AccountId: 011433970860
ContactId: acd7313d-169e-47cc-b5ae-dba6ef41f44a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 538440 ms
Total Talk Time (AGENT): 241947 ms
Total Talk Time (CUSTOMER): 237893 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/acd7313d-169e-47cc-b5ae-dba6ef41f44a_20250327T16:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], um, and I need to get help, uh, or I have a question. I had to take my son to the emergency room.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, because he fell and busted his head.
[AGENT][NEUTRAL] Oh,
[CUSTOMER][NEGATIVE] Um, and I got a $753 bill here. They did nothing at the ER, no CT scan. They didn't even have to.
[AGENT][NEUTRAL] Oh my.
[CUSTOMER][NEUTRAL] Leis had nothing, um, but I didn't know if my APL plan would cover any of this, and I didn't know if it did which claim form to use.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right, Ms. [PII]. I can look at your benefits and also help you with the claim form. Uh, can you please give me your, your policy number?
[AGENT][NEUTRAL] Just
[CUSTOMER][NEUTRAL] Well, I'm trying to sign in.
[AGENT][NEUTRAL] If you don't know it,
[AGENT][NEUTRAL] That's OK if you don't know it we can look it up with your um social.
[CUSTOMER][NEUTRAL] OK, I can give you my social.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] When you're ready, [PII].
[AGENT][POSITIVE] I'm ready, ma'am.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me pull in your policy real quick.
[AGENT][NEUTRAL] OK, Ms. [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Uh, address mailing address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And email address I think is going to be a [PII].
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] It's not that one then it's OK alright I couldn't remember.
[AGENT][NEUTRAL] And then one last verification, can you give me your phone number?
[CUSTOMER][NEUTRAL] Uh yes, it is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, and if our call gets disconnected, can I call you back on that number?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, thank you, Ms. [PII]. OK, so looking at your benefits, and this is just to verify your benefits, it's not a guarantee of payment. You had to go to the ER. Let me see if you have anything for ER.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] You have, um,
[AGENT][NEUTRAL] Outpatient benefits for treatment in an emergency room.
[AGENT][POSITIVE] And it helps, let's see.
[AGENT][NEUTRAL] your outpatient treatment benefits are
[AGENT][NEUTRAL] $2,025 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If um
[AGENT][POSITIVE] For anything outpatient and it helps with deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][MIXED] Well, the original bill to I've got the EOB, it blows my mind. It was $2,0075.47 and like I said, they did nothing. They examined him, said he was fine, and sent us home and then my part is 75,340. So which claim form.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could I, I know that you guys need a copy of the bill, correct?
[AGENT][NEUTRAL] Yes, the EOB and the itemized statement.
[CUSTOMER][NEUTRAL] And then, and
[CUSTOMER][NEUTRAL] EOB and I gotta call and get it out of my statement. They love to not send me that.
[AGENT][NEUTRAL] And also another thing.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Another thing you can do if they are willing to do it for you is you can call them and tell them you have a supplemental insurance policy and give it to them and see if they'll file your claim for you. If they don't, you're gonna need the Medlink claim form. It's M E D L I N K.
[CUSTOMER][NEUTRAL] Meddling
[CUSTOMER][NEUTRAL] OK, let me, I'm on your website, uh.
[AGENT][NEUTRAL] Go to claims and forms.
[CUSTOMER][NEUTRAL] And that's under claims, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Are you on the online service center?
[CUSTOMER][NEUTRAL] And then the link
[CUSTOMER][NEUTRAL] I am.
[AGENT][NEUTRAL] OK good because you can file your claim right there um.
[AGENT][NEUTRAL] Yes, you'll go to you'll go to the med link claim form, you'll fill out your claim form, you'll upload your EOB and your itemized statement and send all three documents together.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, let me just see.
[CUSTOMER][NEUTRAL] Male claim form. There it is.
[CUSTOMER][POSITIVE] Alright awesome I have another question so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, [PII], my husband.
[CUSTOMER][NEUTRAL] Fell septic from strep and was in ICU for several days. I have called on this one before.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have several bills, the ambulance, um, the hospital.
[AGENT][POSITIVE] Oh wow.
[CUSTOMER][NEUTRAL] Do I need to fill out a claim form for each of these bills or do I just get the itemized and one claim form?
[AGENT][NEUTRAL] You can do it all on one claim form and send all your documents under that claim form.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEGATIVE] I'm gonna try to get all this shit today. I've been fighting with them they wouldn't bill it um they said that it kept coming back.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] But it wasn't covered or something which tells me they're not doing it wrong because I know what coverage I have for inpatient, he was in ICU for 3 days.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] So trying to get this taken care of. I'm like I paid for this supplemental plan, but it's just uh it's crazy. Can you give me my policy number?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, for February. OK, let me give you the one for um that's effective from [PII]. Um, it is 2605419.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 2605419
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Yes, ma'am. And then the previous policy was effective from [PII] to [PII].
[AGENT][NEUTRAL] And that policy number.
[CUSTOMER][NEUTRAL] Oh, I
[CUSTOMER][NEUTRAL] I need the one before that. These bills are from [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let's do, uh, [PII]. Let me give you that policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 236 9.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 836.
[CUSTOMER][NEUTRAL] 2369836 and then the current one is 2605419 got it.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, and then I can just log in and upload all this when I get these so you need an itemized statement and it's gotta have like diagnosis codes and all that right?
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yeah, diagnosis and procedure codes.
[CUSTOMER][POSITIVE] Diagnosis and procedure codes, got it alright thank you so much.
[AGENT][NEUTRAL] You're welcome. And also, um, just for if, God forbid you have to ever go again, I pray you don't, but if you do, give them uh your Medlik insurance card along with your primary insurance card.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Give it if you give it to them together, then they can call and verify your coverage and your benefits and um maybe they'll go ahead and file your um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Secondary for you.
[CUSTOMER][POSITIVE] That would be nice. OK, I'm gonna give them a call for the.
[AGENT][POSITIVE] That way, that way you wouldn't have to worry about it all.
[CUSTOMER][NEUTRAL] Yeah it's kind of crazy. I mean I'm, I work in pharmacy I do claims I'm like we do it all the time. I don't understand why these stinking hospitals.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah, especially ones that are super busy.
[CUSTOMER][NEUTRAL] Won't do it but OK thank you so much I.
[CUSTOMER][NEUTRAL] Oh yeah, yeah, I know it's crazy.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much for your help.
[AGENT][POSITIVE] You're very welcome. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] Uh, not today. I think I'm good.
[AGENT][POSITIVE] OK, well, I hope you have a good day and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.