AccountId: 011433970860
ContactId: d5b04f4f-acd4-492b-b742-5be69e805874
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 605010 ms
Total Talk Time (AGENT): 201048 ms
Total Talk Time (CUSTOMER): 208260 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/d5b04f4f-acd4-492b-b742-5be69e805874_20250325T17:01_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, uh, my name is [PII]. I have um
[CUSTOMER][NEUTRAL] Insurance with you guys, but I was trying to file a claim over the internet.
[CUSTOMER][NEGATIVE] And when I went into the claim form, it doesn't give me a form.
[AGENT][NEUTRAL] OK, say that one more time, Ms. [PII], I'm sorry.
[CUSTOMER][NEUTRAL] I mean, can you help?
[CUSTOMER][NEUTRAL] I have insurance.
[CUSTOMER][NEUTRAL] Uh, I have insurance with you guys, and I have, I need to file some claims.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I went into the internet.
[CUSTOMER][NEUTRAL] Uh, put claim forms and I don't get the form, so how do I file the claim?
[CUSTOMER][NEUTRAL] Can you, I mean, can somebody
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] What's your policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] Go with me over.
[CUSTOMER][NEUTRAL] My policy number, I guess 60801, is that the payer ID?
[AGENT][NEUTRAL] No, ma'am, that's uh
[CUSTOMER][NEUTRAL] No policy number is 025 025.
[CUSTOMER][NEUTRAL] 83671
[AGENT][POSITIVE] OK, thank you so much. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, ma'am. Give me one moment, please.
[AGENT][NEUTRAL] Uh, one moment please, I apologize.
[AGENT][NEUTRAL] OK, Ms. [PII], verify your date of birth, mailing address and email address for me, please.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Email address you said?
[AGENT][NEUTRAL] Your date of birth, mailing address, and email address, please.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, [PII]. Email address is [PII] and my mailing address is 2.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, give me one moment just saying if you have uh set up an account on our online service center.
[CUSTOMER][NEUTRAL] I see I see.
[AGENT][NEUTRAL] OK. I do show you have an account set up. So, um, when you log on to the site, it does have it to where you can upload a claim document.
[CUSTOMER][NEUTRAL] Basically, uh, that is the, uh, all I have is uh the receipts.
[CUSTOMER][NEUTRAL] And so what, uh, which phone do I uh
[CUSTOMER][NEUTRAL] Which phone do I uh that
[AGENT][NEUTRAL] The claim form
[AGENT][NEUTRAL] Uh, you will fill out the Medli claim form.
[CUSTOMER][NEUTRAL] Where, where do I get that from?
[AGENT][NEUTRAL] If you're on the website at [PII] or at [PII] under claims and forms, it would say Metlink claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Netlink plans.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] 94
[CUSTOMER][NEUTRAL] I have here uh.
[CUSTOMER][NEUTRAL] Other ways to submit your claim.
[CUSTOMER][NEUTRAL] Mail paper form, download and complete the appropriate claim form. Is that what it is?
[AGENT][NEUTRAL] Yes, ma'am. You can download the form or you can mail it or fax it uh to the office. But if you're going to the claims form, if you scroll down where it has 123, if you select 2, it will show you the other page of claim forms.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Hold on a second. Let me go, let me go online. You said go, go to what?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Secure
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] I know, for the claim forms is at [PII].
[CUSTOMER][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] [PII]. And then what? That's it?
[AGENT][NEUTRAL] Yes, ma'am. Select claims and forms.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Claims and forms. OK.
[AGENT][NEUTRAL] Yes, ma'am. And if you scroll down, you'll see 123. If you select the 2, they take you to the next page of claim forms.
[CUSTOMER][NEUTRAL] 123.
[CUSTOMER][NEUTRAL] What was
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I don't see 123.
[AGENT][NEUTRAL] OK, if you're on claims in form, scroll down.
[AGENT][NEUTRAL] And you'll see 123.
[AGENT][NEUTRAL] And they're kind of highlighted.
[AGENT][NEUTRAL] And blue.
[AGENT][NEUTRAL] Where
[CUSTOMER][NEUTRAL] OK, claim 4 and policy changes document.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I see, I see that claim form, huh?
[AGENT][NEUTRAL] Yes, ma'am. Keep scrolling down right after everyday solution claim form, you should see at the bottom 123.
[CUSTOMER][NEUTRAL] What do
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, 0123, where do I go?
[AGENT][NEUTRAL] Go to the 2nd 1 and they'll go to the 2nd page of claim form and then you'll see Medli claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hospital and then also of like claim form. OK, just click on view details.
[AGENT][NEUTRAL] Ma'am, you would select on download form and then it'll have it to where you can add your information on the claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you can upload it and if you save it to your computer, and you can upload that along with the billing and primary EOB.
[CUSTOMER][NEUTRAL] So if
[AGENT][NEUTRAL] To submit a claim.
[CUSTOMER][NEUTRAL] Um, they they give me all I have is the receipt. Is that good enough?
[AGENT][NEUTRAL] I'm sorry, say, no, ma'am. We can't process just by the receipt. We, since this is your secondary, we do need a primary EOB.
[CUSTOMER][NEUTRAL] What's COB?
[AGENT][NEUTRAL] Explanation of benefits. It's what your primary insurance was sent to you showing what they applied towards deductible, co-pay or co-insurance for the data service you're filing for.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, one of them.
[AGENT][NEUTRAL] Who is your primary insurance with?
[CUSTOMER][NEUTRAL] Uh, Aetna.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] I think, OK, I think that's what they gave one of them did not give it to me.
[CUSTOMER][NEUTRAL] Uh, they, they gave you, uh, they gave you an approval code. You got this thing with record number, trace number, and all of that.
[AGENT][NEUTRAL] I'm sorry. Uh, is that from the, your, the provider or from your primary insurance from Aetna?
[CUSTOMER][NEUTRAL] No, for my provider.
[AGENT][NEUTRAL] Uh, you have to contact their billing department and request the itemized bill showing diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] From who? From the provider?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So you gonna diagnosis?
[AGENT][NEUTRAL] And procedure codes.
[CUSTOMER][NEUTRAL] Let me see if the paper they gave me.
[CUSTOMER][NEUTRAL] OK, you didn't have any of that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] So it's called diagnosis.
[AGENT][NEUTRAL] Yes, ma'am. So along with the claim form, the itemized billing, primary explanation of benefits, uh, that's what we're needing in order to process your claim as secondary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. And you, all right, you're welcome, Ms. [PII]. And is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Thank you, thank you.
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] OK, uh thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Alright thanks.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] That record number.