AccountId: 011433970860
ContactId: 1b6508a1-a421-42aa-bee4-1a22a6112824
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 671000 ms
Total Talk Time (AGENT): 219666 ms
Total Talk Time (CUSTOMER): 215242 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/1b6508a1-a421-42aa-bee4-1a22a6112824_20250311T12:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], this is [PII]. I was calling because I was told to uh upload the explanation of benefits for the septoplasty I had last year, and I don't see it on the website anymore. I don't know what.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] How to check on a claim.
[AGENT][NEUTRAL] You don't, OK, so you're checking the claim status?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and what's your policy number, [PII]?
[CUSTOMER][POSITIVE] Let me get that for you. I should have all that ready.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] 2579094
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 094 and what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII], verify your date of birth, mailing address and email address for me.
[CUSTOMER][NEUTRAL] More than 2.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] The last thing?
[AGENT][NEUTRAL] Your email.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Hm, looks like it could be your work email maybe.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, that's the one that we have on file thank you for verifying.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And uh what was the service date?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the claim is for you?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And that would be 2024, 2024?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, now I don't see any October claims on file for you, [PII].
[CUSTOMER][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] OK, so, on, on the website I was looking at the user guide, it doesn't have an option for me to file a claim just to upload the files. Are my claims automatically file.
[AGENT][NEUTRAL] Right, that's what
[AGENT][NEUTRAL] Yeah, that's what you do. You click that upload button.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And and then a box is gonna pop up for you to select the policy number that you're submitting the claim under which would be the one you gave me, you know what? it's not because the one you gave me didn't become effective until January of this year, so let me look at the policy before this one, it's probably under there which is 246.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 32.
[AGENT][NEUTRAL] 90.
[AGENT][NEUTRAL] And whenever you, yeah, whenever you upload a file we look at the data service and match it up with the policy.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] That you know the date of service falls under let's see, so October.
[CUSTOMER][NEUTRAL] That makes sense.
[CUSTOMER][NEUTRAL] Ouch. Oh my.
[AGENT][NEUTRAL] I don't see it under this policy either.
[CUSTOMER][NEUTRAL] That's weird. I cause I I thought she said upload the explanation of benefits, and I did that. Do I need to do it again?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Let me see. Let me see.
[AGENT][NEUTRAL] And you said the claim is October in October of [PII], right?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then looking under your claim history, I don't see a surgical charge.
[CUSTOMER][NEUTRAL] Oh, what do you mean?
[AGENT][NEUTRAL] You said that you had a surgery?
[CUSTOMER][NEUTRAL] Yeah, I had to set the place to do I.
[CUSTOMER][NEUTRAL] Yeah, and I uploaded the EOB so I don't, I don't.
[AGENT][NEUTRAL] Was it the hospital bill that you uploaded or the surgeons charge?
[CUSTOMER][NEUTRAL] It was the hos, I think it was the hospitals, but his surgeon, the surgeon's information and all that stuff was on there as well.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So are you at a computer now?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, can you log on to the online service center?
[CUSTOMER][NEUTRAL] OK, I'm I'm in there now.
[AGENT][NEUTRAL] You're already there, OK. And so you're OK, so let me.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] OK, so you clicked on the upload file button.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And when you clicked on that it should have populated a box that is asking you to select the appropriate policy number.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And what policy numbers do you see?
[CUSTOMER][NEGATIVE] Well as for me, I see 2,463,290 and the 257, the active one and the last one. I may have picked the wrong one.
[AGENT][NEUTRAL] Yeah, so you'll click on the 246-3290, and if you look at the effective date it says [PII] through does it show your effective date and term date on your end?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It shows, let's see, let me go back.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It shows that just the effective date [PII].
[AGENT][NEUTRAL] OK, alright, so select that one and then click the next button.
[AGENT][NEUTRAL] And then it'll give you the option to upload your claim documents.
[CUSTOMER][NEUTRAL] OK, so that's the file.
[AGENT][NEUTRAL] And you should also receive a confirmation number you wanna write that down?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Make sure I'm putting the right file in there.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, I did that fine.
[AGENT][NEUTRAL] Well she
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Why did I say that?
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] OK, there it is.
[CUSTOMER][NEUTRAL] Oh what did I click on?
[AGENT][NEUTRAL] OK, I do see, did you upload something on [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so it was under the [PII]. That is the date of service. It says [PII].
[CUSTOMER][NEUTRAL] For the data service, let me double check.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Might not be the right one for me.
[CUSTOMER][NEUTRAL] Because I had a surgery on the [PII].
[CUSTOMER][NEGATIVE] I don't know why they would have the data services in 90s.
[CUSTOMER][NEUTRAL] 01 2nd of it now.
[CUSTOMER][NEUTRAL] Uh, for 8000.
[CUSTOMER][NEUTRAL] That was the office visits nasal endoscopy.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I got the wrong thing that looks like.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It was so it was like $7000. I thought that was the actual surgery.
[CUSTOMER][POSITIVE] But I can find it. I'll find it.
[CUSTOMER][NEUTRAL] But I know what to do now to pick the right policy.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, on the ELB it's [PII].
[AGENT][NEUTRAL] That was a nasal endo endoscopy, so that's not it.
[CUSTOMER][POSITIVE] Mm mm, I gotta find the right ELB with the surgery. I can find that. That shouldn't be a problem.
[AGENT][NEUTRAL] So did you did you submit the itemized bill previously?
[CUSTOMER][NEGATIVE] No, I'm actually waiting on that bill, so I got, I'm waiting on the itemized, but they're supposed to mail that to me.
[AGENT][NEUTRAL] Because we'll
[AGENT][NEUTRAL] Yeah, so if you, if you send in only the ELB we're gonna deny it for the itemized bill, so you may wait, you may wanna wait until you, mhm, because we're gonna deny that for the itemized bill.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] Just wait till I get on that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for all your help.
[AGENT][NEUTRAL] Oh, you're welcome and so what is the correct data service? It is?
[CUSTOMER][NEUTRAL] It's [PII]. Yeah, I had the surgery on the [PII], yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what's the name of the hospital?
[CUSTOMER][NEUTRAL] That is so.
[AGENT][NEUTRAL] Nicholas.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Baptist Health
[AGENT][NEUTRAL] Baptist Health I just wanna put it in the notes.
[AGENT][NEUTRAL] OK, where was it an outpatient, uh, service? You were just there overnight? OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] I wasn't even there overnight. They did it at [PII] and they shot me out of there later on.
[AGENT][NEGATIVE] Not even overnight. OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. What type of surgery was it?
[CUSTOMER][NEUTRAL] It's a septoplasty where they go and fix my, yeah, the deviated septum in my nose, yeah.
[AGENT][NEUTRAL] Seto. OK.
[AGENT][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] Got it, got it. OK, alright, so I'll put a note in here that you did call Miss [PII] regarding that data service.
[CUSTOMER][POSITIVE] OK dear, I appreciate it.
[AGENT][NEUTRAL] All right, anything else I can assist with today?
[CUSTOMER][POSITIVE] That is all. You've been great.
[AGENT][POSITIVE] Alrighty you're welcome thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.