AccountId: 011433970860
ContactId: da1de5c2-e885-456e-8d3d-0ad9c2249a43
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 803299 ms
Total Talk Time (AGENT): 297685 ms
Total Talk Time (CUSTOMER): 205971 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/da1de5c2-e885-456e-8d3d-0ad9c2249a43_20250519T14:13_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 was just speaking to someone a few minutes ago and we got disconnected. Um, she was emailing, I think um another department to find out the status of um of the benefit of our group of of our.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What what group and I, I can see if I can find um who you're speaking with.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, this group was just implemented on 51 and we still don't have a group yet because they told me that it's still going through the process.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um, I was telling her that I have a member that's going, it's, it's in the urgent care and it's requesting an ID card. She was telling me that there is nothing, you know, in the system, uh, but she was texting, I think, I mean, emailing, uh, I think enrollment or something like that, and um I can give you, I can give you the name of the group.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, yeah, that would be perfect.
[CUSTOMER][NEUTRAL] OK, the name of the group is spelled [PII] as in [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's pronounced [PII].
[AGENT][POSITIVE] OK, perfect. Oh.
[CUSTOMER][NEUTRAL] The next word is, the next word is.
[CUSTOMER][NEUTRAL] You, you got it? [PII]
[AGENT][NEUTRAL] [PII]. OK, perfect. I will put you on a brief hold and I'm gonna see if I can find who you're talking to, OK.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Ma'am, are you still there?
[CUSTOMER][NEUTRAL] Yes I am.
[AGENT][NEUTRAL] OK perfect um so it looks like you were speaking with [PII] and um so it looks like we received the renewal or the new business request on [PII] and it takes 14 business days to have the group fully set up. So right now we do not have a policy number for it, but if the since you have a um an employee that is currently in um did you say the ER correct?
[CUSTOMER][NEUTRAL] Uh, urgent care, mhm.
[AGENT][NEUTRAL] Urgent care. Um, so if it is covered, um, the effective date is [PII]. So, um, even though they don't have a policy number, even though they don't have an ID card right now, they will be covered under our policy.
[CUSTOMER][NEUTRAL] OK, so, um, what do they do? They need to get the bill and then forward it over?
[AGENT][NEUTRAL] Yes, so even if they did have the um the the policy card ID, they would still have to submit a claim form to us, um, so that way um we have like all the doctor bill, we have all the documentation for it, and if you go on to AM Public Life, um, you will see claims on the right hand side, um, and that will have all of the.
[CUSTOMER][NEUTRAL] OK, hold on, hold on, you're going too fast, hold on, you're going to fast. What's the website?
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] So [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] OK, uh, look under claims and forms.
[AGENT][NEUTRAL] And then claims and forms, yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so then you scroll down and then there'll be all the forms and and if it's easier I'm not quite sure what all you guys have but if it was like hospital um meddling you would just click on whichever form is applicable to the group and then they would download that form or you could also submit that in the OSC, whichever is easier.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Well, this one is an urgent care, so I really don't see this.
[AGENT][NEUTRAL] So we don't have one specific for the urgent care. Um, do you know, um, do you know what they have? It looks
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Do do you know what the group has, what plan they signed up for?
[CUSTOMER][NEUTRAL] Oh yeah, um, they've signed up for the
[CUSTOMER][NEUTRAL] Give me a second.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me see here.
[AGENT][NEUTRAL] And master app let's see.
[CUSTOMER][NEUTRAL] Let me see here I'm looking at the master app uh hold on.
[CUSTOMER][NEUTRAL] Master, uh.
[AGENT][NEUTRAL] It looks like Medlink.
[CUSTOMER][NEUTRAL] Yes, Metlink, yes.
[AGENT][NEUTRAL] Medlink. So you would click on the medlink um form, um, you can sort by filter by product, you can click on Medlink that will get you the quickest, and then you download the form and it's in English and in Spanish.
[CUSTOMER][NEUTRAL] OK, but OK, I see it I see it.
[CUSTOMER][NEUTRAL] Download the form. OK, perfect, um, and then I will forward it to them and they would need to um.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, submit it over to them.
[AGENT][NEUTRAL] Yes, and I believe, um,
[AGENT][NEUTRAL] Yeah, they would just need to fill it out. Um, I believe they would have to submit like the doctor bill after it's been submitted to uh their medical plan.
[AGENT][NEUTRAL] And then um and then we would take a look at it and there is also um on the link it says sign up or log in now and you can file the claim using the OSC service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Which is our online portal.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I see it.
[CUSTOMER][NEUTRAL] Yeah, so they have those two choices. They can either go online or they can fill out the form.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And, and what is the what website again you said? I'm sorry.
[AGENT][NEUTRAL] Um, so if you just look at the form like I clicked on the download the form and on the first sentence it says sign up or log in now, um, and it's called the OSC, the online service center, and if they just click on that, um, then if they don't have an account already set up since it is a new group, we can help them set that up so that way they can track that online easier than submitting it by mail.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] So once the claim is processed, um.
[CUSTOMER][NEUTRAL] That is the form that they use.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So either paper.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] Or online.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK. OK, perfect. Um, do you know what the benefit is for an urgent care for them?
[AGENT][NEUTRAL] No, I do not. Let me.
[CUSTOMER][NEUTRAL] So tell them that the group is still being implemented.
[AGENT][NEUTRAL] So, um, are you by chance the broker or are you um the group?
[CUSTOMER][NEUTRAL] We're the broker's office, yeah, we're the broker, we're the one that submitted it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so do you guys have access to the brochures because that will have like a a plan by plan of hey this is what the outpatient riders are, this is what the, OK, so that will.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, I do. I have it. I have it. I have it. I just wanna make sure that what I see it's 750 per covered person per calendar year for each outpatient service.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] It looks like.
[CUSTOMER][NEUTRAL] But I don't know if they're on plan 1, plan 2, plan 3, or plan 4.
[AGENT][NEUTRAL] So it looks like.
[AGENT][NEUTRAL] There's only one plan that was selected. It was the 3000, 3000.
[AGENT][NEUTRAL] For Medlik.
[CUSTOMER][NEUTRAL] So that was plan 44, OK.
[AGENT][NEUTRAL] And then it looks like their medical total out of pocket is 7800.
[AGENT][NEUTRAL] Which is through AMed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Right, correct.
[AGENT][NEUTRAL] And so
[CUSTOMER][NEUTRAL] So this is covered, they covered like 3000 of it, right?
[AGENT][NEUTRAL] Um, I am not sure on the policy if you want me, I can transfer you over to someone who specializes in medin and can talk you through if a um urgent care. I'm just not sure, um, but I know a lot of times they'll submit it through their, um their uh medical plan.
[CUSTOMER][NEUTRAL] No, no, no, that's fine, that's fine. I'll just, yeah, that's OK.
[AGENT][NEUTRAL] And then like the AMed, they'll submit it through AvMed and then let's say AvMed doesn't cover $300 of the urgent care, then they would submit that $300 to us and see if it would be covered under their plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So they would need like the EOB sent over and all that.
[AGENT][POSITIVE] Yeah, or even just like, um, yeah, that an EOB would be great.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, so I will definitely forward this over over to them.
[CUSTOMER][NEUTRAL] And it's the med link claim form, OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] All right, thank you so much. You have a great day.
[AGENT][NEUTRAL] Of course, you as well.
[CUSTOMER][NEUTRAL] OK, bye-bye.
[AGENT][NEUTRAL] Bye bye.