AccountId: 011433970860
ContactId: 0c1e061d-43bd-4a5f-97ac-28b112f9ac41
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 867549 ms
Total Talk Time (AGENT): 298069 ms
Total Talk Time (CUSTOMER): 338989 ms
Interruptions: 5
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/0c1e061d-43bd-4a5f-97ac-28b112f9ac41_20250609T12:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. Let me ask you something. I was trying to log in online to create like a, you know, like a password to be able to check my account, but I wasn't able to. I don't know if they have my email.
[AGENT][NEUTRAL] Um, actually, um, we upgraded our system and what you would need to do is go in and, um, recreate your policy online and I can assist you with that. Um, could I get your name and a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], yeah. I have through my employer like APL aga policy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Yeah. And what's your policy number?
[CUSTOMER][NEUTRAL] I have the one that is in the hospital or the group number?
[AGENT][NEUTRAL] The in hospitals.
[CUSTOMER][NEUTRAL] It says 018583777.
[CUSTOMER][NEUTRAL] And then it has ML 7.
[AGENT][NEUTRAL] OK, thank you. Thank you, [PII]. Now, please verify your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] Yeah, [PII] is [PII].
[AGENT][NEUTRAL] OK, and please verify your email address.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, I'm showing a different email address. This may be your work email.
[CUSTOMER][NEUTRAL] Maybe my work, yeah, it's my, it's through my job. It's [PII] maybe.
[AGENT][NEUTRAL] Yes ma'am, that's the email address we have on file for you.
[AGENT][NEUTRAL] OK. And are you at the, are you on our website? You'll need to go to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hold on. Uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so on the website, uh-huh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I go where?
[AGENT][NEUTRAL] OK. [PII]
[AGENT][NEUTRAL] Do
[CUSTOMER][NEUTRAL] Under, under search or?
[AGENT][NEUTRAL] Um, and, and the address bar, in the address bar.
[CUSTOMER][NEUTRAL] Oh where do I put that?
[CUSTOMER][NEUTRAL] Oh, OK, so put secure what?
[AGENT][NEUTRAL] Um, [PII]. [PII].
[CUSTOMER][NEUTRAL] Altogether [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And then um are you do you see where it says create policy or create new policy? Click on that.
[CUSTOMER][NEUTRAL] I'm there.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then just let the system know that you're an individual. Mhm.
[CUSTOMER][NEUTRAL] I'm sure.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, you should be able to set up your policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then on the member ID do I put the number up to 7 or ML7 also?
[AGENT][NEUTRAL] Um, you put the number up, yeah, up to 7. Leave the ML part out.
[CUSTOMER][NEUTRAL] I leave it out. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so 01.
[CUSTOMER][NEGATIVE] It's giving me an error. No information was found. That's what I, I was doing that before. I'm putting that number, my last name, my zip code, my date of birth, and uh my email that you said [PII], but it's still not.
[CUSTOMER][NEGATIVE] Not recognizing the usual uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, instead of putting in the policy number, put your social there, see if that will work.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, it's not doing it. And you said the email that is showing is [PII].
[AGENT][NEUTRAL] Yes, ma'am, but this email I'm showing is in all caps. I think it should be all lower case. um, let me try to enter it.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] I mean, I put it in lower case. I don't know if I have to change it to car.
[AGENT][NEUTRAL] Yeah, see if uh caps will work because then our system is showing up in caps. Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah, old town.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEGATIVE] No, it's still not working.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] Is this error no you was found. Try again.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I'm putting my social.
[CUSTOMER][NEUTRAL] All together, the last name [PII] and the zip code [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The email in [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Well, let's see if I change your um email address to all lower case.
[AGENT][NEUTRAL] Let's see, and what's your email address again? Because I just deleted it out. I'm gonna reenter it and.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My name is [PII], yeah, [PII]. [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] So that's [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. I just reentered it in all lower case, see if that works.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, still air, I know.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] [PII] you have only one L? Yeah, I mean, that's what it shows on the card.
[CUSTOMER][NEUTRAL] Maybe I have to put the whole name. It's asking for the last name.
[CUSTOMER][NEUTRAL] Let me try.
[AGENT][NEUTRAL] Yeah, put the last name in it.
[CUSTOMER][NEUTRAL] No, I mean, that's what I have the last name. Those that social needs dashes? No.
[AGENT][NEUTRAL] You can try it, but I don't think so.
[CUSTOMER][NEGATIVE] No, it's not working.
[AGENT][NEUTRAL] OK. If you don't mind holding, I'll check and see if we're having any issues with it this morning.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Sure, and then I was calling actually also to uh someone added to my policy. I need to verify, is it the same coverage? Is it the same account number, or does it get a different card that I can print online?
[AGENT][NEUTRAL] I'm sure, and just like
[CUSTOMER][NEUTRAL] Because I added him through my employer.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and just let me advise you the verification of coverage does not guarantee payment of claims. And what's his name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII] is [PII].
[AGENT][NEUTRAL] OK. Yes, ma'am. I do show that he has been added to your um policy and um I'll, he should receive a card in the mail, but I'll also send a request for a card to be mailed out to him. And yes, his benefits are the same as yours.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] With it, mhm.
[CUSTOMER][NEUTRAL] Please.
[CUSTOMER][NEUTRAL] And this is the same account number, my same account number?
[AGENT][NEUTRAL] Yes, it is the same policy number, the 018583777.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][POSITIVE] OK, yeah, if they can send him a card. Thank you.
[AGENT][NEUTRAL] OK, no problem. And one moment, I'll see if there's any issues with our system. One moment. Thank you.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, ma'am. Thank you for holding. Yes, ma'am. I did find out that we are having issues with the new system this morning with um members being able to reset up their account and they are working on it and they say to try again in about an hour or so.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK. OK. And then you're gonna, I mean, send another card for my son.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] To the address on file that you verify.
[CUSTOMER][NEUTRAL] OK. And then can they usually send a card for me because my card is big.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] I don't know if they can refund a car because mine is falling apart.
[CUSTOMER][POSITIVE] It's like a little plastic thing I spray. Thank you so much.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK. Is there anything else?
[CUSTOMER][NEUTRAL] I'll try in a little bit then.
[CUSTOMER][NEUTRAL] Yeah, I have a question. The, when you go to urgent care, this policy covers for the co-pay and for the hospital copay?
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Up I think up to $1000 per year.
[CUSTOMER][NEUTRAL] Because my son used that.
[AGENT][NEUTRAL] Um, yes, ma'am. I'm showing.
[AGENT][NEUTRAL] Yeah, I'm showing for outpatient services, which is for ER visits and urgent care facilities, we actually cover up to 1000 per calendar year for the co-pay, the co-insurance, and the deductible.
[CUSTOMER][NEUTRAL] Mhm mhm mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then it means something else. He went to an urgent care and I pay out of pocket because I didn't have the card. How do I submit a claim to you?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, well, you can file the claim online once you're able to get in to our website or you can fax or mail us the information. And what we'll need is the explanation of benefits from your primary insurance company for the office for the, the date of the visit. And we'll also need the diagnosis code and we'll need documentation from the urgent care facility with the um diagnosis code on there. So it could be a letter from them, it could be a statement.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So they, they gotta give me the, the diagnosis code and what else?
[AGENT][NEUTRAL] You'll need the explanation of benefits from your primary insurance company for the date of service.
[CUSTOMER][NEUTRAL] I uh.
[CUSTOMER][NEUTRAL] And how is that? It was, he went to the urgent care and then he paid, you know, like the copay, let's say $80. So that's what I'm trying to submit.
[AGENT][NEUTRAL] OK, who's
[CUSTOMER][NEGATIVE] I mean the regular insurance don't pay for that. It's just.
[AGENT][NEUTRAL] Yeah, who's your primary insurance, your regular insurance?
[CUSTOMER][NEUTRAL] It's uh Cigna, Cigna.
[AGENT][NEUTRAL] OK, we, you would need to contact Cigna and get the explanation of benefits from the date of service and what the explanation of benefits will show is that the um copay.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] Yeah, that they charge the copay so that um we'll cover that for you.
[CUSTOMER][NEUTRAL] OK, so once they process that then they should be able to, I should be able to get that from them because it just happened last week.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And then I can make the file online or I can fax it, and then I need to send the diagnosis because I guess from the papers they gave me at the urgent care then.
[AGENT][NEUTRAL] Yeah, make sure that the diagnosis code is on there. If it's not, they can um give you a letter or some type of documentation showing what the diagnosis code is and send that along with the um explanation of benefits from Cigna.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] And the explanation of benefits. OK, perfect. Thank you so much.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Do I need to submit the receipt?
[CUSTOMER][NEUTRAL] Do I need to submit the receipt on the card?
[AGENT][NEUTRAL] Um, no
[CUSTOMER][POSITIVE] No, OK, perfect, thank you.
[AGENT][NEUTRAL] We don't need the receipt unless the diagnosis code is on there. You can resubmit it. You can submit that, but if not, no, all we'll need is the um EOB from Cigna.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][POSITIVE] Explanation of benefits. OK, perfect. Thank you so much. Have a good day.
[AGENT][NEUTRAL] OK. You do the same, [PII]. Thank you for calling APL. Mm bye.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Thank you bye.