AccountId: 011433970860
ContactId: bb240c65-b594-4e43-bd49-2965a8a2ba83
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1133339 ms
Total Talk Time (AGENT): 454466 ms
Total Talk Time (CUSTOMER): 577375 ms
Interruptions: 5
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/bb240c65-b594-4e43-bd49-2965a8a2ba83_20250204T17:40_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I didn't catch your name, [PII]?
[AGENT][NEUTRAL] So, [PII].
[CUSTOMER][NEUTRAL] Oh, [PII], [PII]. Um, hi, [PII]. My name is [PII]. I have uh APL as a gap in, um, bridge, I'm sorry, gap or bridge it's called GA um insurance with my company, and I wanted to process a claim.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Oh, OK. I can give you instructions. Um, do you have the policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes, I have this in front of me.
[CUSTOMER][NEUTRAL] Um, insured coverage individual, you need the group number?
[AGENT][NEUTRAL] It's gonna be the outpatient sir that is in the bottom.
[CUSTOMER][NEUTRAL] Oh, hold on. Outpatient benefit certification number 01.
[CUSTOMER][NEUTRAL] 0, I'm sorry, 01678848 ML 8.
[AGENT][POSITIVE] Thank you. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, of course, [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And Ms. [PII], for security, may I have your date of birth, mailing address and email address on file?
[CUSTOMER][NEUTRAL] Yes. Uh, my date of birth is [PII].
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I live at [PII].
[CUSTOMER][NEUTRAL] And the email on file should be my work email um [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Yes, perfect, thank you.
[CUSTOMER][POSITIVE] Oh, OK. Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this is the first time you're trying to send a claim. OK, so, um, we need 3 documents for a full claim. Um, the first document is a claim form, the claim form you can find it in our website at [PII].
[CUSTOMER][NEUTRAL] Hold on, let me, um
[CUSTOMER][NEUTRAL] Let me see if that's some here.
[CUSTOMER][NEUTRAL] We also encourage you just to register. OK, but um, would this be [PII]. Is that what what the website is?
[AGENT][NEUTRAL] Um, that is to register. Like if you want to submit the claim electronically, that's where you go, you register and you can submit the claim like that. But to get just the claim form, you will click on um [PII] and it will take you to the home page. In the homepage, you're gonna see um a link that says claims and forms and you're gonna click on that.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Clas and forms, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and you're gonna look for Metlink claim form.
[CUSTOMER][NEUTRAL] I'm sorry, repeat.
[AGENT][NEUTRAL] Meddling claim form.
[CUSTOMER][NEUTRAL] Metling, M E T L I N G.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Metlink. It's M E D L I N K.
[CUSTOMER][NEUTRAL] Oh, OK. Needed link. OK. Netlink form. OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And you're just gonna um download the form and go ahead and fill it out. Um, together with that, the first page is gonna give you these instructions, but I'm also gonna give it to you. Um, together with the claim form, you need the itemized bill with diagnosis code.
[CUSTOMER][NEUTRAL] Mhm. So, let me tell you what this is. It's very simple. My doctor asked me to do um
[CUSTOMER][NEUTRAL] To go get some X-rays. And when I went to get my X-rays, they charged me a co-payment of $45.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that's what I'm planing.
[AGENT][NEUTRAL] And the co-payment was for the X-ray or was it for the visit?
[CUSTOMER][NEUTRAL] Mm, it was for the um.
[CUSTOMER][NEUTRAL] I, I don't know, um.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I have the receipt number. I have the encounter number, the service code, um.
[CUSTOMER][NEUTRAL] This is all I have.
[AGENT][NEUTRAL] What's the procedure?
[AGENT][NEUTRAL] Do you see a procedure code?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Uh, procedure code and said I'll counter number. Um, I have service code um.
[AGENT][NEUTRAL] You can give me that. Let me try.
[CUSTOMER][NEUTRAL] It's account number 944.
[CUSTOMER][NEUTRAL] 326-586
[AGENT][NEGATIVE] No. Mm mm, that's not. No, that's not no.
[CUSTOMER][NEUTRAL] How about W three letters WD X?
[AGENT][NEUTRAL] No, that's that it.
[CUSTOMER][NEUTRAL] Have
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] No, that's the same number, the ECD number so all I have an office on a.
[AGENT][NEGATIVE] Yeah, it doesn't sound like.
[CUSTOMER][NEUTRAL] No, I, I mean, I was very surprised um that Baptist, this is from Baptist, by the way.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The Baptist diagnostics.
[CUSTOMER][NEUTRAL] They charged me a co-payment for the, for uh um this was a hip, a hip x-ray. Um, I was surprised because in the past I have gone to this other
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, location, not Baptist, and I don't recall having to pay anything for a um an X-ray. However, I did call up my human resources from right there because I know that I have this gap and I've never used it in my life. So I called um my HR and she told me that, yeah, that there's $1000 of funds that is available to the employee to cover these um these costs.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So she was the one that I, and I said to her, look, uh, I have already paid it because I did not have my gap insurance card with me to provide it for them at that very moment. As a matter of fact, you guys do not send cards out anymore like you used to.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So you know, she, she told me no, look, just go ahead I'll, you know, and um I'll print it, I'll send it to you and you can you know, I'll give you the information, but when I went back to the girl it was too late because she had already charged me. So then that's when HR told me no, you're going to have to um go ahead and submit the claim. And she told me they're very friendly, they're very easy, they'll go walk you through the process, so um that's why I'm calling today.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, and, and that's what I'm doing. I'm just walking you through the process on how to submit the claim and what we need for the claim, and this is for everybody. Is this the same process for everybody?
[AGENT][NEUTRAL] It's just 3 documents that we need to have um sent to us for reimbursement.
[CUSTOMER][NEUTRAL] Yeah, well
[CUSTOMER][NEUTRAL] I, I just don't have that.
[CUSTOMER][NEUTRAL] Code that you're asking for. Um, could it be this one, MR 3233142?
[AGENT][NEGATIVE] Mm no, no.
[CUSTOMER][NEUTRAL] MR 323314 2
[AGENT][NEUTRAL] Mhm and that's why we ask for the documents because when we ask for the documents we will look into it we will check the documents and we will look for that code you don't have to be looking for the code um so basically the, um, let me give you the instructions again because the easiest way is just to go by what we need and it's just easy, um.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] If you can get all the documents, but um, yeah, the claim form is the first one. The itemized bill with the diagnosis codes and procedure codes is the next one.
[AGENT][NEUTRAL] If you don't have an itemized bill with diagnosis codes or procedure codes, all you need to do is get in contact with the place of service, the Baptist. Let them know that you're trying to submit your own claim because you pay out of pocket, and you need an itemized bill with diagnosis codes, and they will send it to you. And that's what it's called, an itemized bill with diagnosis codes.
[CUSTOMER][NEUTRAL] Let me write that down.
[CUSTOMER][NEUTRAL] I imagine with diagnosis.
[AGENT][NEUTRAL] Gosh.
[CUSTOMER][NEUTRAL] With diagnosis?
[AGENT][NEUTRAL] I know if it's coats.
[CUSTOMER][NEUTRAL] Well, oh, cos, OK.
[AGENT][NEUTRAL] Code, the code, uh-huh.
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] OK. And.
[CUSTOMER][NEGATIVE] Oh God help me because these people are horrible, but go ahead.
[AGENT][NEUTRAL] Or do you have like the discharge summary? Did they give you a discharge summary? Not the receipt, but a discharge summary.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] No, they gave me absolutely nothing. They charged my card, $45 and they were not even gonna give me a receipt. I asked for a receipt. So,
[AGENT][NEUTRAL] No, OK.
[AGENT][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] You know, I have the receipt and um.
[AGENT][NEUTRAL] Yeah, we cannot use the receipt. Um, so it's just gonna be the itemized bill, yeah, if you can get a copy of that itemized bill, it will have everything we need and we'll just go ahead and go over it and see exactly what happened. But, um, and we also need a copy.
[CUSTOMER][NEUTRAL] And what was the, and what's the 3rd, what would be the 3rd thing that you need?
[AGENT][NEUTRAL] OK, yeah, that's, that's sounds good. OK, so the third document is the explanation of benefits from the primary insurance showing how much they apply towards the deductible co-payment and co-insurance.
[CUSTOMER][NEGATIVE] Wow, all this for $45. I mean the times that we're living in. I can't believe it. OK, repeat that, please.
[AGENT][NEUTRAL] The explanation of benefits.
[AGENT][NEUTRAL] From the primary insurance.
[AGENT][NEUTRAL] Showing how much they apply of benefits for that date of service.
[CUSTOMER][NEUTRAL] Explanation of benefits.
[CUSTOMER][NEUTRAL] From primary insurance.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Insurance
[CUSTOMER][NEUTRAL] On the day that they did this, [PII]. So that's a phone call to United.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Usually they send us by mail whenever they process a claim or they send it by email or it depends how you have it electronically.
[CUSTOMER][NEUTRAL] So it's 2 phone calls I have to make.
[CUSTOMER][NEUTRAL] Do you think that, do you think that I might be able to find that if I log on to my United? You think they might have it there?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, more than likely, yes, you can get those electronic if you have registered with them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, because it might be worth a try instead of calling because honestly.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The whole entire medical.
[CUSTOMER][NEGATIVE] The field is turned upside down. It, it, it was bad and it got worse after [PII], really bad.
[CUSTOMER][NEGATIVE] In my eyes, really bad. So I will, uh, imagine all the steps that I have to take now just, you know, to make this one claim.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Um, my HR told me, she said, made it sound like it was very simple.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So I, um, this is not simple. I don't know. I know it may be simple for you because you do it all the time, but this is not simple because these are two phone calls already.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, OK. Anything else that you, that you need?
[AGENT][NEUTRAL] No, that's all we need. Those three documents is what we need the claim form, the itemized bill, and the explanation of benefits from the primary insurance. Those are the.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so once I have that, what should I do? May I scan it and email it to your department?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, we don't take emails for security. So, um, the three options that you have to send in a claim will be by fax, by mail, or if you register through the website to create your account, you can upload the documents to your account.
[CUSTOMER][NEUTRAL] So fax mail or upload.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Wow
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there anything else that I need to get?
[AGENT][NEUTRAL] No, that's all. And the instructions are also in the first page of the form. So you're gonna see the same instructions I gave you in the first page of the form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] So I'm gonna say
[CUSTOMER][NEUTRAL] OK. And so, so, um, was my HR
[CUSTOMER][NEUTRAL] Person correct in saying that um we can use um this gap insurance for these circumstances like this?
[AGENT][NEUTRAL] OK, um, let me give you a little bit of information about your benefits, OK? And this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. Um, you do have outpatient benefits. The outpatient maximum is 1000 per year, and um this is to help with the deductibles, co-payment, and co-insurance, um, if you go to an outpatient facility.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Or hospital, urgent care, diagnostic center, or surgery center. Um, it does not cover an office.
[AGENT][NEUTRAL] But it does cover outpatient facilities.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then you have inpatient bed.
[CUSTOMER][NEUTRAL] So just an example, right, just, um, anything from like a colonoscopy or anything like that where there's a a charge, then I can actually claim that or I can present them at that point now that I have my insurance card from APL I can present that to them and they can do the claim themselves directly. Is that correct?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] That is correct. As long as the colonoscopy is a sick like for a diagnostic colonoscopy, not a preventative colonoscopy, then yes, it's uh because we cover sickness or injury. So we don't cover anything that is preventative, it's just sickness or injury.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, understood.
[CUSTOMER][POSITIVE] OK. Um, go ahead, continue with my benefits.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. All right. You also have a um deductible. The deductible only applies to an ER visit. So, um, just an example, if the ER visit is um $300 and you, uh, you have a $100 deductible and we'll go ahead and pay that $200.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. OK. OK.
[AGENT][NEUTRAL] And um and that's also part of that 1000 per year, OK?
[AGENT][NEUTRAL] Um, and you also have an inpatient benefit. The inpatient benefit is 2000. This is if you're in the hospital, 18 hours or more, either observation or hospitalized.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But if you are 18 hours or more in the hospital.
[CUSTOMER][NEUTRAL] OK, OK, I understand.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there anything else?
[AGENT][NEUTRAL] Um, that's all the benefits I see here for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so when I first called, um, the recording also said medical and I, I think I heard dental, so we don't have dental gap, do we?
[AGENT][NEUTRAL] No, no. This one doesn't cover dental, pharmaceuticals, or vision or hearing aid. Uh, this is just for sickness or injury. Um, we have many products as a company, but this is the one that, um, your employer chose, which is the secondary supplemental plan.
[CUSTOMER][NEUTRAL] OK, let me make a note of that. It's good to know that so sickness or injury only.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and one last question, um.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] What I have right now is just uh a paper that I printed, you know, I printed the information. Um, do you guys provide um any uh plastic cards, identification cards?
[AGENT][NEUTRAL] If you want for it it's not, it's not a hard plastic, but I, I can request one. It's a laminated one. Is that OK?
[CUSTOMER][NEUTRAL] Or you no longer
[CUSTOMER][POSITIVE] Yes, that, that's perfect. Yes, please.
[AGENT][NEUTRAL] OK, let me go ahead and get one for you, one moment.
[AGENT][NEUTRAL] OK, I went ahead and requested that card for you. It will go out by mail, so it usually takes 5 to 7 business days for you to get in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, that's fine. OK, I think I have everything I need so thank you very much.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] You're welcome, Ms. [PII], and if you think about anything else, just give us a call back and we can assist you, OK?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah, I'm gonna try to see if I can if I can get as much as I can online rather than making the phone calls because.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][MIXED] The phone calls sometimes can be a little bit disappointing, especially with Baptists. I think that they have, um, I don't know if you're in [PII] or in [PII], if you know the Baptist health systems, but I think they've grown way beyond their um ability to
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] To operate in a functional way, like for, for patients. You know, when you grow too much.
[AGENT][NEUTRAL] It's a large company. Mhm.
[CUSTOMER][NEGATIVE] Yeah, you grow way too much and then your care isn't the same.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, sometimes smaller is better.
[AGENT][NEUTRAL] Yes, that's why I was here here.
[CUSTOMER][NEUTRAL] My, my, my, my opinion, my opinion, let's see what happens with this new person that's coming, just got confirmed, um, to look over our health system under the uh the new [PII] administration. I think we're gonna have a lot of very good things coming our way. But again, you'll remember this conversation, sometimes smaller is better.
[AGENT][NEUTRAL] Yeah,
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, I agree.
[CUSTOMER][POSITIVE] So darling, OK, so thank you again. You have a beautiful day. You were very helpful. Thank you. All right, bye.
[AGENT][POSITIVE] You're welcome. Thank you. You're welcome, Ms. [PII]. Have a good afternoon. Bye-bye.
[CUSTOMER][NEUTRAL] You too bye bye.