][NEUTRAL] There's two dates there. Oh no, [PII].
[AGENT][NEUTRAL] OK, so we do not have a claim on file for you for that data service.
[AGENT][NEUTRAL] And you said you had a, what did you have done on that date?
[CUSTOMER][NEUTRAL] Mhm, OK.
[CUSTOMER][NEUTRAL] First of all, it's a a mammogram, which, I mean, the primary is supposed to pay for that. Isn't that a preventative?
[AGENT][NEUTRAL] Well, it just, I mean, that depends. That, that, that depends on if you were to have something going on. I mean, again, that's one of the reasons we have to have the diagnosis code when we're reviewing claims along with the, you know, an itemized bill.
[CUSTOMER][NEUTRAL] On Amazon?
[CUSTOMER][NEUTRAL] Right, mhm.
[CUSTOMER][NEUTRAL] Uh, it was a mammogram, a mammogram, an ultrasound on the breast and uh and uh ultrasound and transvaginal ultrasound.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK. So again, for those things, um,
[AGENT][NEUTRAL] You know, to submit your claim for us to review.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] So sorry. Along with that, you know, other required information, but as of now, we have not received anything for that data service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, mm OK.
[CUSTOMER][NEUTRAL] So I need to request the itemized bill from from them.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Mhm. Yes, ma'am and make sure you just read it directly off of that claim form and itemized bill with diagnosis.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So where am I supposed to, what does it say to itemize it?
[AGENT][NEUTRAL] Under the 3rd bullet point on the instructions.
[CUSTOMER][NEUTRAL] Uh, the phone that's your company.
[CUSTOMER][NEUTRAL] Right, so I can just upload it. I don't need to like enter anything.
[AGENT][NEUTRAL] You will have to
[CUSTOMER][NEUTRAL] Just upload the itemized.
[AGENT][NEUTRAL] Yes, ma'am, so you're going to complete the statement of the insured section of this claim form. You're you're, you're gonna complete the claim form.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then you will also include the following documents that says must accompany the completed statement. That's the itemized bill with the diagnosis from the provider, the explanation of benefits from your
[CUSTOMER][NEUTRAL] OK, I wait, I only, I only see a, a med link claim form that says statement of insured, and that's it and then and then to sign it at the bottom. What, what else, what other form do I need to?
[AGENT][POSITIVE] Yes, ma'am. Look up at the up up at the very top.
[AGENT][NEUTRAL] Of that form?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] It should say medling claim form and then.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Write, come down just a little bit. It says instructions for the insured or patients, and there's several bullet points there. That's, that tells you what all you need to submit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] Oh my [PII], this is so complicated.
[CUSTOMER][NEUTRAL] OK, complete the statement of the insured. That's the one below.
[AGENT][NEUTRAL] It is
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Then complete the completing section D is not required section or the section B.
[CUSTOMER][NEGATIVE] There's only like 3 pages on this. I don't, I just don't get it. Section D.
[AGENT][NEUTRAL] And each section is labeled. Uh-huh.
[CUSTOMER][NEUTRAL] A B
[AGENT][NEUTRAL] Section D is gonna be on the last page. Yes, ma'am. Section D.
[CUSTOMER][NEUTRAL] I don't see the
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Is on on page 3 of.
[AGENT][NEUTRAL] 3 of 3.
[CUSTOMER][NEUTRAL] 303.
[AGENT][NEUTRAL] That's the authorization to request information including protected health information so that if we needed additional information we would have your authorization to do that so that it did not slow up the claims process.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK. The following documents was accompany that, and then I upload those documents and your signature. OK.
[AGENT][NEUTRAL] Mhm and once you have all of that together, yes ma'am, you would just say that as a file on your computer and upload it into your portal.
[CUSTOMER][POSITIVE] OK perfect alright thank you so much.
[AGENT][POSITIVE] Well, you are very welcome. Is there anything else that I could help you with, Miss [PII] at the moment?
[CUSTOMER][POSITIVE] No, that's it. Thank you so much for your help. OK, bye bye. Take care. Bye bye.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Absolutely. It was my pleasure. Yes, ma'am. Have a great day and thank you for calling ATO.
[CUSTOMER][POSITIVE] You too. Bye-bye. Take care.
[AGENT][NEUTRAL] Bye bye.