AccountId: 011433970860
ContactId: aac88c1b-cf7c-4744-ba75-e71b7d2262f5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 423260 ms
Total Talk Time (AGENT): 131683 ms
Total Talk Time (CUSTOMER): 269919 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/aac88c1b-cf7c-4744-ba75-e71b7d2262f5_20250312T21:26_UTC.wav
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[AGENT][NEUTRAL] You for calling APM. My name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Hi, [PII], good afternoon or good evening. Um, I just have a few questions. I've been having gap with you guys for quite some time now, and I've completely have not utilized it. Um, I was in the emergency room, um, [PII].
[CUSTOMER][NEUTRAL] Um, I'm getting surgery. I just need to know how this works. I know that I have, uh, an explanation of my supplement and how they take care of emergency outpatient surgery, and so forth. So what it is it that I have to do, submit you guys my bill or how is it that I do this?
[AGENT][POSITIVE] OK, I'll be happy to assist with your policy. Do you have your policy number?
[CUSTOMER][NEUTRAL] Um, I have my, uh, coverage. I have my group number and plan with Meridian link in hospital outpatient. I don't have anything with policy on the card itself. All it has is a group number.
[AGENT][NEUTRAL] What's your social?
[CUSTOMER][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] I've been with you guys now for 3 years and I have not even submitted one claim.
[AGENT][NEUTRAL] Alright, and if you can please verify your.
[AGENT][NEUTRAL] Date of birth and email address for me?
[CUSTOMER][NEUTRAL] So my date of birth is [PII]. Now, I'm not sure if you have my work email.
[CUSTOMER][NEUTRAL] On my personal email, so I'll give you both is uh [PII] or [PII].
[AGENT][NEUTRAL] OK, that's we have the [PII].
[CUSTOMER][NEUTRAL] You have to help me, OK.
[AGENT][NEUTRAL] Alright, thank you for that information. Please be advised the verification of coverage is not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, so it looks like someone filed a claim back in [PII]. We paid on it. It was, um, elite imaging for [PII], um.
[CUSTOMER][NEUTRAL] Oh, so they submitted it. OK, I didn't submit it. OK. Was that taken care of?
[AGENT][NEUTRAL] Yeah, so, but, yeah, that was taken care of. So you would just present um our card along with your major medical that way they know that you have the gap insurance that way they'll do like elite imaging and they'll just file directly with us. um, but if you have to file yourself, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] OK, this is.
[CUSTOMER][NEUTRAL] Yes, no, no, I apologize for interrupting you. The thing is, I'm having surgery, so I have a 1000 and something that I have to pay, and they are not taking no gap or anything like that.
[CUSTOMER][NEUTRAL] This is their policy. They just taking the insurance coverage and that's it.
[AGENT][NEUTRAL] OK, so if you need to file for yourself, then um you can submit the claim yourself. We just need the medical diagnosis along with the explanation of benefits from your primary insurance after the claim has been processed.
[CUSTOMER][NEUTRAL] OK, run that by me again. So after the surgery, I, I have some hospital bills when I was in the emergency room. How do I submit that for, for a claim?
[AGENT][NEUTRAL] It's the same. We need the medical diagnosis and we need the explanation of benefits from your primary insurance for each data service that you would like to file for.
[CUSTOMER][NEUTRAL] And I keep all my explanation of benefits, so I, I have that along with the bill. I can do that and, and so how do I do that? Just uh fax it over to you guys or what?
[AGENT][NEUTRAL] It can be mailed, faxed or if you have um if you're registered with the online service center you can upload it there.
[CUSTOMER][NEUTRAL] Oh, maybe I can do that. So you need the explanation and the benefits, um, which will describe the, you know, when I was taking care of, diagnosis, um, I do have paperwork from the hospital, so that, that covers that.
[CUSTOMER][NEUTRAL] And I guess the bill correct?
[AGENT][NEUTRAL] Um, the only thing we need is the explanation of benefits and the diagnosis. Now, unless the bill has the diagnosis on it, we won't need the bill.
[CUSTOMER][NEUTRAL] Yeah, but I, I didn't pay the bill because I have gap, and they want me to pay the bill.
[AGENT][NEUTRAL] I'm just telling you what we need in order to pay a claim, but if you wanna send it extra just to send it and feel good about sending it, then you can send it.
[CUSTOMER][POSITIVE] just to send it so you could, yeah, OK, all right. More is better than less.
[CUSTOMER][NEUTRAL] OK. All right, so I can do that. I could probably do it online. Um, let me see if you have here on the card.
[CUSTOMER][NEUTRAL] Online, you don't have that. Is it under the uh Metlink select group plan or?
[AGENT][NEUTRAL] Um, so the website is gonna be a [PII].
[CUSTOMER][NEUTRAL] Wait, wait, wait. [PII]?
[AGENT][NEUTRAL] And you go under file a claim?
[AGENT][NEUTRAL] Mm mm.
[CUSTOMER][NEUTRAL] You know what, I'm gonna sign?
[CUSTOMER][NEUTRAL] So let me write it down. My apologies, [PII].
[CUSTOMER][NEUTRAL] You have my daughter's name, by the way so I couldn't forget that. Yeah, that's my daughter's name, [PII]. OK, um, so go ahead and give me that, honey, can you lower that for me, please? Go ahead and give me that email, email address again, please.
[AGENT][NEUTRAL] So the website is A as in apple, M as in Mary, the word [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK. And I go there and registered and then I could download the paperwork.
[AGENT][POSITIVE] That's correct. You can upload the um the your documents.
[CUSTOMER][POSITIVE] All right, great. Well, [PII], thank you so much for answering my questions. I'll get those organized and I guess I probably might have to wait for I after my surgery, then I'll get my benefit of you know, of, of explanation, and then I can submit that later on, I guess. My, my surgery is next month.
[AGENT][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEGATIVE] Hm. Yes, next month my surgery, but I do have bills that, you know, and I some information from my HR and they're like, you know, you have gap insurance. Why are you paying for, you know, you know, outpatient or you're paying for emergency care in the emergency room when you have this. So I was a little oblivious. I do purchase, like I said, I did purchase it, but I just never have acted on doing what I need to do.
[CUSTOMER][NEUTRAL] So going forward since I am paying, paying for it, might as well utilize it.
[AGENT][NEUTRAL] Right, right.
[AGENT][NEUTRAL] Might as well, might as well.
[CUSTOMER][POSITIVE] I know, right? All right, [PII], thank you so much. I appreciate your assistance and I'll just go ahead and do that. Either fax it or, or upload it on the on the website.
[AGENT][POSITIVE] Sounds good. Was there anything else I can assist with today?
[CUSTOMER][POSITIVE] No, you, you answered all my questions. Thank you so much. I appreciate it and you have yourself a wonderful, I don't know where am I talking to you from, what state are you in?
[AGENT][NEUTRAL] I'm at the call center in [PII].
[CUSTOMER][POSITIVE] [PII], so we're in the same, same time zone, so you have a good evening.
[AGENT][NEUTRAL] Thank you for calling APL. You do the same.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] So you