AccountId: 011433970860
ContactId: 196ec13c-05fd-4495-8d0b-31a29575f77b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1788829 ms
Total Talk Time (AGENT): 427548 ms
Total Talk Time (CUSTOMER): 678929 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/196ec13c-05fd-4495-8d0b-31a29575f77b_20250127T16:29_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATO. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, how are you doing? Good morning. Um, I was calling regarding a charge that it was approved back in December, um, but now it's saying it having the uh.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, you know, uh, withdraw the money. So in other words, when I have my procedure, uh, they couldn't contact you in order to go through the payment, and, uh, they charge it to my credit card.
[CUSTOMER][NEGATIVE] So later on I was trying to call and then finally the office um approved by you, it was approved by you guys and it was charged to APL but now it's still showing that the charge in my credit card so and then they send me a card or a letter letting me know that I wasn't available uh to give me the refund back.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] So they need more proof of your authorization.
[CUSTOMER][NEUTRAL] So, that's my question. So how can I get approved?
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] You can mail me when you guys authorize the payment.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, let me have your name and a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] Sure. Uh, sure. My name is [PII] and the group number, I think it's 24141.
[AGENT][NEUTRAL] May I have a callback number just in case we get disconnected me.
[CUSTOMER][NEUTRAL] Of course, [PII].
[AGENT][NEUTRAL] OK, and I need the policy certificate number. It's gonna be in the bottom of the card, on that.
[CUSTOMER][NEUTRAL] Well let's see. I will say it is uh the inhospital benefit er number.
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] OK. 0205.
[CUSTOMER][NEUTRAL] 1511 M as in Maria, L as in Laura, and number 7.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm of course.
[AGENT][NEUTRAL] OK, and may I have your date of birth, mailing address and email address for verification?
[CUSTOMER][NEUTRAL] Sure, [PII]. Uh email is [PII].
[AGENT][NEUTRAL] We have your work email, Miss. [PII].
[CUSTOMER][NEUTRAL] Um, I don't remember where it was.
[CUSTOMER][NEUTRAL] What's that?
[AGENT][NEUTRAL] We have your work email.
[CUSTOMER][NEUTRAL] You have my what? I can't, I can understand you.
[AGENT][NEUTRAL] Work, work email.
[CUSTOMER][POSITIVE] Oh, working [PII], yes, of course. It's uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so it did change from [PII] approved [PII] the [PII].
[CUSTOMER][NEUTRAL] What's that?
[AGENT][NEUTRAL] Did it change um recently?
[CUSTOMER][NEUTRAL] If I change what, my email?
[AGENT][NEUTRAL] Yes, uh-huh, we have a different one.
[CUSTOMER][NEUTRAL] Mm, well, no, you ask.
[CUSTOMER][NEUTRAL] Yes, um, one is from [PII], and my personal email is [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, and what is the mailing address, Ms. [PII]?
[CUSTOMER][NEUTRAL] My address is [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what is the date of service that we're looking into?
[CUSTOMER][NEUTRAL] Oh, this, uh, procedure happened on [PII] last year, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Was it for Genesis Care USA?
[CUSTOMER][NEUTRAL] Um, it was in the Coral Springs, uh, urgent care.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I don't know if the Genesiscare is the name from what they use.
[AGENT][NEUTRAL] Let me look at this claim. One moment. Let me put you on a brief hold. I'm just gonna go ahead and check on this claim and see what it is for, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me in this moment on.
[CUSTOMER][NEUTRAL] Yes, how are you doing?
[AGENT][NEUTRAL] OK, so, um, I'm looking at the documents that um it was sent with the claim for that date of service. I see Crow Spring Surgical Center. Is that the one that um you're calling in regards to? OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] So, OK, so for this one they did send the explanation of benefits and the claim, but the explanation of benefits didn't show the amount that they applied towards the deductible co-payment and co-insurance because it's not a detailed explanation of benefits. So what we're gonna need is for you to send in the explanation of benefits from the primary insurance and um for a refund directly for to you if you already pay out of pocket because based on the information they sent in, it was fully paid.
[CUSTOMER][POSITIVE] Right, because they took my credit card until they contact you and they get resolved, and then actually one person from uh Coral Springs or accounting, uh, I spoke with her and she said yes, it's being authorized by APL and then I'm sending the information over so it's all good, it's all approved.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, once
[CUSTOMER][NEUTRAL] And then after that, nothing happened.
[AGENT][NEUTRAL] Once you pay something out of pocket, when they send it through the provider portal, the provider sending the claim, it's gonna say that it was fully paid, so there's nothing for us to pay. So when something like this happens, what you need to do is send us a claim for a reimbursement directly to you, from us to you. Um, so right now what we need is for you to submit the claim for reimbursement.
[CUSTOMER][NEUTRAL] Oh, OK, sounds good. So do I have to go to a web page?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You, um, yes, um, you can go to our website at [PII].
[CUSTOMER][NEUTRAL] OK, give me a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can you repeat again?
[AGENT][NEUTRAL] Sure, that's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect, let me see if I can do it right now. [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] Alright, so it's, we are in the page and then I have to go.
[AGENT][NEUTRAL] Hey, you'll click on claims and forms.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then you're gonna look, mhm.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] OK. Otherwise the mail, paper form, fax. So you guys have to, I have to download the, the form.
[AGENT][NEUTRAL] Um, yes, you have two options, but yes, you will have to download the form. Um, you're gonna look for the meddling claim form.
[CUSTOMER][NEUTRAL] That's what it is.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Which one is that?
[AGENT][NEUTRAL] Metlink
[CUSTOMER][NEUTRAL] Medley. OK, let me see. I'm right now there dental, electronic funds, everyday solutions.
[CUSTOMER][NEUTRAL] Meddling claim form. OK, so download form. So can I, can I fill it up uh digital, right?
[AGENT][NEUTRAL] Yes, um, if you wanna, um, send it in digitally and you can go ahead and register your account, just create an account. I'm not sure if you have one or not, but if you want to create an account, you will click on, um, you will click on sign in on the top of that page.
[CUSTOMER][NEUTRAL] It looks like I know, mhm.
[AGENT][NEUTRAL] And you can create the account.
[CUSTOMER][NEUTRAL] Oh, that's what happened the last time I tried to create a new new account and then it wasn't allowed. OK, let me see if I can do it with you real quick. I am individual with APL insurance portal. I am an employer group. No, I'm right. I can't proceed, but I, OK, perfect. I'm an individual. next, now last name. Yeah, it happens like I did the assistant could locate my group ID that's I remember now. [PII].
[AGENT][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] And then I have to put, uh, OK, my social.
[CUSTOMER][NEUTRAL] OK, resident.
[CUSTOMER][NEUTRAL] The email have to be from work or my personal email?
[AGENT][NEUTRAL] It's gonna be the email we have on file, um, so it's gonna be the one you just gave to me which is the last name and first name [PII].
[AGENT][NEUTRAL] And you said there's no um dot or anything in between your name, the last name and your first name, correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, there is not that, OK.
[AGENT][NEUTRAL] OK, it's all together, yeah. Is it supposed to have a [PII] or no?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It's supposed to have a dad, yeah.
[AGENT][NEUTRAL] OK, I can, I can go ahead and update. So it's after your last name, there's a [PII] and then [PII].
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] OK, let me update that. uh OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I already updated. Mhm.
[CUSTOMER][POSITIVE] Let me see. Perfect. Let me go through.
[CUSTOMER][NEUTRAL] Alright, now say create an account, user ID.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, the email I get in from work.
[CUSTOMER][NEUTRAL] It is important to have the cups in my last name.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] By name or not really?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, the email address is either um you can do it all caps if you would like because it's all caps on our end, but I don't think that will make a difference.
[CUSTOMER][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh my God, let's see phone number [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] The like.
[CUSTOMER][NEUTRAL] Let's see if he was.
[CUSTOMER][POSITIVE] Your account has been successful.
[CUSTOMER][NEUTRAL] Didn't happen that last time. I was also with uh.
[CUSTOMER][NEGATIVE] With a person from your company. Oh, it was so horrible you couldn't go.
[CUSTOMER][NEUTRAL] Yes I
[CUSTOMER][NEUTRAL] You know, I can log in.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Say hello [PII], and your phone number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect, let me send you a go.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] All right. Your phone is OK.
[CUSTOMER][POSITIVE] Beautiful. Now I'm in my account and um.
[CUSTOMER][NEUTRAL] So from there I go to claim and forms, correct?
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][NEUTRAL] Uh huh and then I look for the.
[CUSTOMER][NEUTRAL] OK download.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Let me see
[CUSTOMER][NEUTRAL] OK, and move on. OK, so now I start. So if I finish like uh right now with you, I can um
[CUSTOMER][NEUTRAL] You can see if it went through?
[AGENT][NEUTRAL] I can check and see if I got it like um because uh you're gonna need to send more than just the claim form. I don't know if you noticed the first page it has all instructions um the instructions include that you need to add or send in an itemized.
[CUSTOMER][NEUTRAL] No, OK.
[AGENT][NEUTRAL] [PII] which uh we already have the one that they send in for the from the doctor's office but we still need one from you because this one does have signature on file so this one if we process it needed to go to the provider which is not gonna go to the provider because it was fully paid, so if you can call him and get them to send you an itemized bill with the diagnosis code, we can go ahead and use that to send you the refund or reimbursement.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] They actually gave me uh in paper bill.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] So the the receipt that I paid and a month's bill.
[AGENT][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] So can I send you that.
[AGENT][NEUTRAL] OK, we need that, but we also need um the the copy of the explanation of benefits from the primary insurance showing how much they apply towards the deductible co-payment and co-insurance.
[CUSTOMER][NEUTRAL] So again, they have to send me uh items.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Receive?
[AGENT][NEUTRAL] No, it's gonna be an itemized bill. That's what it's called, an itemized bill, mhm, with the diagnosis codes and procedure codes.
[CUSTOMER][NEUTRAL] Oh, I didn't.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] My bill. OK. So if I submit the form right now, um, and then later on, can I put the, the rest of the, of the, of the information that you're requesting, or, or have to be all together?
[AGENT][NEUTRAL] Um, you can send them separately. Um, you just, um, whenever you send it in, if you can send it as soon as possible because the the claim will be processed at 7 to 10 business days. So even if it's complete or incomplete, it's gonna process. So, um, if you can just send it as soon as possible, the rest of it, even if you send it separately in a different claim, it will be fine. We'll put it all together and go ahead and process, OK?
[CUSTOMER][POSITIVE] OK, perfect. So I'm gonna finish first the claim right now, so if you can tell me if you receive it, that would be great. So I just want me to send all the information. Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] I'm waiting on the system.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Almost back.
[AGENT][NEUTRAL] Did you get a confirmation number?
[CUSTOMER][NEUTRAL] Uh, through text, yes.
[CUSTOMER][NEUTRAL] To open my account, yes.
[AGENT][NEUTRAL] No, um, a confirmation number when it went through.
[AGENT][NEUTRAL] When it was uploaded.
[CUSTOMER][NEUTRAL] We went through the claim.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, let me see. I haven't, I haven't downloaded yet the the form. I'm, I'm filling it out right now.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Mm, give me 2 seconds. I will almost.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm filling out. OK, email address have to be from work.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, section B about the patient, I have to fill up again my name.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, signature.
[CUSTOMER][NEUTRAL] I just put my name, I guess, right, because I don't know how to.
[CUSTOMER][NEGATIVE] Oh, doesn't go.
[CUSTOMER][NEUTRAL] Like I cannot sign.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] How do I put my payment?
[AGENT][NEUTRAL] Do you have Adobe?
[CUSTOMER][NEUTRAL] I don't.
[AGENT][NEGATIVE] Then it's probably not gonna let you.
[CUSTOMER][NEUTRAL] So maybe I print it.
[CUSTOMER][NEUTRAL] I sign it and then I send it to where? From where?
[AGENT][NEUTRAL] Mm OK, you can print it, sign it, and then you can upload it to the, to the account to the website if you have a way of scanning the information into the computer, you can upload it or you can take pictures and upload them to your account.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh, OK. There's more, there's more page. It's medical. I, I have to put up my policy number. Let me see if it after finish filling that up, it will go.
[CUSTOMER][NEUTRAL] In my signature.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Relationship person, OK.
[CUSTOMER][NEUTRAL] Yeah, it looks like I have the same.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then when I have to go back to claim some forms.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] When I go to make the lien claim form.
[CUSTOMER][NEUTRAL] Oh, I have to go to my account and then download it there you're saying?
[AGENT][NEUTRAL] Upload it, uploaded onto your account. Yes, you will go, yeah, you will go to the um [PII], sign in, go into your account and then upload the claim. Mhm.
[CUSTOMER][NEUTRAL] Upload it, sorry.
[CUSTOMER][NEUTRAL] Oh, I see that.
[CUSTOMER][NEUTRAL] Mhm. And then also I allow that with the animals um.
[CUSTOMER][NEUTRAL] Should I, should I also upload how uh.
[CUSTOMER][NEUTRAL] Which which credit card I pay?
[AGENT][NEUTRAL] No, you don't have to send that information because if we do a refund, it's just gonna go back to you a refund. Is, is it gonna be a check um.
[AGENT][NEUTRAL] That we're gonna send out
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Perfect. All right, so I will download it and then um when I, when I, um, submit it, upload it, sorry, when I submit it, I have, I wait 10 days and I call back or I just call back to make sure.
[CUSTOMER][NEUTRAL] You guys receiving.
[AGENT][NEUTRAL] If you want to call back to see if we got it, you can do that, but you're gonna get a confirmation number. Once you get a confirmation number, it means that we got it and you're gonna see it listed under your claims on the website and that's how you know that we did receive the paperwork. Um, now again, it's gonna be 7 to 10 business days for us to process the claim.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And in order to be uh refunded, we need all documents so it it has to be the itemized bill with the diagnosis codes and the explanation of benefits together with the claim form, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, perfect. Let me see if I can uh do you have time? I don't wanna keep you too long. I just want to see if I can upload it right now and you see if it went through, so I know how to deal with the uh.
[AGENT][NEUTRAL] That's fine.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Documents.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so now.
[CUSTOMER][NEUTRAL] See.
[CUSTOMER][NEUTRAL] 010.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I have it. So I'm gonna do.
[CUSTOMER][POSITIVE] I feel fine.
[CUSTOMER][NEUTRAL] Um, this year to, um.
[CUSTOMER][NEUTRAL] Mm, uh-huh.
[CUSTOMER][NEUTRAL] OK, file claim. OK, I select the medley come. OK, click here.
[CUSTOMER][NEUTRAL] Claim claim's first name. Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh one job.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 73 OK next.
[CUSTOMER][NEUTRAL] Select files.
[CUSTOMER][NEUTRAL] So it's gonna be.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I see upload.
[CUSTOMER][NEUTRAL] But I cannot be for 20 or so.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Alright, so I guess I have to, um,
[CUSTOMER][NEUTRAL] I don't know. Alright, so I don't wanna hold you in. I just gonna.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know how to erase the file because, OK, there you go. Let me see. Maybe I just can give you the first so because the third page is like a
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Like a general information.
[AGENT][NEUTRAL] Mhm, right.
[CUSTOMER][NEUTRAL] Mhm. So let me see now it goes through only with 2 to 5 files cannot see 20, uh.
[CUSTOMER][NEUTRAL] I know, I have to take a smaller picture. All right, so I will do that.
[AGENT][NEUTRAL] OK. Is there anything else I'm gonna help?
[CUSTOMER][POSITIVE] All right. Thank you. And your name?
[AGENT][NEUTRAL] My name is [PII]. It's [PII]
[CUSTOMER][POSITIVE] Oh, perfect. Thank you so much for your help.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.