AccountId: 011433970860
ContactId: ed605f76-b2b7-4c54-9fc5-89100d48450c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 352750 ms
Total Talk Time (AGENT): 182805 ms
Total Talk Time (CUSTOMER): 133295 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/ed605f76-b2b7-4c54-9fc5-89100d48450c_20250103T16:27_UTC.wav
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[AGENT][POSITIVE] Good morning. Good morning. Thank you for calling APL. Hi, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. My name is [PII]. I have a.
[CUSTOMER][NEUTRAL] A policy with APO?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I, in November, on [PII], I went to emergency medical er I went to emergency to the hospital for emergencies, for emergencies, sorry, and they were confused about my APL. So I don't know if it went through cause I just logged in and I don't have any claims pending.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then I just got my, I just got my bill through my UnitedHealthcare from like the, I guess this claim that UHC took care of, but I had given them the APL so I don't know if there's anything additional I need to do or even if there was any coverage from APL.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Well, I can check on your policy and see if um the provider sent the claim to us and then um I can check your benefits and let you know if emergency room is covered for your secondary.
[CUSTOMER][NEUTRAL] So I don't
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and Mr. [PII], may I have a good contact number just in case we're disconnected and then your policy number?
[CUSTOMER][NEUTRAL] OK, the phone number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the policy number is 1902318.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And I have you here, Mr. [PII], can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] The date of birth is [PII].
[CUSTOMER][NEUTRAL] My mailing address [PII].
[CUSTOMER][NEUTRAL] And the email it might be my work email [PII].
[AGENT][NEUTRAL] Yes, and thank you so much for verifying your information. And hold on one moment, let me check for the data server. You said [PII], right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I don't see any claims on file for that data service. So there's two things, well, let me check the benefits first, but I'm pretty sure with Metlink emergency rooms are covered. Hold on one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So while I'm pulling that up, there's two things you can do. Um, either, well, you said they already had our information though, right?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I gave it to them, but then like when they maybe do it on the on an app?
[CUSTOMER][NEGATIVE] And then they wouldn't, they didn't have enough digits, my, my policy number for APL what they were asking for and they said oh we'll figure it out, but then I don't know if they did because I didn't get any confirmation.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Yeah, it doesn't look like they did. So we have two options. Either you can give the provider a call, let them know that you've called us and there was no claim on file. Um, I would give them our phone number since they're kind of confused, um, providers call all the time. We can verify the benefits and let them know how, you know, how to process the claim because we're 2.
[AGENT][NEUTRAL] Um, but you do have emergency room coverage. Your outpatient is up to $2500 per calendar year and that includes the hospital emergency room. But while we're on the line, let me just check and make sure since it was [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, and you still have all your benefits. So you still have that full 2500 for them to file and and use, you know, depending on what the amount is.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so I should give them a call and then give them your your your APO's information with my policy number and then they can contact is that how it works?
[AGENT][NEUTRAL] Mhm. And that policy number that you gave me is your correct policy number. They can add a 0 in front, but we don't need that. Um, and then if there is any pushback or anything, you do have the option to file the claim. Um, so you've already received the explanation of benefits from United Healthcare. Have you received any bills from the hospital?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Not physically. I, um, I got a call and it was, it was a call from a number I didn't know and I didn't wanna answer and then they told me um to call back with uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It looks like they're reading a script so I wasn't sure if my information got stolen because I, I found it kind of funny on the voicemail, but I looked online on the UHC and I see my claims here through them.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so if you do decide to file the claim, like after you talk to them, if you do decide to file, you'll just need your explanation of benefits from United Healthcare, you'll need the itemized bill from the hospital.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] With the diagnosis codes and procedure codes and the charges, and then the Medlink claim form, which can be found on our website.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and that's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And as soon as the page pops up, you're gonna look at the top right for claims, um, claim forms, and then you'll just scroll down and Metlink is probably on the second page because it's um alphabetical order.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, I got you.
[CUSTOMER][POSITIVE] Alright, I'll get started and and see how it goes.
[AGENT][POSITIVE] Alright, well, if you need any help, you can definitely give us a call. The provider can call also, we'll be more than happy to help.
[CUSTOMER][POSITIVE] All right, thank you so much and have a great day.
[AGENT][POSITIVE] You also, and thanks for calling APL Mr. [PII]. Was there anything else I can help you with?
[CUSTOMER][POSITIVE] Oh, that's, I'm sure I'll call back later and try to figure something out, but I'll be fine. Thank you so much.
[AGENT][POSITIVE] You're welcome. Have a great weekend and happy New Year.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][NEUTRAL] Bye-bye.