AccountId: 011433970860
ContactId: d35a9082-103c-4d34-a574-95cff302d72c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 443890 ms
Total Talk Time (AGENT): 329662 ms
Total Talk Time (CUSTOMER): 79052 ms
Interruptions: 0
Overall Sentiment: AGENT=2.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/d35a9082-103c-4d34-a574-95cff302d72c_20250121T17:23_UTC.wav
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[AGENT][NEUTRAL] Hey, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, um, I have your insurance and I've been getting care at U Health, but I only recently found out that they don't actually.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, go to APL that I have to do that myself.
[CUSTOMER][NEUTRAL] And I've never done it, so I'm not sure what to do.
[AGENT][POSITIVE] OK, um, yeah, I can definitely help you. It seems like we wanna figure out how to file a claim for your policy.
[CUSTOMER][NEUTRAL] Yeah, I, I thought.
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] They did it but they say they don't.
[AGENT][MIXED] Yeah, um, that's a bummer. Um, it's really convenient and nice when they do that and take care of it for you, so I am really sorry that they don't, but we accept some claims submitted by insured, so, um, I'll help get you on the right track.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, do you mind if I have your name, please, and the policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, Ms. [PII].
[AGENT][NEUTRAL] Thank you. And what is that policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] 02405635
[AGENT][NEUTRAL] Thank you. And while I'm getting that policy pulled up, do you mind if I snag a good callback number as well?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. I appreciate that. And
[AGENT][NEUTRAL] Perfect. Would you be able to verify for me, please, your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And there's just a few other bits of information to verify, if you could verify with me your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, perfect. Thank you so much. So, I see you have our Medin policy with us. Um, so,
[AGENT][POSITIVE] I want to give you all the right information without overwhelming you. Um, the first thing I'd recommend is setting up an online portal with us. I can email you out like a
[AGENT][NEUTRAL] A card or not a card but like just a PDF like a user guide on how to set up our online portal and then all the features that has how to submit a claim through it um but it's what's nice is it's like a one stop area you can view all your policy information you can submit claims you can check your own claim status um you can set up for direct deposit if uh for benefits payable because if you're filing the claim the money goes to you where if.
[AGENT][NEUTRAL] The provider files the claim the money goes to them but you can set it up so it goes into your bank account instead of um waiting on a check so there's a lot of features in the online portal and I'd recommend um that is the very first thing if you're gonna be filing claims because it gives you so much access and power um but in order to do that I do have to have an email address on file and I don't would you like to put an email address on file?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, uh, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, I have your first name, [PII], your last name [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, cool. I am updating that, um, and I'm going to, I'm gonna make sure I'm putting like these documents in an email for you so you get everything you need.
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] So then the next thing you would do is you would want to fill out a claim form and I'm gonna put that in an email to you too so you don't have to hunt it down, um, but the claim form is wonderful because it has like basically the front of it's just a list and it's gonna help you figure out all the documents you need to get together um in order to submit the claim and have all the right information.
[AGENT][NEUTRAL] And I can talk over some of those with you, but don't panic if you don't remember it because it will all be on that claim form for you um but you're gonna want your.
[AGENT][NEUTRAL] Explanation of benefits from your primary insurance because the way this policy works is, you know, we try to pay on things that are applied to your co-pay, or co-insurance, um, and etc. so we need to see how your major medical applies different charges to your co-pay co-insurance, um, so that way we can figure out what we're doing. So your explanation of benefits, um, you're going to need your itemized bill from your major or from your provider that has the procedure codes.
[AGENT][NEUTRAL] Um, and then it needs to have your diagnosis code on it, um, and you can get that from, you said you went to, you have.
[AGENT][NEUTRAL] U of Miami? You Health. I'm sorry, I don't know where [PII] came from, um, but
[CUSTOMER][NEUTRAL] You have.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] It's the University of Miami health system.
[AGENT][NEUTRAL] Oh, perfect. OK, um, so you can ask them for, you know, a copy of a form with your procedure codes, um, and it just an itemized bill and then a form with your diagnosis code. And so then typically it's just those three things and you would upload them all um through the online portal and then the examiner would get them, they process them, they'd make their decision, um, benefit ifs paid would come to you and.
[AGENT][NEUTRAL] And that's kind of the process it sounds like a whole lot, especially.
[AGENT][NEUTRAL] If you've never done it before, um, do you have any questions over anything I just said? I'm, I'm sure you do. It was a lot of information.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I think I'll just have to see it and go from there um.
[AGENT][NEUTRAL] Just see it and go from there, OK.
[AGENT][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] So given that I just found out that this information, could I go back to other bills that I paid because I thought you guys rejected me?
[AGENT][POSITIVE] Yeah, absolutely. We do not have a timely filing limit, so you are welcome to submit a claim with us at any time and we will take care of it for you. Well, I say take care of it, we'll process it and um as long as the date of service was while you were insured with us, um, even if you submitted it 4 years from now, we're still gonna honor that we don't have a time limit.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK um alright so I'll look for your email.
[AGENT][POSITIVE] Perfect and I did I attach that claim form for you in that user guide, um, and it's just gonna say APL user guide in the subject line and it's gonna come from [PII] and that's gonna be on its way to you. I'm hitting send on it now.
[AGENT][POSITIVE] Um, and if you find yourself along the way of getting the documents together and you have more questions or you're not sure if it has, you know what I mean, don't hesitate to reach out to us. We're here to help you every step of the way.
[CUSTOMER][POSITIVE] OK, great, thanks very much.
[AGENT][POSITIVE] Hey, it's my pleasure, Ms. [PII]. Is there anything else I can do to take care of you, my friend?
[CUSTOMER][POSITIVE] No, that's it thank you.
[AGENT][POSITIVE] It's my pleasure. You have a wonderful day and thank you for calling APO.
[CUSTOMER][POSITIVE] OK thanks bye.
[AGENT][POSITIVE] Thanks bye.