AccountId: 011433970860
ContactId: ec602051-7e55-4630-99b5-1e94a1dcbbeb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 490420 ms
Total Talk Time (AGENT): 254011 ms
Total Talk Time (CUSTOMER): 255570 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/ec602051-7e55-4630-99b5-1e94a1dcbbeb_20250305T21:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi. Um, I have a question. Um, I got the, uh, I don't know what do you need from me, like an ID number, pay your ID number or policy certificate number?
[AGENT][POSITIVE] Um, yes, to get your account pulled up, um, if I can get that policy certification number, that'd be great.
[CUSTOMER][NEUTRAL] 02463488.
[AGENT][NEUTRAL] 488? OK. And uh what was your name?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, and then [PII], can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you and then I'm just gonna verify some information really quick can I get your date of birth please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address that we've got on file for you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Um, I've got a different one. It's at unique [PII].
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][POSITIVE] That's it perfect thank you so much for verifying that. What can we help you with today?
[CUSTOMER][NEUTRAL] Yeah, hi. Um I was uh I was in, uh, got into an emergency last [PII]. And as far as I'm concerned, um, I got a bill from, from them. And since I don't really understand what the APL gap is, but it seems like I can file a claim uh with this uh the, the bill that I got from, from the hospital.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, yeah. Mhm.
[CUSTOMER][NEUTRAL] It's uh like uh emergency, emergency and you know they did a lot of things. But I'm looking online and um I don't know how to file a claim using your website.
[AGENT][NEUTRAL] No worries. I know it's gonna be a bit confusing. OK, so whenever you are ready I will go ahead and let you know all of the necessary information we need to file a claim for this kind of policy, um, if you wanted to write it down.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, sure. OK, sure.
[AGENT][NEUTRAL] OK, let me know when you're ready.
[CUSTOMER][POSITIVE] Uh yes, I'm ready.
[AGENT][NEUTRAL] OK, so first of all, it would be the correct claim form and you of course that's on the website. Uh this kind of policy, it's called Medin, so M E D L I N K Medlink.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Needin, uh-huh.
[AGENT][NEUTRAL] Yes, OK, and then we would need the itemized statement.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That shows diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, what they sent to me is, um, they send me a bill, OK? But, um, United Health, send me, send me, uh, extra bill, um, hold on, OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, yes, OK, so we do need, um, we also do need the explanation of benefits from your primary insurance. So the itemized statement that shows diagnosis and procedure codes and then the explanation of benefits from your primary insurance and wherever you went for treatment, I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, the internet, OK.
[CUSTOMER][NEUTRAL] Mhm. Yeah, let me, let me just, OK, so what I, what I received from the United Health is something that's showing claim detail. Is that something that you, you need?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] That might be the explanation of benefits from them, um, just for good measure though because.
[CUSTOMER][NEUTRAL] Like a green beef.
[CUSTOMER][NEUTRAL] It's like backup service.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Types of service, notes, provider bill amount saved, something like that. That's the only thing I got.
[AGENT][NEUTRAL] OK, so wherever you went for treatment, whatever pro uh provider's office you went for treatment, um, or facility, they will have that information. So if you, uh, wanted to call them and or email them and request this information, the itemized statement with those codes.
[CUSTOMER][NEUTRAL] And, OK.
[CUSTOMER][NEUTRAL] What kind of
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Itemized itemized statement.
[AGENT][NEUTRAL] Yes, that shows diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] With code
[CUSTOMER][NEUTRAL] OK, the, uh, OK, I'm writing it down. I see.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And procedure code.
[AGENT][NEUTRAL] Yes, and then the explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So explanation of benefits.
[AGENT][NEUTRAL] Yes, and they will have all of that information and then once you have all that then you can go ahead and um upload all of that information through our online portal and then of course with that correct claim form filled out and then that's it you're good to go.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so the claim form is Meddin, right? You said something Medlink.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK, let me just see that with the [PII].
[CUSTOMER][NEUTRAL] Everyday solution. There's some hospital in the let me think me the claim form, OK, so I just have to download the form and then I have to put together all those, uh, I think my statement with code. Yeah, they did not give it to me, they just gave me a bill.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Right, that's usually how they'll do it. Sometimes you'll have to ask specifically for this information, and if they have any questions or anything, they're more than welcome to give us a call as well [PII] we do talk to providers all the time, so if there's any confusion or anything, we can definitely help with that.
[CUSTOMER][NEUTRAL] Mhm. OK. So I have, I just have to call them and, um, and tell them to, to give me the itemized statement with code.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, they can either send it directly to us or they can send it to you and then you can file it with us, however it was easier.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, OK, OK, yeah. I don't, I probably I don't really know what to call. OK. But, um, it seems like, uh, United Health already gave me the, the explanation of benefits and what they, what they paid and what is everything. So that's why I'll, I'll give it to you guys. So, OK. So, once, yeah, so once I have the form, I just have to go ahead and upload it to, uh, I think I saw something with the, with the, the thing. OK. OK, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] All right. OK. But is this something that the ATL gap will pay once I, um, once, once everything is, uh, once I, everything I, I put down all the information correctly?
[AGENT][NEUTRAL] Yes, that's all the information that we need, um, and so if you were to upload any of that without the other information, so like if you just uploaded that EOB, um, it would deny as we were missing the itemized statement with those diagnosis and procedure codes, um, so once you have all of that you just.
[CUSTOMER][NEUTRAL] Do you know?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] it all at the same time um through our website it gets to us almost instantly so from there it can generally take about 7 to 10 business days for claim information to complete processing. It doesn't always take that long but that you could view the status uh on the website or of course you're more than welcome to give us a call as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] Or you guys will pay me, right? And then I will pay, uh, but I have to pay them first.
[AGENT][NEUTRAL] If you were the one who files the claim, then the payment would go to you and so on the website there is a spot where you can set up direct deposit um if you wanted it that way then you'd get that money within um a few business days uh otherwise we would mail you a paper check.
[CUSTOMER][NEUTRAL] Is that how it works?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm mhm.
[CUSTOMER][NEUTRAL] Oh, OK, yeah, I think I just have to upload my, uh, my what do you call this my information, my account information. All right, OK, let go, we're gonna go ahead and call uh the hospital and see if they can provide that itemized statement with code. OK. And then you just say something about diagnosis and procedure code you said something.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am. Did you have any other questions for me? Oh sorry.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] That itemized statement has to show those diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And they will have that information.
[CUSTOMER][NEUTRAL] Oh, OK, so that's.
[CUSTOMER][POSITIVE] There should be 2 things from the hospital. OK. All right. Let me go ahead and call them up. All right. Thank you so much. Bye.
[AGENT][POSITIVE] All right, you're very welcome. I hope you have a great rest of your day, [PII].
[CUSTOMER][POSITIVE] You too. Thank you. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.