AccountId: 011433970860
ContactId: 032c9ea2-cbef-4b91-a5fc-3cb5d40046ac
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 957489 ms
Total Talk Time (AGENT): 531417 ms
Total Talk Time (CUSTOMER): 272720 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/032c9ea2-cbef-4b91-a5fc-3cb5d40046ac_20250123T21:57_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, so, I have a, uh,
[CUSTOMER][NEUTRAL] I was trying to get like a refund because I didn't even know that I had the APL card because we never got them in the mail for all of last year and then we figured it out and.
[CUSTOMER][NEUTRAL] Um, my doctor's office says that I have to call y'all to get the refund for the co-pay that I've paid.
[CUSTOMER][NEUTRAL] And they gave me like a breakdown I'm supposed to send you.
[CUSTOMER][NEUTRAL] Does that make sense? I don't know.
[AGENT][NEUTRAL] So you're so you're trying to find out how to file a claim on a policy that you have with APL?
[CUSTOMER][NEUTRAL] I, I guess so.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yes ma'am, I can help you and you're the insured, is that correct?
[CUSTOMER][NEUTRAL] Um, well, it's under my husband's like he's the main person, but I'm spouse.
[AGENT][NEUTRAL] OK, so yes ma'am, I can help you with this. uh, and who am I speaking with?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and Miss [PII], what is a good call back number that I can reach you on if we get disconnected?
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] Thank you. And your policy number?
[CUSTOMER][NEUTRAL] I don't know let me pull it up. She finally sent it to me through email.
[CUSTOMER][NEUTRAL] Um, OK, policy number is 019862887.
[AGENT][NEUTRAL] OK, thank you. So give me a moment to get the policy information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, I may have missed. OK, I'm so sorry. Give me just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so, uh, first off, Miss [PII], I will need to verify several things with you for security and also any information that I provide for you will be a verification of benefits and not a guarantee of payment. So if you could first please verify the primary subscriber's name and date of birth and then your date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] Did you say his name? Sorry.
[AGENT][NEUTRAL] Uh huh his name and date of birth.
[CUSTOMER][NEUTRAL] OK. OK. [PII] [PII].
[CUSTOMER][NEUTRAL] And then [PII] [PII].
[AGENT][NEUTRAL] Thank you. Your home mailing address?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, now there is a different address on file.
[CUSTOMER][NEUTRAL] OK, that might be why we haven't got our card. That's weird.
[AGENT][NEUTRAL] So what is, I, I can't, I can't tell you. No, ma'am. You have to, we'll have to verify that with me.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEGATIVE] Oh, you can't
[CUSTOMER][NEUTRAL] Is it [PII]
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] It isn't.
[CUSTOMER][NEUTRAL] What's your job?
[CUSTOMER][NEUTRAL] What is your jobs um they had somebody come in to work and set this up so I'm wondering if they could.
[CUSTOMER][NEUTRAL] The county's his job's address.
[CUSTOMER][NEUTRAL] Hang on one second, he's looking that up.
[AGENT][NEUTRAL] I, I was gonna say, is Mr. [PII] there with you?
[CUSTOMER][NEUTRAL] Yes, he is.
[AGENT][NEUTRAL] OK, because I will have to, I really need to verify the information with him, Miss [PII], so that I can update it even though you're covered under the policy, we cannot make any changes to the information that we have other than with the primary policy holder.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's fine he's right here. What you got?
[AGENT][POSITIVE] Oh great.
[AGENT][NEUTRAL] Hi, Mr. [PII]. This is [PII] with [PII]. How are you today?
[CUSTOMER][POSITIVE] Great.
[AGENT][NEUTRAL] Good. So um we're trying to verify the address for you all and what Ms. [PII] has given me so far is not what we have.
[CUSTOMER][NEGATIVE] OK, uh, the 18401 is not right.
[AGENT][NEUTRAL] We don't have that.
[CUSTOMER][NEUTRAL] That's how, that's where we live now. We've been here since I've worked there, so that's why I was trying to see. And we never got our card last year and this is probably why they probably put the address in wrong or something.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It wouldn't be a hassle address, would it be?
[AGENT][NEUTRAL] What is that address? What is that address, Mr. [PII]?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] We had a PO box, but we were at [PII]. Does that sound right? [PII] was one of them.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK, what was the second one, yeah, what was the second one for, did you say [PII]?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] [PII]. Yes. [PII].
[AGENT][NEUTRAL] OK. And that's, what's the city, state, and zip again for that address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. So we'll come back to that in just a minute. What is your best contact number, Mr. [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you and is that your cell number?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, thank you. And then the last thing, um.
[AGENT][NEUTRAL] I need to add an email address for you on file because we do not have one so what email do you want to have added?
[CUSTOMER][NEUTRAL] Uh, did she tell you what the numbers are on? I'd have to look it up. It's a it's, it's a [PII].
[AGENT][NEUTRAL] You would have
[AGENT][NEUTRAL] Yeah, I mean,
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so [PII] excuse me, [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, thank you. And then if you'll verify the last 4 of your social.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you so I can update the address now you do need to contact your employer.
[AGENT][NEUTRAL] Regarding your address to make sure that they get it updated because that is how we received your enrollment information was the [PII] address.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, that was on my license because they wouldn't accept a PO box, uh, uh, that makes sense now so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So yes, sir, just make sure to get with them to get that updated, but I can go ahead and update with you over the phone. So what do we need to have for you now?
[CUSTOMER][NEUTRAL] On the address [PII].
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Spell the spell the city.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so I'm gonna repeat this back to you to make sure that I got it all correct. [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so I have gotten all all of your information has been updated with APO um now I'm going to email you to this email that I added, um.
[AGENT][NEUTRAL] A user guide for our portal, it's called the online service center this user guide will explain how to create your profile and it also tells you the different things that you can do within the portal. So it's my understanding that Miss [PII], and I'm assuming you can still hear me, is that correct? OK, it's going to be filing a claim and actually.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah. Yes, yes.
[AGENT][NEUTRAL] Once you have all of the documents together, which I'm going to tell you what you will need.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Once you have everything together and set up your profile you can actually upload it into the portal for us to review. Now you do have to do your uploads from a computer it does not currently support mobile functionality but this user guide, you know, will explain all of that as well.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] So give me just a second and I'm gonna go ahead and send that well actually.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] OK and um can we get ID cards sent to the right address?
[AGENT][NEUTRAL] Mhm. And you'll also have access to them in your portal as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, then that's fine then.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Um, there's a copy of the policy and certificate in there. There's the ID cards. You will also be able to see the claims that we have processed, received and processed over the last 24 months. That's all viewable through the portal.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] You want
[CUSTOMER][NEUTRAL] Do you need him anymore?
[AGENT][POSITIVE] Uh, no. Well, I've got the information updated. I'll just be sending this email in just a moment and then, um, if there's any, you know, anything else, anything that we might need to update, yes, but if every, I think everything is good to go, so he's fine. Thank you very much, Mr. [PII].
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so give me just a moment, Ms. [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's taking a moment to load a piece of information.
[AGENT][NEUTRAL] And I didn't tell him this, but you'll, when you all are setting up the profile, Ms. [PII], everything that it asked for all of the information is gonna be his information.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK. All right. Um, so I have just sent this email, let me.
[AGENT][NEUTRAL] OK, so I have just emailed this claim form.
[AGENT][NEUTRAL] And also that user guide. Now the claim form can be obtained by going to our main website for future reference if you all need to file a claim on this policy but I went ahead since I was sending the user guide and just attached it because on the claim form, it does have the instructions on page one for how to complete the claim form and the additional documentation that you're gonna need to submit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Don't try to write this down, but you'll have to have an itemized bill that includes your diagnosis from your provider and also the explanation of benefits from your primary insurance company for that data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's finish it.
[AGENT][NEUTRAL] Now, mhm, and again that information is on the top of the first page of the claim form so you can kind of, I call it a checklist just kind of use that as a checklist for what you need and once you have everything together then you can just um upload it into the portal and you can also in the portal you can opt in for text notification alerts and you can also add in direct deposit information so that if we are able to pay benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Then it can be, you know.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Direct deposit versus a paper check, but that's just a personal preference.
[CUSTOMER][NEUTRAL] So I, um, I go to like the chiropractor and stuff uh every other week and
[CUSTOMER][NEUTRAL] So every 2 weeks I'm going, is it better to like wait for the whole year and do it all at one time, or do I need to do each?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] That's a, that's just a personal preference. We do not have a timely filing limit, but they won't file for you is that what have they told you they won't file your claims with the secondary?
[CUSTOMER][NEUTRAL] OK, cause like the
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, my therapy place won't, um, file it for me, but they gave me like a whole list of all my appointments and everything that I'm an item I still, I guess, um, so I didn't know if that would be easier just to do it that way or like am I having to do it each individual or can I do a.
[AGENT][NEUTRAL] No, you can, it's really whatever is easier for you, just make sure that you have the itemized bills for each data service, and they all will have to have your diagnosis code on them and then make sure to have the explanation of benefits that correlates with each of those dates of service. So just whichever, you know, is um.
[CUSTOMER][NEUTRAL] Multiples at a time.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] It's easier for you, it's, it's fine. Now, on this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Claims, you know, are processed as they're received. So in saying that, you know, on your, for example, your outpatient benefit maximum per calendar year, Ms. [PII] is $2000 per covered person for covered outpatient services and you don't have a deductible.
[CUSTOMER][NEUTRAL] OK, gotcha.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, the policy, we will review for the treatment itself, but not for your visit. The visit charge is not, would not be covered under this policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But we could review, you know, the treatment done in the office.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] So in saying that, again, you know, since we process claims the way in the order that they're received,
[AGENT][NEUTRAL] You know, if you were to have something else come up.
[AGENT][NEGATIVE] That a claim was filed on, you know, and you have waited till the end of the year, you know, those benefits could possibly have already been exhausted on something else. There's no way, you know, for me to.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, that makes sense.
[AGENT][NEUTRAL] Be able to fully answer that, but um just keep that in mind.
[AGENT][POSITIVE] And again, it's just whatever is easier for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] Yes, ma'am. So do you have any other questions?
[CUSTOMER][NEUTRAL] I think that is it.
[AGENT][POSITIVE] OK, well, if anything else comes up, please give us a call. Otherwise, thank you again for calling APL and I hope that you all have a very nice evening.
[CUSTOMER][POSITIVE] You too. Thank you so much.
[AGENT][POSITIVE] Yes, ma'am. You're very welcome.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye-bye.