AccountId: 011433970860
ContactId: c7ba302e-a8f3-42f1-846e-0419ee12db63
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1186640 ms
Total Talk Time (AGENT): 401581 ms
Total Talk Time (CUSTOMER): 555328 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/c7ba302e-a8f3-42f1-846e-0419ee12db63_20250220T14:39_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] Hi [PII], my name is [PII].
[CUSTOMER][NEUTRAL] And um,
[CUSTOMER][NEUTRAL] I'm calling to get some clarification of claims and also claims that I can file for myself too.
[AGENT][NEUTRAL] So you need um clarity on the, on claims that have already been processed and then you want to know how to file claims?
[CUSTOMER][NEUTRAL] Well, yeah, because I, yeah, uh, well, to see if something is covered because I did a procedure and um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] When I did the procedure, they had just uh you know, the option that I got was you have to pay this out of your pocket right here today, even though I have the insurance, so I don't know if that you, you know, if this is, uh, if that procedure was covered underneath it, you know, some people don't wanna be bothered they'd be like, oh well, you can do the claim yourself.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. Right. OK. Well, I can definitely look at the claim for you and the coverage. Um, and Ms. [PII], may I have a good contact number in case we're disconnected and then your policy number?
[CUSTOMER][NEUTRAL] Sure, so, um, my phone number is [PII].
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] My number here is [PII].
[CUSTOMER][NEUTRAL] 73.
[CUSTOMER][NEUTRAL] 1859 MLS
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And that was 19731859?
[CUSTOMER][NEUTRAL] No, 189.
[AGENT][NEUTRAL] 89. OK, sorry about that. Hold on.
[CUSTOMER][NEUTRAL] So let me
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] All right, I have you here and I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so I don't use my email. I'll verify it, but I don't use it, uh, so it's it's so, yeah, I don't want people sending stuff there.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it's [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What else? um.
[AGENT][NEUTRAL] Your mailing address and date of birth.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Is my date of birth, and it's [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Um, OK, so for the claims, you said you needed clarity on two claims?
[CUSTOMER][NEUTRAL] Um, yes, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I got, I think I got an email or a letter or something saying that they paid 2 payments this month here.
[CUSTOMER][NEUTRAL] To gastro health?
[AGENT][NEUTRAL] Let me see if this is gastro. Oh yes, we have 2 here. Um, so,
[CUSTOMER][NEUTRAL] I don't even know who.
[AGENT][NEUTRAL] Let me see, is this, so we received them. Let me see if the second one is in as well. OK, yeah. So we received them both on [PII].
[AGENT][NEUTRAL] Um, and they were both paid out on, it looks like one was paid, OK, go ahead.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So what are they for though?
[AGENT][NEUTRAL] Um, let me see what this is. Hold on one moment.
[CUSTOMER][NEUTRAL] And when was the service?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] It says inpatient. Did you go to the hospital?
[CUSTOMER][NEUTRAL] Yes, I was in the hospital.
[AGENT][NEUTRAL] OK, so that
[AGENT][NEUTRAL] Um, hold on one second, I'm looking up the coding.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, this is for a hospital stay.
[AGENT][NEUTRAL] Well, hospital care.
[CUSTOMER][NEUTRAL] OK, OK, alright, because I'm like, OK, yeah, and.
[CUSTOMER][NEUTRAL] Mm, my issue is with gastro, OK.
[CUSTOMER][NEUTRAL] I was just confused because I know I wasn't in a doctor's office.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Because I was in the hospital.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, yes, and so I'm like.
[CUSTOMER][NEUTRAL] How is the gastro doctor billing if I do need a procedure? OK, so also.
[AGENT][NEUTRAL] 000.
[AGENT][NEUTRAL] Yes, it looks like it's 2 different days though.
[CUSTOMER][NEUTRAL] I was in the hospital for.
[CUSTOMER][NEUTRAL] Uh, 8 days.
[AGENT][NEUTRAL] So they may be um just in the process of sending the claims and so far we have [PII] and [PII].
[CUSTOMER][NEUTRAL] Right, and that's probably when they, you know, I had a CT scan.
[CUSTOMER][NEUTRAL] Ultrasound.
[CUSTOMER][NEUTRAL] I even had an echocardiogram because now I have a heart murmur. So yeah, uh, I just wanted to see what you know these these claims are for because I thought it was from a doctor.
[CUSTOMER][NEUTRAL] OK, now here's another thing I did procedure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, back in April of last year.
[CUSTOMER][NEUTRAL] And the procedure that I did.
[CUSTOMER][NEGATIVE] They didn't give me an option.
[CUSTOMER][NEGATIVE] To you, you know, like I said, to use my card, it just was like, oh, you have, you have to pay us $200.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I don't know, you know, I know, like, normal procedures like stuff that um
[CUSTOMER][NEUTRAL] I normally give my card and they deal with certain stuff like my MRI's and stuff, so I wanted to see if uh this procedure I was covered. I've already paid for it, but if it was if it was something that I could be reimbursed for.
[AGENT][NEUTRAL] OK. And what type of um
[AGENT][NEUTRAL] Was it like a, it was a procedure, you said?
[CUSTOMER][NEUTRAL] No, it was diagnostic, really.
[AGENT][NEUTRAL] Diagnostic? OK. Let me see. Hold on one moment.
[AGENT][NEUTRAL] There are newer certificate. Hold on one moment.
[CUSTOMER][NEUTRAL] Uh, I try to find the name of it.
[AGENT][NEUTRAL] It was done in the like an outpatient facility or was it done like in the office?
[CUSTOMER][NEUTRAL] It was done in a doctor's office.
[AGENT][NEUTRAL] OK. Um, so yes, it would be the same, um, up to $500 per calendar day. Your, um, your policy covers, well, should cover any treatment in the office as long as it's not cosmetic, it would just be um up to that $500 per day. So you would have two options since it's already passed. You said it was last year, so like for us, we don't have a deadline. Do you know if they build your primary as well?
[CUSTOMER][NEUTRAL] Right, the primary pay, the primary.
[AGENT][NEUTRAL] Because
[AGENT][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] The primary paid what they were supposed to pay. In fact, I just spoke to Florida Blue.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And they paid.
[CUSTOMER][NEUTRAL] They said they were billed $1,157. Uh, their deal is to pay 4 I think $2359 on it.
[AGENT][NEUTRAL] And then that remaining balance would have been sent to us along with whatever your co-pay or anything you had to pay. So you can, you can either reach out to the doctor, the doctor's office and let them know that you have this secondary insurance, um, depending on
[CUSTOMER][NEGATIVE] Well, I told them, I told them they didn't want to deal with it. They said I could find my own claim.
[CUSTOMER][NEUTRAL] I told them.
[AGENT][NEUTRAL] Well,
[CUSTOMER][NEGATIVE] They was like no
[CUSTOMER][NEUTRAL] So I have, I have my credit card bill where I paid for it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And they had also give me a receipt.
[AGENT][NEUTRAL] Right, but now you're gonna have to file, so there's so them saying that they don't bill us, that one could either be they're not familiar with us and just didn't want to do it, or they really don't bill to secondary. If you want me to give them a call with you, I can to give them the information, or if you want to file the claim on your own, I can let you know what's needed to file the claim.
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEGATIVE] I would just file it on my because I've already spent my money.
[AGENT][NEUTRAL] OK. Um, so to file a claim, you can fax it to us, you can mail it, or you can um send it electronically on our portal.
[CUSTOMER][NEUTRAL] You have a portal?
[AGENT][NEUTRAL] Which one do you think you, uh.
[CUSTOMER][NEUTRAL] OK, so is the portal your website? It's on your website?
[AGENT][NEUTRAL] I can show you how to get to it from our website. Are you near a computer?
[CUSTOMER][NEUTRAL] Yeah, I'm actually in front of one just one second here because I wanted to see the name of the claim, um, so I was trying to go back to Florida Blue.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, it's the 1234.
[CUSTOMER][NEUTRAL] To see
[CUSTOMER][NEUTRAL] What's the name? because they paid them.
[CUSTOMER][NEUTRAL] Uh, January, I'm sorry.
[AGENT][POSITIVE] Oh, no, you're fine. Take your time.
[CUSTOMER][NEGATIVE] The problem
[CUSTOMER][NEUTRAL] OK just one.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And see.
[CUSTOMER][NEUTRAL] Alright and.
[CUSTOMER][NEUTRAL] HCA West side region.
[CUSTOMER][NEUTRAL] getting close to it.
[AGENT][POSITIVE] Mhm. Take your time.
[CUSTOMER][NEUTRAL] Uh, for the specialist, uh, [PII].
[CUSTOMER][NEGATIVE] I just can't use it.
[CUSTOMER][POSITIVE] And that's good.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I see that's much like that.
[CUSTOMER][POSITIVE] It's uh, oh yes, I found it.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I found it.
[CUSTOMER][NEUTRAL] So, they said it's called.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, it's stuff.
[CUSTOMER][NEUTRAL] esophagu, esophaa, mortality.
[CUSTOMER][NEUTRAL] monometric study of the esophagus or the gastriocal junction study with interpretation and report.
[AGENT][NEUTRAL] Mhm. Um, any, if it's considered a diagnostic test and it's in an outpatient facility or in office, it'll still be that 500 per day.
[CUSTOMER][NEGATIVE] Right, OK, well, the only thing because they've been paid, they, the other part of it has been paid, it's just that they never give a chance they just charged me 200 right then and there, so I.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I will send you.
[CUSTOMER][NEUTRAL] The thing for I will send uh my receipts.
[CUSTOMER][NEUTRAL] And stuff so at least I can find these codes and everything so you know exactly what it is for because I'm sure your website is gonna want the name of what and all of these stuff.
[AGENT][NEUTRAL] Well, I'm going to tell you what's needed and how to get um to it. The claim form is online as well. You're going to go to the same place for the claim form and the port, the same website for the claim form and the portal.
[CUSTOMER][NEUTRAL] OK, um
[CUSTOMER][NEUTRAL] OK, all right. Uh, just one second here. And is it on the American public life?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, so it will be [PII].
[CUSTOMER][NEUTRAL] Website.
[CUSTOMER][NEUTRAL] OK, so I'm on your website. OK, I see the place that says claim forms.
[AGENT][NEUTRAL] Yes, so you'll click on claim forms and scroll down to where you see um files and documents and you're looking for the Medlink claim form.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's in alphabetical order, but you may have to go to the second page there, you'll see a 123.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just one second here, OK.
[CUSTOMER][NEUTRAL] OK. Oh, don't do that.
[CUSTOMER][POSITIVE] Got it. OK. Prime forms. OK, so prime forms.
[CUSTOMER][NEUTRAL] OK, I see where it says claim forms, um.
[CUSTOMER][NEUTRAL] But what it does to claim forms and my uh sign in and registered.
[CUSTOMER][NEUTRAL] One of my, OK.
[AGENT][NEUTRAL] Are you under claims and forms still?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK, um, and then did you scroll down to where it says claim forms and policy change documents?
[CUSTOMER][NEUTRAL] No, I haven't seen that. I see claim form on 9 24/7. Other way mail mail paper form, fax form, claim forms and policies changed that, yeah, I see that now.
[AGENT][NEUTRAL] Yes, so scroll down, depending on how many is allowed on your page, you may have to click on number 2.
[CUSTOMER][NEUTRAL] OK, so I scroll down it says view accident authorization, uh, cancer claim, change, uh, continuation of health coverage cover.
[CUSTOMER][NEUTRAL] Which one am I looking for again?
[AGENT][NEUTRAL] You're looking for the Medlink claim form?
[CUSTOMER][NEUTRAL] Medli OK Medlik.
[CUSTOMER][NEUTRAL] Let me write it down too.
[CUSTOMER][NEUTRAL] Times.
[CUSTOMER][NEUTRAL] Ma.
[CUSTOMER][NEUTRAL] Link L I N.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Hospital and I found that link.
[AGENT][POSITIVE] OK, good.
[AGENT][NEUTRAL] So you'll download that form and you can save the copy and then um you can fill it out, you know, when you as you fill your claims. Anytime you submit a claim, you'll need the Medli claim form.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You'll need the explanation of benefits from your primary insurance?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you'll need the itemized bill.
[AGENT][NEUTRAL] From the doctor's office.
[CUSTOMER][NEUTRAL] Right. And I got, I had it. It prob, I have to look it up. It's probably, it's crushed and everything, but I don't think I gained weight.
[AGENT][NEUTRAL] And just make sure it has the, it needs to have the diagnosis codes and the procedure codes on the itemized bill with the charges.
[CUSTOMER][NEUTRAL] You know.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Diagnosis for.
[CUSTOMER][NEUTRAL] Diagnosis code and what code?
[AGENT][NEUTRAL] Um, the diagnosis code and the procedure code.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. Yes, I guess, um, that, that will be it. Um, just gonna try to get my 200 I needed.
[AGENT][NEUTRAL] Now, for the online portal, um, I looked up to see if you had an account on the online portal and you do, um, if you want to scroll back up to the top of that page where you saw claims and forms to the right of it, it says sign in.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You'll go ahead and click sign in and log in. Um, if you, I have your username, if you don't remember the password, just enter the username.
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] Um, uh, I was on there, no, I just, uh, so I, it says claim file claims online 24/7 sign in.
[AGENT][NEUTRAL] Right, you're gonna click on login and then your username is [PII].
[CUSTOMER][NEUTRAL] No, no, I have that. I have, I have my username and password. I write them down so.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yeah, I, I, I logged, I'm logged in on your website.
[AGENT][NEUTRAL] OK, well, um, once you're on your um dashboard, you should see where it says upload documents or file a claim.
[CUSTOMER][NEUTRAL] A claim I see claim forms at the top.
[AGENT][NEUTRAL] Are you in the dashboard or you're still on the website?
[CUSTOMER][NEUTRAL] When I log in
[CUSTOMER][NEUTRAL] I'm on my account.
[CUSTOMER][NEUTRAL] Where it says welcome [PII].
[AGENT][NEUTRAL] OK, and do you see anywhere that
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Upload file.
[AGENT][NEUTRAL] Yes. So when you're ready to file the claim, you'll just click on that and follow the prompts and then it'll take you to where you, um,
[AGENT][NEUTRAL] can file your claim and upload your documents.
[CUSTOMER][POSITIVE] OK, alright, thank you very much.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today, Ms. [PII]?
[CUSTOMER][NEGATIVE] No, I just wanted, you know, to see if I could recoup that because the from right there I just wasn't like, you know, why didn't he, they ran it, but I guess they just didn't wanna be bothered with it.
[AGENT][NEUTRAL] Right, and that happens a lot. Um, if that happens again, I would just have them, give them our phone number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And your policy number and have them give us a call to verify benefits because they, they do do that and it's just a matter of, I'm not familiar with that, I don't want to deal with it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] All right. Thank you very much.
[AGENT][POSITIVE] You're very welcome. Well, thank you for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] OK, thanks.
[AGENT][POSITIVE] You're welcome. Bye bye.