AccountId: 011433970860
ContactId: fd9b62ff-cd6a-47ae-adae-0e4704a758b0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1290609 ms
Total Talk Time (AGENT): 428435 ms
Total Talk Time (CUSTOMER): 833647 ms
Interruptions: 10
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/fd9b62ff-cd6a-47ae-adae-0e4704a758b0_20250416T20:54_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] [PII], I'm going to believe that there's no one working in that queue but you. It's, that's, it's not, I'm not gonna say anything other than what I just said earlier because I'm always getting you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I know.
[AGENT][POSITIVE] That's funny.
[AGENT][NEUTRAL] Yeah, believe it or not, we do have a bunch of people on the phone.
[CUSTOMER][NEUTRAL] Sorry, I have an insured.
[CUSTOMER][NEUTRAL] Mm, I have an insured on the phone who's calling about her accidental policy. Now, I was able to read some stuff to her about it, but she has more questions about it. So I'm not sure if you're familiar with the accidental policy or not. Let me know when you're ready for the policy number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, what is that policy number?
[CUSTOMER][NEUTRAL] 2446426. That's 2446426.
[AGENT][NEUTRAL] OK, and what is her name?
[CUSTOMER][NEUTRAL] This is [PII]. I'm not gonna pronounce the last name because they may, I may butcher it but she's verified all of her information.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And her callback number is [PII] and she's a very sweet lady. She's just confused about her policies and I had to give her all the information I could on Metlink and then she got to the accidental policy.
[AGENT][NEUTRAL] OK, all right. So if she's filed a claim, there's not much I can answer other than what we can see, but I can. Oh, OK.
[CUSTOMER][NEUTRAL] No, she didn't file a claim. She just want to know the benefits for accidental, just the benefits, no claims on file.
[AGENT][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] Yeah, I can, I can pull up her policy.
[CUSTOMER][NEUTRAL] 01 moment.
[CUSTOMER][NEUTRAL] Alright, thank you [PII] hold on one moment. did you pull it up before I transfer?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Uh, I'll go ahead and get on the phone with her and let her know that I'm pulling it up just in case it doesn't come up before she's on the phone.
[CUSTOMER][NEUTRAL] Did I give you the policy number 2446426?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Alrighty, so let me let her know. Hold one moment.
[AGENT][POSITIVE] OK. All righty. You're welcome.
[CUSTOMER][POSITIVE] Hello [PII]. Ms. [PII] is gonna assist you better with your um accidental policy, but thanks for calling APL, and you have a great weekend, OK? Thank you. You too. You're welcome. Goodbye.
[AGENT][NEUTRAL] Hi, Ms. [PII], this is [PII] in the care team.
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][POSITIVE] Yes, ma'am. um, yes, so I was. Hi there. I was calling to find out more information. Um, I've, I've never filed a claim before so I'm, um, you all have been very helpful on, on helping me out with that, um, for the first time and I'm just, uh.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah, I
[CUSTOMER][NEUTRAL] I, um, have the accident and the med linking 11 2nd. yeah.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Good, good. Sorry about that. I'm trying to corral a couple of dogs here. I'm having to dog sit my son's dog and it can get uh a little overwhelming. Oh man, one's enough, but 22 is definitely a lot. OK, yes. So, um, so I've got, uh, I know I've got the Medlink and the accident insurance, and I've
[CUSTOMER][NEUTRAL] Like I said, I've never filed a claim before, which is very unfortunate, but I'm ready to do so. I, I wanna get caught up and get, get going with that. So I wanted to find out is the accident insurance, um, just like, um, the Medin where you, you know, um, have kind of unlimited time to be able to like retro back and.
[CUSTOMER][NEUTRAL] You know, have unlimited time to submit those or is there like only a certain amount of time to be able to get those submitted and you know how all how does all that work?
[AGENT][NEUTRAL] OK, all right. So let me pull up your, I think I just helped you with your Medlik policy if, if I'm not mistaken, we talked about being old school.
[CUSTOMER][NEUTRAL] Oh, probably.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, yes, yes, yes. OK, yes.
[AGENT][NEUTRAL] OK, I'm gonna pull up your accident policy because some of those accident policies.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] If it's filed after 72 hours, the benefit goes down. So let me check on yours and make sure.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Um, let me just see.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And then yeah I wasn't sure what plan even I fall under too if you could check that as well.
[AGENT][POSITIVE] Yes, I can check the plan for you right now, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you're under plan one.
[AGENT][NEUTRAL] And when you go into that online service center to file a claim, you're gonna choose the accident claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] That first page of the accident claim form.
[AGENT][NEUTRAL] Gives you very specific uh it's kind of like a cheat sheet it'll tell you exactly what you need to send in with your claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm not seeing anything, let me see.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Not seeing anything about 72 hours on this one, but let me double check.
[AGENT][NEUTRAL] It's gonna be just a second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so if you have to go to urgent care for your urgent care benefit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, you have 72 hours.
[AGENT][NEUTRAL] To go to urgent care for your urgent care benefit.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] So if the accident is after 72 hours,
[AGENT][NEUTRAL] Then, um,
[AGENT][NEUTRAL] The benefit does go down and that's all depending on what's sent to end um as far as your itemized statement and the procedures and diagnosis codes that they gave on those as far as what it'll pay but you can um file exactly the way you do the med link you just choose that accident claim form.
[CUSTOMER][NEUTRAL] OK, alright, and then um.
[CUSTOMER][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] Um, let's see, so.
[CUSTOMER][NEUTRAL] Now.
[CUSTOMER][NEUTRAL] As far as like,
[CUSTOMER][NEUTRAL] Like getting a um like an X-ray, MRI, CT, anything like that. Um, it has, it, it, like, it has to be from an accident or it has, like, how does that, how do you, like, how does that
[CUSTOMER][NEUTRAL] Like, I, I guess I, um, like, like I had an MRI uh like this past Friday. Like, how does that, how, um,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that was, I mean, the MRI was.
[CUSTOMER][NEUTRAL] From a like needed from
[CUSTOMER][NEUTRAL] I needed the MRI due to, like, just, it was basically because I had an emergency room visit from just like an unknown occurrence of bilateral sciatica that just came out of nowhere, you know, so they, they recommended that I get an MRI.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I had a CT in, you know, initially in the ER. And so, you know, all of these things happened, and I honestly,
[CUSTOMER][NEUTRAL] You know, wasn't even thinking at the time that I had accident insurance. So, you know, it's like, oh my gosh, like, I have accident insurance. So it's like, OK, now, you know, now I'm thinking back, and I, obviously, I had a, an ER visit and all this stuff, so.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Is there a 72 hour limit on that ER visit?
[AGENT][NEUTRAL] Well, on your, um, accident surgery, I'm sorry, not surgery. I was looking at your benefits. Sorry about that. On your accident, it has to be an injury.
[CUSTOMER][NEUTRAL] Yeah, that's OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, did you fall or did something like that happen? It cause accident is covered for injuries.
[CUSTOMER][NEUTRAL] Uh oh.
[CUSTOMER][NEUTRAL] Oh, OK, um.
[CUSTOMER][NEUTRAL] Well, no, I mean, I.
[CUSTOMER][NEUTRAL] I wouldn't, no, I mean, it wasn't, it wasn't a fall. I mean, it was just, it was a, it was an ER it was an emergency room treatment. I didn't realize that it had to be a fall. I
[AGENT][NEUTRAL] Right, so
[CUSTOMER][NEUTRAL] Because it says whether you're a weekend warrior or a couch, you know, I mean, I don't, I didn't realize that it doesn't, it didn't say um on here that it had that it had to be a fall. I don't see where it says that it has to be a fall.
[AGENT][NEUTRAL] No, it doesn't, it doesn't, it doesn't have to be a fall, but it has to be an injury.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And the injury, I don't know if, if you can see your policy in the online service center. There is like many, many, many different things on there as far as the type of injuries, how it happened, um.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Even goes right down to which finger if you get burned, how much square inches is burned. I mean, it's very specific.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Like an injury, a burn, um, a broken finger, broken leg, a dismemberment, concussion, um,
[AGENT][NEUTRAL] Those kinds of things are considered accident.
[AGENT][NEUTRAL] Now, if you had those procedures done in the emergency room,
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Let me look back on your Medlik policy.
[AGENT][NEUTRAL] And see if you have ER on that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, cause that, I mean, I don't know I guess, I guess when you look at this initially, you know, sitting in a, in a lunch and learn you know thing it it's not very clear, you know, you look at, you're looking at this, you know, considering whether you're gonna get this.
[CUSTOMER][NEUTRAL] You know, get this benefit or not you're looking at emergency room treatment, urgent care treatment, you know, you're thinking this could be for anything, you know, you're not thinking that it would be for, you know, all of these very specific things that you're now listing. I don't, I feel like that's kind of misleading but anyway.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] No, that, that accident policy, policy is very specific. Um, now, your Medlink policy, um, let me check on it to see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] It has um benefits, your outpatient benefits.
[AGENT][NEUTRAL] That we went over earlier can be used at.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] A free-standing outpatient surgery center, hospital emergency room, hospital outpatient facility, an MRI facility, a physical therapy facility, or an urgent care facility.
[AGENT][NEUTRAL] So, really, I would think that you would need to find the file those procedures on your Medlink policy because it covers all those facilities.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, but excuse me, and, and I, and I probably, I like, like I was um discussing with, with the other um representative as well, um.
[CUSTOMER][NEUTRAL] You know, what you and I didn't, didn't discuss is I
[CUSTOMER][NEUTRAL] I didn't unders I didn't understand at first when you and I were talking that, um, cause she, she had, she had looked in, and she was like, oh well, I see that somebody has already been processing claims on your behalf. And I was like, huh? And she was like, yeah, I see where, you know, and she kind of went into explaining it a little differently than you had.
[CUSTOMER][POSITIVE] And, and, you know, which, again, I mean, you guys, you know, both did a very great job at, you know, giving me information that I needed, but just in, in very different ways and the way that she explained it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Excuse me, I'm so sorry, she said that.
[CUSTOMER][NEUTRAL] Um, basically, what, what's happening or, you know, is every time I go to doctor, urgent care, wherever, I always submit both my Blue Cross Blue Shield card and my APL card. I always give both. And so what's happening is the provider is submitting these claims on my behalf.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And is getting the benefit back instead of me getting it. They're getting, y'all, y'all, they're getting paid, instead of me getting paid.
[CUSTOMER][NEUTRAL] is what's happening, or is what's happened. Um, so, and, uh, and basically, I guess the way that the other representative, uh, helped me to make it make sense was
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, basically, I'm, I'm getting the remaining bill, you know, at a, at a smaller amount is, you know, cause I asked her, I said, is that kind of then probably why I'm not seeing, you know, 300 to $400 bills or whatever. I'm only seeing, you know, 20 $30 you know, whatever it is type bills.
[CUSTOMER][NEUTRAL] And she's like, yes, that's probably why because they're getting, you know, they're getting the ben or the, you know, they're getting reimbursed or, you know, whatever the word is, whatever the terminology is, you know, from APL they're getting basically the payment back that I would have gotten had I uh had I basically paid.
[CUSTOMER][NEUTRAL] I don't know. I, I, I, I think, I mean, whatever she said made sense to me at that at the time, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Right. So they're filing the claim and they're getting reimbursement from the claim that they filed and they're giving you the remaining balance after both insurance is paid.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right. Exactly. Basically what the patients, you know, what my portion would be then after, yeah, what's left. Um, and, and that's fine that's fine actually because that kind of takes
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Takes the work, you know, it takes kind of my work out of it. Um, I'm, I'm kind of OK with that, really. I, I, it, it saves me time because I, I, I really, it's like, I really don't have time to do it, and I don't have the computer. So, in, in the big scheme of things, it's probably fine. Now, the, but the accident part,
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] is not fine because what me and the, well, the other lady said she wasn't trained or whatever to talk about the accident. I think the difference, right? And I'm, I, I'm sorry, I didn't catch your name.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] My name is [PII] It's [PII].
[CUSTOMER][NEUTRAL] What's your name?
[CUSTOMER][NEUTRAL] [PII], yes, thank you. Um, so, [PII], I think the difference between Medlink and A, and you tell me if I'm wrong, is accident actually pays me.
[CUSTOMER][NEUTRAL] It doesn't pay any claim.
[CUSTOMER][NEUTRAL] Right? It pays me directly. So that's, that's why, right.
[AGENT][NEUTRAL] Right. If you, yes, if you have an accident. Yes, ma'am.
[CUSTOMER][NEUTRAL] Right, so that's where.
[CUSTOMER][NEUTRAL] You know, it's like I wanna, I would wanna make sure that I.
[CUSTOMER][NEUTRAL] You know, definitely, you know, dot in my I's and cross my T's with the accident portion. But now that you're explaining it to me a lot more clearer, it, it definitely um doesn't seem like it.
[CUSTOMER][NEUTRAL] Really has applied to me yet, um, because I
[CUSTOMER][NEUTRAL] haven't had a quote unquote injury. Um.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] But I thought that it would have applied to me because again, it's, it's very just um very gray um on how it's uh.
[CUSTOMER][NEUTRAL] How it's outlined on this paper is it just really says, you know, emergency, like I said, emergency room treatment, urgent care treatment, it doesn't go into great details. So it's, it's very.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] I don't know. Uh, it's kind of misleading really to.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um,
[AGENT][POSITIVE] And the best thing to do.
[CUSTOMER][NEUTRAL] You know, I mean, it just, yeah, it just that I don't see what you're seeing, um.
[AGENT][NEUTRAL] Right. The best thing to do, so you can get a complete and full understanding of how the policy works is when you go into that online service center, click on your accident policy and get it to where you can read it. That way you can have a very good understanding of how the policy works um for you if you were to have an accident or, you know, things like that.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] And the med link too. I mean, you can click on that one and read it too, um, that way you have a better understanding than just the flyer that you're looking at. It, it's very specific.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Like, oh yeah.
[CUSTOMER][NEUTRAL] OK, OK, yeah. All right, yeah, definitely cause um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know, I've, yeah, I've got, I've, I've.
[CUSTOMER][POSITIVE] Sometimes I have a lot going on and let's hope I don't have any more than what I already have going on, go on. But um in, in the event that I do, I need, I need to know. So that's, you know, that's why I, I got some of these things, you know, just in the event, you know, so, um, but yes, I definitely wanna be in, informed. Yeah.
[AGENT][POSITIVE] Yes, ma'am. We'll, we'll pray that you don't.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right. And that's what we do.
[AGENT][NEUTRAL] That's also what we do um when I tell you like earlier when I said hold on, I'm gonna pull up your policy and see how it reads, I'm actually pulling up the same policy that you'll see in the online service center and reading it to make sure I have a good understanding of what it says, so I don't tell you anything wrong.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Right, right. Yes. OK. All right, cool. All right. Well, um, I will definitely, uh,
[CUSTOMER][NEUTRAL] Log on, log on when I get, um, I, I, I just, certain things I can do on my phone, certain things like, like this type of stuff. Um, I, I just, I refuse to do it on my phone. So I've got to get to a, a computer whether I go to the library or something. I've got to make the time. I do. I can't, I refuse to do it on my phone. So I will make the time to, to find out what these, what these benefits uh hold for me and uh
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Rights a lot
[AGENT][NEUTRAL] Yeah, so tiny.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] I understand.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] I thank you so much, [PII].
[AGENT][POSITIVE] Oh, you're so very welcome.
[CUSTOMER][POSITIVE] I appreciate all your information, yes.
[AGENT][POSITIVE] Well, you're very welcome. I, like I said.
[CUSTOMER][NEUTRAL] And I know
[AGENT][POSITIVE] I enjoyed talking with you again and definitely get a computer because you thought you had to pull out a magnifying glass earlier. If you get it on your phone, you're really gonna have to pull out a magnifying glass to read it all.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I know, I know. I mean, at least I can dig it up, but still, I just, uh uh, who's got time for that? No, I, I need to, I need to get with the times and get me a computer. I sure do, but
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Anyway, yes, but thank you again and you have a happy [PII] and if I need anything, I know y'all are right there.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] You too.
[AGENT][POSITIVE] Yes, ma'am, we are always.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you so much. Yes, ma'am. All right. Well, you
[AGENT][POSITIVE] You're very welcome. You have a
[AGENT][POSITIVE] You have a good night and thank you for calling APL.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much. Take care.
[AGENT][POSITIVE] You're welcome. You're welcome, Miss [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Thank you. Bye bye.