AccountId: 011433970860
ContactId: ccd4cf6d-d3c6-4d98-8dda-6042596e2726
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 562830 ms
Total Talk Time (AGENT): 268973 ms
Total Talk Time (CUSTOMER): 239383 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/ccd4cf6d-d3c6-4d98-8dda-6042596e2726_20250123T20:29_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, um, I had a few questions, but first I'm going to start with, um, what information do you need from me? Uh, we have had this plan for a few years, but now it's showing as not active, so I don't know if it's something um that you can look into or if I have been calling my HR to find out because online it shows that we're active through the company.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, sure, I can assist you with your policy and see if it's active or not. Um, may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, my name is [PII], like I say [PII]. My phone number is [PII].
[AGENT][NEUTRAL] And may I have the policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Um, the policy number is 01984141.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, for security, may I have your date of birth?
[CUSTOMER][NEUTRAL] My date of birth is [PII]. I'm not the primary though, my husband is.
[AGENT][NEUTRAL] OK, that's fine. And may I have the mailing address on file?
[CUSTOMER][NEUTRAL] Uh, mailing address is [PII].
[AGENT][NEUTRAL] OK, it looks like you have to contact the HR department and see what they did if they changed companies or if they still with us, but it is lapsed, it is terminated.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Got it. OK, um, and if I still have like claims that are pending from when it was active, I, I don't know if it's like I said, I don't know if they change companies or if it's a, um, an error, um, that would still get paid even if the policy is lapsed or now with the new company as long as it was while we're covered.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] Correct. If you have any claims that you need to submit and it's during the time that the policy was active, you can still submit the claims. There is no timely filing limits. Um, we go by the day that it was effective until the day that it terminated.
[CUSTOMER][NEUTRAL] OK, and then, um, what if there's some really old claims because, uh, I, um, believe there's some, some stuff from [PII] that, um, and so it's not doesn't show up on my.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On, on my, uh, portal because it says like the last 24 months so it's just outside of that period.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, it's fine as again, as long as the policy was active during this time of service, you can go ahead and submit the claim. It looks like the policy became effective on [PII]. Um, let me see if it was, um, effective that date as well. Let's see, so [PII].
[AGENT][NEUTRAL] OK. Well, um, it looks like you was added to this policy on [PII]. Let me double check just to make sure, OK?
[CUSTOMER][NEGATIVE] Oh, no, no, it's not for me, it's for my daughter. She was, she should have been at it when she was born.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Um, for [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, yes, she was added on [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, yeah, it's for her uh.
[CUSTOMER][NEUTRAL] Um, OK, and how do I submit the claims because I like, I don't, since they're not showing online as like a claim number policy number, what do I do to actually submit them since they're not?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Since you cannot use the website because the policy is terminated, um, you will have to either mail it or fax it. Those are gonna be the only two options we have since the policy is not active.
[CUSTOMER][NEUTRAL] Uh, do I email something?
[CUSTOMER][NEUTRAL] 00 jeez, that's even more complicated. Hopefully it's something that they totally it's an HR issue and they reacted to it. Um, OK, so if I mail or fax, what um, do you mean? I assume.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so we're gonna need the claim form and we're gonna need two more documents together with the claim form. Um, the claim form you can find it through our website at [PII] and you will look for the meddling claim form.
[AGENT][NEUTRAL] And uh the first page is gonna give you instructions, which is the same information that I'm gonna ask you for, which is the itemized bill with the diagnosis codes and procedure codes.
[AGENT][NEUTRAL] And we also need the copy of the explanation of benefits from the primary insurance showing the amount applied towards the deductible co-payment of co-insurance.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] OK, so itemized bill, diagnosis, and procedure code and explanation of benefits.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] And where is the claim form called? I didn't um.
[AGENT][NEUTRAL] Um, you will go to, OK, you'll go to [PII] and you will pull the claim form. The claim form is under Metlink, Metin claim form.
[CUSTOMER][NEUTRAL] You said.
[CUSTOMER][NEUTRAL] Oh, under Medlink, OK.
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] That's me.
[CUSTOMER][NEUTRAL] OK and um.
[CUSTOMER][NEUTRAL] The diagnosis and procedure code, um, is that something we could write in if it's not written on the itemized bill or on the explanation of benefits, would it be there?
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Um, it will only be an explanation of benefits if you work with Blue Cross Blue Shield. If you don't work with Blue Cross Blue Shield, it's not gonna be there that they are the only ones that put that information in the ELBs. Um, so basically if, if you don't have it and you need to call to get it, you will just write it down either on the ALB or the itemized bill. We just need it in writing.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, yeah, yeah, that's fine. I just wanted to make sure that it's not something that had to be like.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And, yeah, mm.
[CUSTOMER][NEUTRAL] Pre-printed from them like I, I can, it could be manually written in OK.
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] OK, and then, um, well, I guess I'll call the, uh, I'll call my husband. Well, my husband will I figure out what the gas plan going forward, but, um.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Do, um,
[CUSTOMER][NEUTRAL] If we do have access online again.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You said I have to mail or fax since it's a terminated, but say they find out it's an error and then they reactivate it right away. Is it still the same process of mailing or faxing it or um I need to gather this data in anyway, but what is the process then if I have online access so I submit it to.
[AGENT][NEUTRAL] OK, if yeah, if, if by any chance they will reactivate the policy or you have access to the online service center, you can upload the claim through there um it's gonna say upload documents and that's how you, um, upload the claim by clicking upload documents into the account.
[CUSTOMER][NEUTRAL] OK, I think, well, uh, when I'm, I'm logged in now and then actually there is, it's saying that it's lapsed, but it actually does have a link for me to upload documents. I can just upload stuff there.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Oh OK. Yeah. Yeah, as long as it let you in, yeah, you can upload the claim. Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and so I filled out that claim form as well and then just upload it all together, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] All right. And then what is the um
[CUSTOMER][NEUTRAL] I guess fax number um.
[AGENT][NEUTRAL] OK. Well, the fax number is also on the claim form, but I can go ahead and give it to you. Let me know when you're ready.
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK, the the fax number is [PII].
[AGENT][NEUTRAL] 3659423.
[AGENT][NEUTRAL] That's attention claims.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] OK, perfect. um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and I guess they would just get back to me via mail like if um it's covered or not covered, yeah, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Correct, yes. Once it's processed, once we get it, it, it takes 7 to 10 business days for us to process the claim. And once we make a determination either to pay it or um if we need additional information or if, if there's anything or if we're not paying for any reason, we'll go ahead and send you an.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Explanation of benefits. If you have access to the online service center, you will get like that notification saying that it's ready. If not, you just wait on the regular mail, which that's how we're gonna send it out regardless. You're gonna get one by mail even if you have online service center you're still gonna get that copy by mail.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][POSITIVE] Got it. OK. All right, wonderful. Um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, great. Uh thank you.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm, I don't think so. Yeah, I don't think so. Thank you.
[AGENT][POSITIVE] OK. You're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you bye bye.