AccountId: 011433970860
ContactId: e4fe172f-1eaf-4be7-a0ed-1afbcbfa7145
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 751989 ms
Total Talk Time (AGENT): 338115 ms
Total Talk Time (CUSTOMER): 342916 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/e4fe172f-1eaf-4be7-a0ed-1afbcbfa7145_20250410T20:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hi [PII], um, I have a, a couple of medical bills and that I was going to submit for a claim, um.
[CUSTOMER][NEUTRAL] I, I guess it, I kind of forgot that we had this um coverage. How do I go about submitting a claim and they're from, they're from last year, not like too late last year, but maybe 3 or 4 months ago, um, is that OK?
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, absolutely. um, can I get your name and your callback number and I can help you with submitting claims.
[CUSTOMER][NEUTRAL] Sure, uh, my name is [PII] and my callback number is [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is your policy number, [PII]?
[CUSTOMER][NEUTRAL] Uh, it's under my wife, um.
[CUSTOMER][NEUTRAL] Do you is it the uh payer ID number or?
[AGENT][NEUTRAL] It might say member ID or inpatient or outpatient certificate number.
[CUSTOMER][NEUTRAL] OK, yep, uh, I've got that right here it's um.
[CUSTOMER][NEUTRAL] 02356519 ML 7
[AGENT][NEUTRAL] OK, alright, let me look that up real quick.
[AGENT][NEUTRAL] And I'll just need to verify the policy and [PII], uh, can you please give me your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is your address, phone number, and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Uh, so it's, uh, it's under my wife, it's, I think it's [PII], um, and then what what were the other questions?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, do you know the email address or the phone number on the policy?
[CUSTOMER][NEUTRAL] Uh, I believe it would be [PII] or [PII].
[AGENT][NEUTRAL] OK, thank you so much. I appreciate you verifying that information for me. OK, so, um, I do notice that the policy did lapse on [PII].
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] So I think, I think I just have an old card, um, I.
[AGENT][POSITIVE] Yes, let me get the new policy up for you.
[CUSTOMER][NEUTRAL] I, I don't, yeah, can, can you look that up with the information, um.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] That you have.
[AGENT][POSITIVE] Yes, sir. I've got it pulled up right now, sir.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're very welcome. OK, so in order to file a claim, um, if your wife is signed up in the online service center, you could file a claim through there, um, I, I can't give information about the online service center unless she's there to be able to give me consent to speak with you about it.
[CUSTOMER][NEUTRAL] Well, uh, I, so we're both covered like it's, it's a family plan.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So, uh,
[CUSTOMER][NEUTRAL] I[PII], I.
[CUSTOMER][NEUTRAL] I sign up myself or does it have to be under her?
[AGENT][NEUTRAL] It has to be under her because she's the account holder.
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEUTRAL] But um basic information um if you guys go into uh secured [PII]
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That is the link to the online service center and you can file claims through there.
[AGENT][NEUTRAL] Once you sign up for it.
[CUSTOMER][NEUTRAL] OK, and I, I think, I think she's got, I think she is signed up for it because I know she, she, she filed a claim for something that she had, um, and then we got the check and I was like, oh, I need to do that as well for some, some things that I had, um, and so how does it work does do, um.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] OK, good. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do we just file do we pay the bill and then file a claim and get reimbursed, or do you guys pay the providers directly?
[AGENT][NEUTRAL] We pay the providers directly if they submit the claim.
[AGENT][NEUTRAL] So if they submit the claim from the facility, then we send the check to them.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, OK, and what type of stuff it would be covered so I had um I had a kind of a um an emergency room visit, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let's see this would have been.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] [PII] or sorry uh [PII], um, and now I have, uh, it looks like.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Another $1400 that's that's due, uh can I call the hospital and give them the information for for APL and.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They'll they'll file or they'll submit the claim to you guys or how do I, how do I go about doing that?
[AGENT][NEUTRAL] You can do that and if they're willing to submit the claim to us there's a payer ID number on your card.
[AGENT][NEUTRAL] That they can use to uh set the uh submit the claim electronically.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] If they decide that they do not want to do that for you, um, if you go to that uh [PII], if you guys go to that website and sign up for the online service center, you would click on your policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you're gonna click on claims and forms.
[AGENT][NEUTRAL] And you guys would choose the claim form that says Medlink, M E D L I N K.
[CUSTOMER][NEUTRAL] Yep
[AGENT][NEUTRAL] And if you submit it, uh, you'll need to have the explanation of benefits from your primary insurance, the part that they paid.
[AGENT][NEUTRAL] And then you'll also need the itemized statement from the facility itself that has the uh diagnosis codes and procedure codes. So 3 pages needs to be submitted, or 3 documents, that's claim form, the EOB, and the itemized statement.
[CUSTOMER][NEUTRAL] OK, and if I just pay it myself and then get um reimbursed, what would I need to submit?
[AGENT][NEUTRAL] You would still need those 3 documents.
[CUSTOMER][NEUTRAL] Those 3 documents, OK.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Uh, can you tell me what those are again?
[AGENT][NEUTRAL] It's the explanation of benefits.
[AGENT][NEUTRAL] And you get that from your primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you get the itemized statement.
[AGENT][NEUTRAL] From the provider, the facility that you went to.
[AGENT][NEUTRAL] The hospital.
[CUSTOMER][NEUTRAL] Yeah, I think I, I think I have that right here, um, and then what's the 3rd 1?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the claim form, the Medlink M E D L I N K. Yes, sir.
[CUSTOMER][NEUTRAL] Cuon.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] And if you download that all on your computer, you could upload it through the online service center.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK, got it. OK, uh.
[AGENT][NEUTRAL] That's the easiest way. And, OK.
[CUSTOMER][NEUTRAL] And um and then so what I guess what's covered by this plan? I know it's a secondary insurance plan but.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What what types of uh.
[AGENT][NEUTRAL] It, it
[AGENT][NEUTRAL] Yes sir, um, and this is just to verify your benefits. It's not a guarantee of payment. So what you have, you're correct, it is a supplemental insurance policy that helps with deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um,
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Great, uh thank you very much. So, well, I guess, sorry, last question, um, we had our, our son is on the um.
[CUSTOMER][NEUTRAL] On our plan, he was born, uh, just like a month and a half ago, um, and he had, um, his, his ears came out and they were like deformed and so we had to have a procedure done by uh uh an ear molding, um, procedure done to to fix them so uh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, that sorry, yeah, that's that's what we had done and the person that we, we had do it did not, did not accept insurance, um, would that be, yeah, and it was like 5 $4000 or $5000 would that be something that you guys cover or would we have to go through our.
[AGENT][NEUTRAL] Uh yeah, sir.
[AGENT][NEGATIVE] Oh no.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Primary insurance first and then you would cover what they don't cover.
[AGENT][NEUTRAL] So you go through the primary insurance first, you file the claim with the primary first, um, depending on what the primary pays, um, then you can file the claim because you'll have to have that explanation of benefits from the primary, um, that's part of the three documents that need to be sent in, file with your primary first and depending on the diagnosis and procedure codes that they pay.
[AGENT][NEUTRAL] Uh, is how we go off of what we pay for your secondary, so you would file with them first and then submit a claim on your own through that online service center like you're getting ready to do for yours and you can do it on on your son at that time and it'll all be based on what the primary pays.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] Got it. OK, alright, [PII], thank you so much. I appreciate all your help.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] It is no problem at all, Mr. [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] Um, can you give me the, the, uh, updated inpatient and outpatient benefit certificate number?
[AGENT][NEUTRAL] Uh, yes, sir.
[AGENT][NEUTRAL] It is 244.
[AGENT][NEUTRAL] 351 6.
[CUSTOMER][NEUTRAL] So it it would that be.
[CUSTOMER][NEUTRAL] So what I have now is 0235619 uh would this be 02423563516 ML 7 or?
[CUSTOMER][NEGATIVE] It that that just doesn't match.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] Right, I understand. So the policy number is 2443516 ML 7 stands for inpatient and ML 8 stands for outpatient.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so the, the new policy number is 02423516, got it, OK.
[AGENT][NEUTRAL] No, no, it's 0244.
[CUSTOMER][NEUTRAL] 244-024-4
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 351 6.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] All right, sorry, thank you.
[AGENT][NEUTRAL] That's OK, that's OK.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][POSITIVE] Nope that should do it thank you very much.
[AGENT][POSITIVE] You're very welcome, [PII]. I hope you have a wonderful day and we thank you for calling APL.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Bye-bye, sir.
[CUSTOMER][POSITIVE] Thank you bye.