AccountId: 011433970860
ContactId: 0a60979d-e3c2-4b48-96c1-6fdae3b66704
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 319929 ms
Total Talk Time (AGENT): 120933 ms
Total Talk Time (CUSTOMER): 176425 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/0a60979d-e3c2-4b48-96c1-6fdae3b66704_20250314T16:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm actually just got a letter in the mail, um, I guess my claim that I submitted was, um, rejected, and I'm trying to, because it's not very clear exactly why, so I'm trying to figure out exactly why.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, Ms. [PII], I can uh look at your claim status for you. Can you please give me your policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 2521636
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, Miss [PII], can you verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then also we're gonna need to verify your address, phone number, and email address that we have on the policy for you.
[CUSTOMER][NEUTRAL] OK, so it is [PII]. Um, phone number, you said?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And then email address that I had a problem before um so it's either gonna be [PII] or it could be my company's email which is [PII].
[AGENT][POSITIVE] OK thank you I appreciate you. I have your company email address on on the policy for you.
[CUSTOMER][NEUTRAL] I'm not sure which one.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, on that letter that you got, do you have a claim number?
[CUSTOMER][NEUTRAL] So yeah, I actually do. I'm online right now as well, so let me get the um.
[CUSTOMER][NEUTRAL] Let's see here, let me close this here. OK, so I have on your website it has a confirmation number, a policy number, a claim number. Here it is 3573384.
[AGENT][NEUTRAL] OK, let me look that claim up real quick, Ms. [PII].
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it has a remark on the claim that the benefits are payable only if your major medical insurance provider provides benefits. If this claim is later paid by your major medical insurance, please send the explanation of benefits showing benefits were paid.
[AGENT][NEUTRAL] So basically what we need is the explanation of benefits from your major medical showing the part that they paid.
[CUSTOMER][NEGATIVE] Yeah, because I submitted the explanation of benefits but it didn't pay anything because I don't think they, they covered it. So if they don't cover it I still can't submit for credit with APL.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Got you. Alright, and then so.
[AGENT][NEUTRAL] They go hand in hand.
[CUSTOMER][NEUTRAL] OK, so our HR department hasn't really been clear on some of the details with APL and so the other thing is I'm not sure if we have a procedure done and we pay a copay on it. Do are we able to submit that for reimbursement or co-pays not covered?
[AGENT][NEUTRAL] Uh, depending on the, the benefit that's covered, uh, this policy does help with deductible co-pay and co-insurance, and you'll always need to send that explanation of benefits from the primary with.
[AGENT][NEUTRAL] The APL policy for your claims.
[CUSTOMER][NEUTRAL] OK. And, OK, and will a diagnosis code be required every time cause some of the, my insurance company doesn't, their explanation of benefits does not detail a diagnosis code. So I'm just curious to see if.
[AGENT][NEUTRAL] So what you'll need in that case, um, there's always 3 documents that you need to send the claim form, the explanation of benefits, and the itemized statement. The itemized statement is what will have the diagnosis and procedure codes and you get the itemized statement from the facility.
[AGENT][NEUTRAL] That you went to.
[CUSTOMER][NEUTRAL] Oh yeah, they're, they're not, yeah, they're not very cooperative. So, uh, OK. Yeah, a lot of the facilities, they don't call back and give you that. They don't return your calls. OK, great. Alright, so at least I cleared it up. That's why I had a feeling that it was the case, but, you know, a lot of these like in this case, they, they didn't want to build the insurance cause they said the insurance wasn't gonna cover it, so they didn't even make an attempt to build the insurance, they just billed me.
[AGENT][NEGATIVE] Oh no.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The price, so that's why, right, so that's why I can't if you're saying that I have to bill the insurance, they didn't bill it so there's no proof that they, you know.
[AGENT][NEGATIVE] Oh no.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] The insurance truly didn't pay for it or not.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, I understand. OK.
[CUSTOMER][POSITIVE] OK. Right. Yeah. All right, thank you so much. I appreciate it. Have a good weekend.
[AGENT][POSITIVE] You too miss [PII]. I hope you have a nice weekend also and thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you bye bye.