AccountId: 011433970860
ContactId: ea62c1fc-c8b6-47ab-98cd-aa7be6fd618e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 522840 ms
Total Talk Time (AGENT): 268145 ms
Total Talk Time (CUSTOMER): 147981 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/ea62c1fc-c8b6-47ab-98cd-aa7be6fd618e_20250514T19:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Um, my name is [PII]. Um, I have a policy through my, my job, um, so I had, uh, an emergency appendectomy done about two weeks ago, um, and I just had a few questions, what I need.
[CUSTOMER][NEUTRAL] Uh, what documents I need from the hospital to submit a claim.
[AGENT][NEUTRAL] OK, let me just take a look at your policy. Do you have your policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, um, it's 214.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 95.
[CUSTOMER][NEUTRAL] 04.
[AGENT][NEUTRAL] OK, let me pull this up.
[AGENT][NEUTRAL] All right. And then if I could get your date of birth and then address please, [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And then address?
[CUSTOMER][NEUTRAL] The address is [PII].
[CUSTOMER][NEUTRAL] Uh, ZIP code [PII].
[AGENT][NEUTRAL] Thank you. All right. Um, so you have a secondary policy with us. So what you're gonna need is, first off, you need a claim form.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Claim forms can be obtained on our website.
[AGENT][NEUTRAL] And um
[AGENT][NEUTRAL] I can give that to you if you need that. Do you need the web address?
[CUSTOMER][NEUTRAL] Actually I I have it pulled up. I'm looking at it right now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I need a claim form.
[AGENT][NEUTRAL] Yep, so on our site, you're gonna click claims and forms, and you're gonna scroll down until you find the med link claim form. They're all in alphabetical order.
[CUSTOMER][NEUTRAL] So meddling claim form OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So when you pull that up actually, um, page one is pretty much just like instructions as far as what you need.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um, so you're gonna have to fill out the claim form in its entirety, of course. We need the explanation of benefits from your primary insurance for the date of service to show what they paid, what was applied, and what's remaining.
[AGENT][NEUTRAL] And you're gonna need an itemized bill with diagnosis codes from the doctor or hospital. Uh, this could also be um like a admin discharge summary. You could submit that if you can't get an itemized bill with the diagnosis codes, that's another option.
[CUSTOMER][NEUTRAL] OK, so itemized bill or.
[CUSTOMER][NEUTRAL] Uh, discharge report.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, uh, hospital, yeah, admin discharge report.
[CUSTOMER][NEUTRAL] Is that right, is that what you
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the claim form explanation of benefits from my main insurance and then the bill or discharge report anything else?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, no, just the most important thing on the itemized bill is that it needs to have a diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, a lot of times they'll give you an itemized bill and us as just everyday people see it and we see a lot of codes on there. Generally, those are procedure codes. Procedure codes are things that are like, you know, this is what was administered or given. We need the diagnosis code, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, and then you can submit the the claim to us, uh, you can do it online, you can do it via fax, or you can put it in the mail, so that's just really whatever you prefer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and uh you guys have um direct deposit available, right?
[AGENT][NEUTRAL] Mhm, yeah, so if you create, yeah, log in and everything, you can have the uh any sort of payment direct deposited instead of a check mail, yeah.
[CUSTOMER][NEUTRAL] On your website?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, as far as the explanation of benefits from insurance, what, what exactly is there a particular document or something I need to ask for from the insurance?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, no, so it would just be whatever dates that you are being treated for, um, that you need the explanation of benefits for those dates because it needs to show what, if any, was applied towards your deductible, co-pay, and co-insurance for, you know, that's what we need.
[CUSTOMER][NEUTRAL] OK, is, um, is that something?
[CUSTOMER][NEUTRAL] That I have to call them about or I can actually pull it up on their website because I know it shows, you know, like the charges that were made what was covered, you know, a whole bunch of fees that were waived and.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] they, they work out like a deal with the hospital, so does that work or you need like an actual document that I have to call them and ask for?
[AGENT][NEUTRAL] No, I mean, if you have access to the online system, most major insurances.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You can get your explanation of benefits there. So, yeah, it should be something that's available to you online. You shouldn't have to call them.
[CUSTOMER][NEUTRAL] OK, and then as far as what you guys cover, um, is it just like the emergency room stay? is it um because I spent one night in the hospital.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And you know, obviously I had surgery and I have to go to the ER so what's actually uh covered on.
[CUSTOMER][NEUTRAL] You guys
[AGENT][NEUTRAL] Let's see here.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK. So, inpatient on your plan is described as being in the hospital for 18 hours or longer.
[AGENT][NEUTRAL] Um, outpatient, it would be anything underneath that. So, under your outpatient benefits, uh, you do have hospital emergency room. So, the emergency room is probably gonna fall under the outpatient portion just because initially, that's, you know, you hadn't been admitted at that point.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, the outpatient benefit maximum is $500 per day. That's the maximum that your outpatient benefits are gonna pay.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, anything, anything else is gonna fall after you were admitted is gonna fall under inpatient for like surgery or anything like that. Your inhospital maximum is $3000 per calendar year. So that's the most that it's gonna cover for any of the in-hospital like benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Um, towards the treatment and surgery. There is no deductible or anything like that on here that needs to be met, so you don't need to worry about that either.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK great OK alright I think that answers everything I need I appreciate it.
[AGENT][POSITIVE] Yeah, not a problem, and if you have any other questions or concerns, feel free to give us a call. We're happy to help.
[CUSTOMER][POSITIVE] OK, thank you so much I appreciate it.
[AGENT][POSITIVE] You're welcome, [PII]. Have a good one.
[CUSTOMER][NEUTRAL] OK, all right, you too.
[AGENT][NEUTRAL] OK