AccountId: 011433970860
ContactId: f24a2168-4546-4c24-86a7-07de7b2bc79d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 558919 ms
Total Talk Time (AGENT): 261013 ms
Total Talk Time (CUSTOMER): 216759 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/f24a2168-4546-4c24-86a7-07de7b2bc79d_20250528T20:58_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, I was just trying to figure out um how to do the claim, um, I.
[CUSTOMER][NEUTRAL] Um, see on the website, oh hold on, the session timed out, um, to submit claim forms, um, and then.
[CUSTOMER][NEUTRAL] Are the only documents that I need to upload the.
[CUSTOMER][NEUTRAL] Um, like, so it's for a hospital stay, so I am filling out the hospital indemnity, I don't know how to say that, but the hospital one, and then.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, do I just need to also upload the itemized bill? Is that all, or do I need to do something else to submit a claim?
[AGENT][NEUTRAL] Um, well, it could be more. Let me take a look at the policy and um you said it's for a hospital stay, right?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] And the number is [PII].
[AGENT][NEUTRAL] Thank you for that. And then the claim number?
[AGENT][NEUTRAL] I'm sorry, I said claim number. I meant to say policy number, I'm sorry.
[CUSTOMER][NEUTRAL] Um, well, I'm starting to.
[CUSTOMER][NEUTRAL] Oh, that's OK. um 02.
[CUSTOMER][NEUTRAL] 58.
[CUSTOMER][NEUTRAL] 6771
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] OK, here we go, and I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] And um.
[CUSTOMER][NEUTRAL] Email address, I think is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. OK, so there's a few things. So first, you don't have the hospital indemnity policy, so you can't use the hospital indemnity claim form. You're looking for the um if you're online or or I can send it to you, the Medlink claim form because you have a Medlink policy.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] So since this is your secondary policy, um, well, you really have two options. Either you can provide the provider, the hospital with um this policy number or a copy of the ID card and have them file the claim. If you do want to file the claim on your own, um, anytime you file, you're going to need your Medlink claim form.
[AGENT][NEUTRAL] The explanation of benefits from your primary insurance and then the itemized bill or the universal bill from the provider, um, that could be the doctor's office, hospital, whoever, um, or wherever you went to to get the services, and the itemized bill needs to have the diagnosis codes.
[AGENT][NEUTRAL] Procedure codes.
[AGENT][NEUTRAL] And then all the charges.
[CUSTOMER][NEUTRAL] OK, so when I went into the hospital and gave them um like this insurance, they seemingly didn't know what to do with it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, so would it be easier if I just.
[CUSTOMER][NEUTRAL] I, I, I don't know, like, would, would it make more sense to just fill out the midlink claim form or do I send it over?
[AGENT][NEUTRAL] I mean, it's really up to you, whatever you prefer. Um, if they are giving kind of pushback anytime any provider gets pushback, just give them the card and tell them to call us to verify the benefits. But for this particular policy that you have, we're second to your primary, so we help pay like your co-pays, your deductibles, um, co-insurance after primary, um.
[AGENT][NEUTRAL] Hm. So it's up to you. I can send you the claim form.
[AGENT][NEUTRAL] Or I can show you how to get it online.
[CUSTOMER][NEUTRAL] OK, I think I found the, yeah, I found the midlink claim form so I can fill that out and then I just, yes, so then I would just add both of those, the medlink form and the.
[AGENT][NEUTRAL] You found it? OK.
[CUSTOMER][NEUTRAL] Um, itemized bill to the upload files.
[AGENT][NEUTRAL] Mhm. And then for your primary insurance, have you received an explanation of benefits or, or even their portal, um, they may have, they'll probably have the explanation of benefits on the portal.
[CUSTOMER][NEUTRAL] Yeah, I have
[CUSTOMER][POSITIVE] Yeah, I, I should have that, yeah.
[AGENT][NEUTRAL] OK, well then, yeah, as long as you have those 3, then um once we receive it, we'll go ahead and process it for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, and then can you tell on there, so, uh, um, that it'll be paid $2000 of my hospital bill, is that right?
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment.
[AGENT][NEUTRAL] So you have, let me see, deductible.
[AGENT][NEUTRAL] So the policy will pay up to $2100 for both the inpatient and the outpatient benefits. So it, yes, it could, we could pay up to that amount, depending on, you know, what we get from the paperwork and what's still owed after the primary, but it is that max of 2100.
[CUSTOMER][NEUTRAL] OK, um, and then.
[CUSTOMER][NEUTRAL] Is
[CUSTOMER][NEUTRAL] So basically, so I just had a baby, so that's why it was like that was the hospital stay, um, and then would, would, would it be covered or like should I put in claims for any of the other like the prenatal doctor visits? Does it say if that covers anything? I'm just trying to understand.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] All that this I got coverage covers.
[AGENT][NEUTRAL] No, you're fine.
[AGENT][NEUTRAL] So basically your policy covers like in in hospitals, which is after admission and then outpatient, um, for the like for your labor and delivery, that would use that that's probably going to use most of your inpatient benefits for the year, um, and then for like your office visits, um,
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] You do have treatment in a physician's office, um, that your outpatient um benefits could go towards, so I mean, I would file those too just in case the worst they can say is it's not covered, but I would rather try and it might be.
[CUSTOMER][NEUTRAL] So it's 2100 for each both inpatient and outpatient? OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, for each, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and
[CUSTOMER][NEUTRAL] I mean this might not be a question, you know, but where would
[CUSTOMER][NEUTRAL] Uh, no, that's yeah.
[AGENT][NEUTRAL] You sure?
[CUSTOMER][NEUTRAL] Never mind, I, I was just trying to figure out where I got the like information to uh to like um do outpatient like what yeah sorry how what would I do to file the outpatient ones I guess.
[AGENT][NEUTRAL] Oh, it's the same process. Um, you'll just submit the claim form, the, the itemized bill and the um explanation of benefits, and then I mean really you can do it all at once and then the examiner is just gonna go through all the documents that are sent in to see all, you know, all of what benefits can be applied. So it could be both, we can do it all at once.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. Um, it would it also be the medling claim form?
[AGENT][NEUTRAL] Yes, everything
[CUSTOMER][NEUTRAL] It's all just that for everything?
[AGENT][NEUTRAL] Mhm. For you for medical, everything is going to be the Medli claim form with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. I think, I think that's all my questions.
[AGENT][NEUTRAL] You sure?
[CUSTOMER][NEUTRAL] I think so. I'll, I'll call back if I have more.
[AGENT][POSITIVE] All right. Well, congratulations on the little one and thank you so much for calling APL. Was there anything else I can help you with?
[CUSTOMER][POSITIVE] Um, I don't think so. Thank you so much.
[AGENT][POSITIVE] All right. Have a great day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye bye.