AccountId: 011433970860
ContactId: b1c84cd1-9376-4e2d-9eef-e952db90ef82
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 873039 ms
Total Talk Time (AGENT): 263852 ms
Total Talk Time (CUSTOMER): 359410 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/b1c84cd1-9376-4e2d-9eef-e952db90ef82_20250224T16:17_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, hi [PII], um, I just wanna, I need some assistance on I don't know how to file the claim.
[CUSTOMER][NEUTRAL] Um, I got some bills for last year and I wanna file them.
[AGENT][NEUTRAL] OK, well, I can help you with filing a claim. May I have your name and a good contact number?
[CUSTOMER][NEUTRAL] Sure, [PII]
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have a good contact number and then your policy number?
[CUSTOMER][NEUTRAL] Sure, it's um.
[CUSTOMER][NEUTRAL] 561.
[CUSTOMER][NEUTRAL] 543-249-4
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Policy number, let me, let me get my card.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] I don't know. I'm looking at the card. What number you need?
[AGENT][NEUTRAL] It should say um in hospital or outpatient policy cert number, you see, OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I have um.
[CUSTOMER][NEUTRAL] 02201436M
[CUSTOMER][NEUTRAL] L7.
[CUSTOMER][NEUTRAL] And that's in hospital.
[AGENT][NEUTRAL] Thank you for that, and I do have your policy here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] verify your date of birth
[CUSTOMER][NEUTRAL] Sure, it's um [PII].
[CUSTOMER][NEUTRAL] And the email is a [PII].
[AGENT][NEUTRAL] Thank you for that. And then your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So, um,
[CUSTOMER][NEUTRAL] Information
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You'll need to, well, really 3 things. Depending on how how long ago the services were, you can call your provider and let them know that you have a secondary insurance and have them bill us. Um, if you want to file a claim on your own, you can mail it to us, you can fax it, or you can send it online.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, I'll send it online. Where do I where do I go?
[AGENT][NEUTRAL] So you'll go to I
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah, go ahead, sorry.
[AGENT][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] You'll go to our website which is
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEGATIVE] I pay the bills every month for the company and I'm on the website now. I have to go to a different website for this.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, no, if you're on our main page, you'll just click on sign in to the right there.
[CUSTOMER][POSITIVE] Oh yeah yeah yeah I see it OK.
[AGENT][NEUTRAL] And then log in. Have you ever used the portal before?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, only to pay the bills and stuff, the monthly premiums to a P&L.
[AGENT][NEUTRAL] For the company.
[CUSTOMER][NEUTRAL] You know, for the company
[CUSTOMER][NEUTRAL] Yeah, but never is an in.
[AGENT][NEUTRAL] Right, do you have your, like your own?
[CUSTOMER][NEUTRAL] Uh, no, I don't think I've ever, so I'll have to sign up first time, I guess, right?
[AGENT][NEUTRAL] Yeah, so click new user this time and then I'm an individual.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] And then you can follow the prompts if you want to set it up while we're on the phone, you can. Let me see if you, I'm not showing you have one either.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah, uh, yes.
[CUSTOMER][NEUTRAL] OK, so if I go [PII].
[CUSTOMER][NEUTRAL] See it's
[AGENT][NEUTRAL] Our website?
[CUSTOMER][NEUTRAL] When I do, yeah, when, when, when I do um.
[CUSTOMER][NEGATIVE] The problem is when I um.
[CUSTOMER][NEUTRAL] When I
[CUSTOMER][POSITIVE] Let me log out maybe that'll help out.
[CUSTOMER][NEUTRAL] Oh here it is new user, yeah, as an individual.
[CUSTOMER][NEUTRAL] OK, so I'll need to do all of that.
[CUSTOMER][NEUTRAL] Does it take long?
[AGENT][NEUTRAL] Oh no, we can, um, you can set it up while we're on the line if you like.
[CUSTOMER][NEUTRAL] Let me see. OK.
[CUSTOMER][POSITIVE] Oh, OK. All right, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Um, social security number, last name, my zip code.
[CUSTOMER][NEUTRAL] Uh, let me put my.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] No user was found, that's not good.
[AGENT][NEUTRAL] OK, um, let me go to, OK, so go.
[CUSTOMER][NEUTRAL] Last name is
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Go back to
[CUSTOMER][POSITIVE] I think I got everything.
[AGENT][NEUTRAL] Step one
[CUSTOMER][NEUTRAL] OK, it doesn't let me go on.
[AGENT][NEUTRAL] Oh you might have to press cancel down at the bottom.
[CUSTOMER][NEUTRAL] Yeah, let me just.
[CUSTOMER][NEUTRAL] New user an individual.
[AGENT][NEUTRAL] Mhm. I'm an individual.
[CUSTOMER][NEUTRAL] With A P&L insurance.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then um it will ask you for your last name, and then in the social and member ID put the full social there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then, um,
[AGENT][NEUTRAL] What email address are you using?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] My personal maybe.
[CUSTOMER][NEUTRAL] Uh, maybe I should use the my business email. Maybe that's what's registered.
[AGENT][NEUTRAL] Right, we have the
[AGENT][NEUTRAL] Yes, we have the business email on file. I can change this to personal, they just have to match.
[CUSTOMER][NEUTRAL] Uh, OK. No, no, no, no problem, no problem, I'll just leave it like that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Maybe that's probably what.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] Now let's create the account.
[AGENT][POSITIVE] Yes, OK, then you're in the right place.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, hold on, let me just create it.
[CUSTOMER][NEUTRAL] Uh, password, I'm sure they want something.
[CUSTOMER][NEUTRAL] It's asking for my email again. I should just leave it the same, right? Make it easier, yeah.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] All right, uh [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, well, was there anything, well, actually, once you log in, let me know when you're to your dashboard.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, it's
[CUSTOMER][NEUTRAL] Why
[CUSTOMER][NEUTRAL] Let me uh
[CUSTOMER][NEUTRAL] Hold on a second, let me just, uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me log in
[CUSTOMER][NEUTRAL] Come on.
[CUSTOMER][NEUTRAL] It it
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] That's weird
[CUSTOMER][NEUTRAL] Alright, I'm in.
[AGENT][NEUTRAL] You're in, OK, and then you're looking for um on your dashboard it should say like upload files.
[CUSTOMER][NEUTRAL] Is it?
[CUSTOMER][NEUTRAL] Yes. OK, that's.
[AGENT][NEUTRAL] OK, so that's where you go to start uploading the documents for your claim.
[CUSTOMER][NEUTRAL] OK, so I got um.
[CUSTOMER][NEUTRAL] My, my billing from United Health Healthcare, it's got the claim processing codes and the amounts all of that on there, so I think that's all you need, right?
[AGENT][NEUTRAL] So, um, back on our website, our main website where it says claims and forms, you'll submit the Medlink claim form.
[CUSTOMER][NEUTRAL] Oh yeah, I, I see here meddling group medical support. I don't, I don't know is that the form? No.
[AGENT][NEUTRAL] Um, on our, on the website where you saw that sign in claims and forms is um right next to it.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Uh, do I have to log out?
[AGENT][NEUTRAL] Well, you'll go, you don't have to log out of the portal, you just need a new tab. You're gonna go to our website.
[CUSTOMER][NEUTRAL] Oh, OK, hold on a second.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] Oh my goodness, it just defaults and.
[CUSTOMER][NEGATIVE] If I open up a new tab it defaults to.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It, it, so I gotta go back to the um to the website and to the main website and download a form.
[AGENT][NEUTRAL] Right, so when you file a claim with us, you, you can't submit just the billing. You need the claim form, the billing, and the explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right. Hold on, please. I definitely need your help here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] And I'll find the form on the um.
[AGENT][NEUTRAL] On our main website.
[CUSTOMER][NEUTRAL] On the main, OK, I'm there now claim forms oh there it is.
[CUSTOMER][NEUTRAL] OK, claim forms.
[CUSTOMER][NEUTRAL] What what do I need? The paper form?
[AGENT][NEUTRAL] Um, when you go to claim forms, you're gonna go scroll down to where you see claims forms and policy change documents.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] And you'll probably have to go to the 2nd page for Medlink because it's in alphabetical order.
[CUSTOMER][NEUTRAL] OK, this accident claim form.
[AGENT][NEUTRAL] Mhm scroll all the way down.
[CUSTOMER][NEUTRAL] Authorization to this oh, OK, change.
[AGENT][NEUTRAL] To where you see the 12, and 3.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Direct deposit form electron oh my goodness. Oh yeah, 12 and 3.
[AGENT][NEUTRAL] Just keep scrolling down, uh-huh, and click on number 2.
[AGENT][NEUTRAL] And the Medlink claim form is the 3rd on this page.
[CUSTOMER][NEUTRAL] Yeah, they're already
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah. OK.
[AGENT][NEUTRAL] So you'll download that form. You can save a copy of the form, um, just so you'll have it when you file claims, um, but you'll fill it out and then you can upload this, the explanation of benefits and the itemized bill.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][MIXED] OK, and OK, it doesn't look that scary that form looks based very not 10 pages.
[CUSTOMER][NEUTRAL] Uh, just, yeah, you, you know how the medical forms are, uh, question, my, my policy, what, what's the coverage on it right now?
[AGENT][NEUTRAL] Let's see, hold on one second.
[AGENT][NEUTRAL] OK, so just for the call, all the information provided is a verification of benefits, not a guarantee of payment. So for inpatient, well, your policy covers inpatient and outpatient, um, inpatient is after admission. So you have up to $1500 to use towards inpatient benefits per year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then you also have the outpatient benefits, which is $1000 per calendar year. So that's for like the emergency room, urgent care, outpatient um surgeries.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so, so the coverage because I, I have both, so when I file both.
[CUSTOMER][NEUTRAL] One will go for the 1000 and the other one go for the 1500.
[AGENT][NEUTRAL] Right, so you'll just submit the documents and then the examiner, once they see all the coding, that's what determines inpatient or outpatient, and then they'll just, yes, take from whichever one will use that benefit.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, understood. All right, thank you very much.
[AGENT][POSITIVE] You're welcome. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that's it. Thank you. Have a good day.
[AGENT][POSITIVE] You're welcome, [PII]. Well, thanks for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thank you, you too, very helpful. Have a good day. Bye.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Bye-bye.