AccountId: 011433970860
ContactId: c5992fa3-1769-4fc2-a92e-33f3be949bd1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 784609 ms
Total Talk Time (AGENT): 380594 ms
Total Talk Time (CUSTOMER): 254330 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/c5992fa3-1769-4fc2-a92e-33f3be949bd1_20250429T12:08_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], I put in a claim and I'm not sure.
[CUSTOMER][NEUTRAL] They said that additional information is needed, but I sent in a critical illness application.
[CUSTOMER][NEUTRAL] And so I'm trying to understand what additional information that they need because they stated everything on the critical illness.
[CUSTOMER][NEUTRAL] Application.
[AGENT][NEUTRAL] And are you the policy holder?
[CUSTOMER][NEUTRAL] Yes I am.
[AGENT][NEUTRAL] OK, what's your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and I can barely hear you. Can you spell your first name for me?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] And your policy number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It is 227-058-2.
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I can barely hear you. I heard the [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and did you say you're calling on a claim?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me one moment to pull up your file.
[AGENT][NEUTRAL] And if you can verify your date of birth, mailing address and email address, please?
[CUSTOMER][NEUTRAL] It's [PII]. It's [PII] [PII].
[AGENT][NEUTRAL] And what's your zip code?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what is the month of your birth date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you know the date of service of the claim?
[CUSTOMER][NEUTRAL] Uh, I wanna say [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I can't confirm.
[AGENT][NEUTRAL] OK, so I'm showing the claim that was processed on yesterday and you'll receive an explanation of benefits in the mail shortly. Um, we're requesting additional information. It says that in order to complete the processing of this date of service, please submit fully itemized billings with the diagnosis and procedure codes, and we'll also need a copy of your primary insurance explanation of benefits as well, and it is for [PII] this year.
[CUSTOMER][NEUTRAL] So here's my question, so I've been seeing them throughout the year.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I have
[CUSTOMER][NEUTRAL] So because I've been diagnosed with it, I've had treatment I have all different kind of things so the application they put the code on the application you guys are asking for what code because they already put it on the application.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] When you say the application, what do you mean?
[CUSTOMER][NEUTRAL] The application that I submitted, the critical application, they put the actual diagnosis correct.
[AGENT][NEUTRAL] Oh, you mean the claim form?
[AGENT][NEUTRAL] Right, and in addition to the claim form I think on page one of that claim form, it also states that we need an itemized bill.
[AGENT][NEUTRAL] As well.
[CUSTOMER][NEUTRAL] From the actual where where I got service at correct?
[AGENT][NEUTRAL] For that
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] And then because our the APL policy is secondary to your major medical plan, we also require a copy of their explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] From my insurance, my primary insurance.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] So you would need to either, you know, you can download it from their website or you can reach out to them and have them send you a copy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so it doesn't, so each service I get I have to put in a claim because I, I thought it was just in general because I've had several services that's what I'm saying so.
[AGENT][NEUTRAL] From like different providers?
[CUSTOMER][NEUTRAL] Same provider but I've been seeing him first.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And is it for different dates of service?
[CUSTOMER][NEUTRAL] Do I have
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, so if, um, did you submit more than one date of service this time or is it just for [PII]?
[CUSTOMER][NEUTRAL] I just put [PII] and understanding that it would go for the rest of for all from here on out, but I guess that's that's not how it works.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, it's not, um, and so each time you see this health care provider we'll need an an itemized bill, uh, each time you see this this provider or any provider, we require an itemized bill for a specific date of service in question and then the explanation of benefits also referred to as the EOB, uh, that corresponds with the date of service. So for instance this is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, we require the itemized bill. Is this at a hospital or is it a specialist office?
[CUSTOMER][NEUTRAL] It's a specialist.
[AGENT][NEUTRAL] OK, so you'll contact that office and request the itemized bill and let them know it's the one that includes your diagnosis code, which is the reason for the visit and then procedure codes, which is what they did when you were there.
[CUSTOMER][NEUTRAL] OK, so diagnosis and procedure codes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh huh, on the itemized bill and it include other stuff to your bill charge, the name of the provider and other information that we use to process the claim as well and then uh your primary EOB needs to match the data of service and the provider's name.
[CUSTOMER][NEUTRAL] So, uh, I don't even know if the data service we just put, I think that's when we signed the application. I'm not sure if that's even the correct date of service this.
[AGENT][NEUTRAL] The date of service is the actual date that you went to see your doctor.
[CUSTOMER][NEUTRAL] Do they put that on the application because I just put the [PII] and ask what date I signed it and I signed it on the [PII].
[AGENT][NEUTRAL] Oh, no, no, no. It's the date that you were seeing. So if you went to the doctor on the [PII], it has to show the [PII] when you report it to that doctor.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's the date of service.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So every time I want to submit a claim, do I put in this actual, is there a specific application I just put in this critical application.
[AGENT][NEUTRAL] And, and when you say application, do you mean claim form, the APL claim form?
[CUSTOMER][NEUTRAL] A claim form correct.
[AGENT][NEUTRAL] OK, what type of policy do you have with us? Is it the gap policy?
[CUSTOMER][NEUTRAL] I'm not sure.
[CUSTOMER][NEUTRAL] It says extended uh.
[AGENT][NEUTRAL] OK. Do you have a copy of what you sent to us?
[CUSTOMER][POSITIVE] Yes I do.
[AGENT][NEUTRAL] Um, what is the name of the claim form? It should be a name at the top like Medlink or critical illness claim form.
[CUSTOMER][NEUTRAL] It says critical illness claim form.
[AGENT][NEUTRAL] OK, so the policy that you have is a Metlink claim form.
[AGENT][NEUTRAL] Um, I don't show that they're requesting the claim form, uh, because it's pretty much houses the same information on each.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let me take a look at the critical illness. So did your attending physician fill out a part of that critical illness form?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Let me look at it.
[AGENT][NEUTRAL] OK, so under the Metin claim form.
[AGENT][NEUTRAL] It doesn't require a form for the, your doctor to fill out.
[AGENT][NEUTRAL] Um, it's just, uh, a portion for you to complete.
[AGENT][NEUTRAL] And that's it.
[CUSTOMER][NEUTRAL] And where do I get that medling form?
[AGENT][NEUTRAL] It's on our website.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you able to go there now? I could direct you um as to which one to to select.
[CUSTOMER][NEUTRAL] You said it's a
[AGENT][POSITIVE] Uh, secured.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, uh huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And when you get to the site.
[AGENT][NEUTRAL] It should say, or you should see.
[AGENT][NEUTRAL] Uh, workforce benefits that work for you?
[CUSTOMER][NEUTRAL] Do I go to claims form because one once do I log in? Don't log.
[AGENT][NEUTRAL] On the home
[AGENT][NEUTRAL] Well, on the home page. I'm just trying to make sure you're on the right page.
[CUSTOMER][NEUTRAL] Oh, OK, let me log out because it says.
[AGENT][NEUTRAL] And there is a claims and forms link in the upper right that I'm gonna have you click on.
[CUSTOMER][NEUTRAL] OK, so online service center and it says welcome to online service center and then it has me.
[AGENT][NEUTRAL] OK, so you you entered [PII]. Our website is just [PII], where you are now is where you upload a claim, but that's not the right one to download a claim form.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so it's [PII]
[AGENT][NEUTRAL] It's just [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][POSITIVE] Welcome to Workforce Benefits that work for you.
[AGENT][NEUTRAL] Mhm. On the upper right you'll see a link, claims and forms click that link.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] At Hyperlink.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then just scroll down.
[AGENT][NEUTRAL] And you should see claim forms and policy change documents.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the first one you should see is accident claimed or alphabetized.
[AGENT][NEUTRAL] So the Metin is gonna be on page 2.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, Medli claim form.
[AGENT][NEUTRAL] Mhm and click that download form button to the right.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And then on page one.
[CUSTOMER][NEUTRAL] OK, I got it.
[AGENT][NEUTRAL] It, it kind of outlines what documents are required, um, an itemized bill with diagnosis, um, and procedure codes too, but this says diagnosis.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And most of them they if you you request the itemize it's gonna include both.
[AGENT][NEUTRAL] And then the explanation of benefits from your primary insurance. Excuse me.
[CUSTOMER][NEUTRAL] OK, and so I wanna be so each time I see them I have to do this for every single time.
[AGENT][NEUTRAL] You'll have to complete this form and then attach the two the two other documents that's required.
[CUSTOMER][NEUTRAL] Documents correct so every single time.
[AGENT][NEUTRAL] Now if you, if, if you're submitting.
[AGENT][NEUTRAL] So do you usually submit just one day of service at a time?
[CUSTOMER][NEUTRAL] No, I'm, I'm trying to submit them all. I have several.
[AGENT][NEUTRAL] OK, so for each date of service.
[AGENT][NEUTRAL] If you, if you submit them all at the same time um.
[AGENT][NEUTRAL] You can fill out the one claim form, but we do need the itemized bill.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And your primary explanation of benefits for each data of service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And those need to have the codes and the procedures correct?
[AGENT][NEUTRAL] On the itemized bill. Mhm.
[CUSTOMER][NEUTRAL] OK, OK, I could do that, but I could submit because I'm trying to submit all of them at one time because I have several.
[AGENT][NEUTRAL] Mhm. You know, just make sure you have the itemized bill and your primary insurance explanation of benefits for each date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the character.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then complete this claim form and attach it on the front and put it on the front top.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] And you can upload them on you know the secured website where you were before.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] The original one, OK.
[AGENT][NEUTRAL] Secure do it in public.
[CUSTOMER][NEUTRAL] OK, alright, I got it. I think I got it so the critical illness form does not apply to me because of the type of benefits I have.
[AGENT][NEUTRAL] Correct. You do not have the critical illness policy. You just have the meddling policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right perfect thank you so much.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Bye bye.