AccountId: 011433970860
ContactId: e758453e-768f-43ec-8d7d-6dd2c99a8652
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 670989 ms
Total Talk Time (AGENT): 271189 ms
Total Talk Time (CUSTOMER): 220617 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/e758453e-768f-43ec-8d7d-6dd2c99a8652_20250213T21:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I have uh insurance with your company.
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] What do you need to identify myself? You need uh.
[CUSTOMER][NEUTRAL] An account number what do you mean?
[AGENT][NEUTRAL] Uh, yes sir, I'll need that, but first, Mr. [PII], can I get your call back number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is your policy number?
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] I just pulled it out one moment here.
[AGENT][POSITIVE] Yes, sir. Take your time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think.
[CUSTOMER][NEUTRAL] OK. It's uh 01986454.
[AGENT][NEUTRAL] OK, let me pull your policy up for us real quick.
[AGENT][NEUTRAL] OK, [PII], um, can you please verify your date of birth for me?
[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] [PII]. Email [PII].
[AGENT][NEUTRAL] OK, looks like I have a work email address for you.
[CUSTOMER][NEUTRAL] OK, now it's [PII], but you should send stuff to [PII].
[AGENT][POSITIVE] OK, I'll get that fixed for you, um.
[AGENT][NEUTRAL] Uh, we're gonna update.
[AGENT][NEUTRAL] Your email address real quick.
[AGENT][NEUTRAL] OK, I've got the email corrected for you now, sir.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] How can I help you with your policy today?
[CUSTOMER][NEUTRAL] OK, there was a claim made by.
[CUSTOMER][NEUTRAL] But that's the hospital.
[CUSTOMER][NEUTRAL] I don't know if you see my notes. I called this like I don't know how long, a couple of months ago.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] There was an amount, uh, what happened is that I went in for surgery.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] And that was on.
[CUSTOMER][NEUTRAL] Let's see what the date on that was [PII]. I don't have the dates here. Maybe I do have it over here. One moment.
[CUSTOMER][NEUTRAL] Sometime in September I think it was, let me see.
[CUSTOMER][NEUTRAL] One month.
[AGENT][POSITIVE] Yes, sir. I'm showing one.
[CUSTOMER][NEUTRAL] Do you have any notes or not?
[AGENT][NEUTRAL] Yes, I'm looking at a claim that was sent in um for a data service of [PII].
[CUSTOMER][NEUTRAL] Yes, that's it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim was in the amount of $1,734.37.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes sir, I've got that claim pulled up now um it was paid.
[AGENT][NEUTRAL] Let me see who it was paid to for you real quick.
[AGENT][NEUTRAL] I'm gonna pull up this check number real quick.
[AGENT][NEUTRAL] We paid um Bethesda Hospital.
[AGENT][NEUTRAL] In the amount of $1,7344.37.
[AGENT][NEUTRAL] Let me give you the check number.
[AGENT][NEUTRAL] It is 2021739.
[AGENT][NEUTRAL] And the check has cleared the bank.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Good.
[AGENT][NEUTRAL] Yes sir, the check cleared the bank on [PII].
[CUSTOMER][NEUTRAL] When, when did it clear?
[CUSTOMER][NEGATIVE] OK, a long time ago, that's crazy and like I actually called today and they didn't have a record of it. That's nuts.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Oh my, well, you can give them that check number and let them know the amount and that it cleared the cleared their bank on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, now.
[AGENT][NEUTRAL] And it was a single check.
[CUSTOMER][NEUTRAL] OK, now I have uh a couple other questions.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, so the cap.
[CUSTOMER][NEUTRAL] Covers up to 2000 a year, right?
[AGENT][NEUTRAL] Let me look at your benefits real quick.
[AGENT][NEUTRAL] OK, and this is just to verify your coverage. It's not a guarantee of payment. Uh, your inpatient calendar year benefit amount is $2000.
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So what is the best way to make a claim?
[CUSTOMER][NEUTRAL] On a couple of other.
[CUSTOMER][NEUTRAL] I never made a claim. Uh, there was 1 2000.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Actually 2 in 2000.
[CUSTOMER][NEUTRAL] Uh, 2 actually.
[CUSTOMER][NEUTRAL] One is it one?
[CUSTOMER][NEUTRAL] Oh yeah it's for the calendar year, so probably one.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] One bill would cover the whole thing, so I've got something in [PII] and something in [PII].
[AGENT][NEUTRAL] OK. So, mhm.
[CUSTOMER][NEGATIVE] Where, uh, where I, I paid everything out of pocket and never made a claim for a bill.
[AGENT][NEUTRAL] Yes sir.
[AGENT][POSITIVE] Oh my. Oh goodness. OK.
[CUSTOMER][NEUTRAL] Or maybe.
[CUSTOMER][NEUTRAL] Maybe you can verify, can you verify that there was no payment made out to anybody on your part in those two years?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me check for you.
[AGENT][NEUTRAL] No sir, I do not see anything for [PII] at all or [PII].
[CUSTOMER][NEUTRAL] What about 200, about [PII]?
[AGENT][NEGATIVE] Nothing for [PII]. I showed that there was a payment that went out in [PII] to radiology, but nothing in [PII] or [PII].
[CUSTOMER][NEUTRAL] OK, good. So what is the best way to make that claim if I have a statement from the hospital, each one of those bills is like, you know, that that was what was paid was like over $30,000 and so obviously I had to pay the deductible, so I maxed out.
[AGENT][NEUTRAL] Oh yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If I send you an invoice with the dates and when I was in the hospital, is that enough for you?
[AGENT][NEUTRAL] No, what you're going to need to do is I'm gonna give you a website to go to so you can get the claim form.
[CUSTOMER][NEUTRAL] OK, I'm gonna, I'm gonna write this down one moment, one moment.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, what is the website?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] When you get on that website in the top right hand corner you're gonna click on claims and forms.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you're gonna click on the med link claim form. It's M E D L I N K.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You're gonna need to send in your Medli claim form.
[AGENT][NEUTRAL] You're gonna need the explanation of benefits from your primary insurance.
[AGENT][NEUTRAL] And you're also gonna need your itemized statement with your diagnosis codes and procedure codes.
[AGENT][NEUTRAL] You'll need those 3 things.
[CUSTOMER][NEUTRAL] I know my statement and then what is, OK, tell me the first two again.
[AGENT][NEUTRAL] Uh, your explanation of benefits from your primary care physician.
[CUSTOMER][NEUTRAL] The first
[AGENT][NEGATIVE] Your itemized
[CUSTOMER][NEUTRAL] Ex explanation of benefits or my primary care. What, how would he know?
[AGENT][NEUTRAL] You get the explanation of benefits from your primary insurance company, the explanation of.
[CUSTOMER][NEUTRAL] Oh, from the insurance company so you said the physician one moment it's from the insurance company, OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, sir.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you'll get the
[CUSTOMER][NEUTRAL] And then the second one.
[AGENT][NEUTRAL] The itemized statement will come from the facility that you went to.
[CUSTOMER][NEUTRAL] Yes, but was #2. I'm missing one.
[AGENT][NEUTRAL] Uh, the claim form from the website, the Medlink claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh it it's something that I fill out and send in?
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] And let me give you the address.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then where do I, I can't, I can't put it, uh, drop it into your website online?
[AGENT][NEUTRAL] No sir, because your policy lapsed, so you can't use the online service center when a policy is lapsed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Where do I send?
[AGENT][NEUTRAL] You're gonna send it to APL claims.
[AGENT][NEUTRAL] And that's going to be [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that city is [PII].
[AGENT][NEUTRAL] And the state is [PII].
[AGENT][NEUTRAL] And the zip code?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK, let me repeat it's [PII].
[AGENT][POSITIVE] Yes, sir, that's correct.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] You're very welcome Mr. [PII] I hope you have a wonderful weekend and I thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you ma'am appreciate it.
[AGENT][NEUTRAL] Bye-bye, sir.