AccountId: 011433970860
ContactId: 1f97ccac-bea0-4e01-b870-6950c2fec637
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1046500 ms
Total Talk Time (AGENT): 519366 ms
Total Talk Time (CUSTOMER): 299984 ms
Interruptions: 4
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/1f97ccac-bea0-4e01-b870-6950c2fec637_20250506T17:08_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, uh, I got you back, um, so [PII], that, um, you were just talking to Cedar Hills Townhouse, she now has a question about her, uh, her own policy and a claim that she submitted.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so she has a question on her policy specifically and a claim, is that right? Alright, [PII], what's her policy? Yeah, what's her policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That, that, that she submitted, yeah.
[CUSTOMER][NEUTRAL] 654.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] 6026.
[AGENT][POSITIVE] All right, I will be happy to speak to her.
[CUSTOMER][NEUTRAL] All right, here you come.
[AGENT][POSITIVE] Alright, thank you.
[AGENT][NEUTRAL] Hi, [PII].
[CUSTOMER][NEUTRAL] Hi, how are you?
[AGENT][NEUTRAL] Hi, this is [PII] again. OK, so [PII] said that you now have a question regarding a claim on your own policy. Is that correct?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yes ma'am, I can help you with that. So I'll need to verify all of your information first for security and then any information that I provide will be a verification of benefits and not a guarantee of payment. So first off, if you'll please verify your date of birth.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And what is your primary personal number, not the work number?
[CUSTOMER][NEUTRAL] Uh, let me see, hold on.
[CUSTOMER][NEUTRAL] Let me see because they but it's so late on there.
[CUSTOMER][NEUTRAL] Yeah, and the little car.
[CUSTOMER][NEUTRAL] The policy number?
[AGENT][NEUTRAL] No, your cell phone number or your primary phone number?
[AGENT][NEUTRAL] That we should have on file on your personal account, not your work number, but your phone number.
[CUSTOMER][NEUTRAL] Uh, by that it's on the car, right? The insurance card.
[AGENT][NEUTRAL] No, ma'am, your, your your telephone number, what is your personal telephone number?
[CUSTOMER][NEUTRAL] Oh, it's [PII]. OK, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, you said [PII], say it again for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, that was [PII]. Is that correct?
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] OK, thank you. And then what is your email address? I need to add your email on file.
[CUSTOMER][NEUTRAL] My personal email.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Is is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I don't know is this that one you have in the system?
[AGENT][NEUTRAL] OK, so again, that's [PII]
[CUSTOMER][NEUTRAL] Mhm. [PII].
[AGENT][NEUTRAL] [PII]. OK, thank you.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so have you ever set up your personal profile, [PII] in the online service center portal with APO where you can have access to your personal information?
[AGENT][NEUTRAL] I will email you the user guide on how to set that up so that you can set up your own personal profile and you'll be able to have access to your claims information and your ID cards.
[AGENT][NEUTRAL] And all of that online.
[CUSTOMER][NEUTRAL] OK, send me that information because I don't think so. I set up like that.
[AGENT][NEUTRAL] Mhm, sure.
[AGENT][NEUTRAL] Right, OK, so it would be different.
[CUSTOMER][NEUTRAL] Um, but my thing is because I can.
[AGENT][NEUTRAL] Yes, ma'am. What's the data service uh-huh, that you're like wanting to information on? What's the data service?
[CUSTOMER][NEUTRAL] I send a claim.
[CUSTOMER][NEUTRAL] What's the day of what?
[AGENT][NEUTRAL] The date of service.
[CUSTOMER][NEUTRAL] A survey.
[AGENT][NEUTRAL] That you submitted
[AGENT][NEUTRAL] Date of service. When did you go to the doctor? No, ma'am. When did you go to the doctor or the hospital or whatever it was that you submitted a claim for?
[CUSTOMER][NEUTRAL] Oh, OK, the, the day I submit the claim.
[CUSTOMER][NEUTRAL] It was for the MRI. Let me see, I tell you now. Hold on.
[AGENT][NEUTRAL] And what day did you have that done?
[CUSTOMER][NEUTRAL] Hold on just still with of March.
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] [PII] of this year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so yes, ma'am, I do see that we did receive that claim and it does show that this claim was denied.
[AGENT][NEUTRAL] Um, the claim number and you will be able to see this once you set up your portal, [PII], but the claim number is 358.
[AGENT][NEUTRAL] 9133.
[CUSTOMER][NEUTRAL] But I send it again.
[AGENT][NEGATIVE] Right, and it was denied as a duplicate.
[AGENT][NEGATIVE] The 2nd time you sent it, it was denied as a duplicate.
[CUSTOMER][NEUTRAL] Was declined to?
[AGENT][NEUTRAL] Uh, because of being a duplicate of a previously submitted claim?
[CUSTOMER][NEGATIVE] I no got it. What is the form you I have to uh submit it again.
[AGENT][NEUTRAL] I'm sorry, I didn't understand your question.
[CUSTOMER][NEUTRAL] Can you uh email the form to submit the claim again? I have to submit the claim again because I sent a double with the previous one.
[AGENT][NEUTRAL] OK, so let me look at the, OK, so let me look at what the what the remark is on the initial claim that was reviewed.
[CUSTOMER][NEUTRAL] to be with homeowners or something.
[AGENT][NEUTRAL] OK, so one of
[AGENT][NEUTRAL] OK, so for the prescription, there was a prescription on there. That was one thing and that was denied because the policy does not provide a benefit for prescription drugs.
[CUSTOMER][NEUTRAL] We are out of the office at the first time.
[AGENT][NEUTRAL] And then the
[CUSTOMER][NEUTRAL] No, that is not for prescription that's for MRI.
[AGENT][MIXED] Right, but medication is not covered.
[AGENT][NEUTRAL] The other codes were not.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] It states benefits are payable only if your major medical insurance provider provides benefits.
[AGENT][NEUTRAL] If this claim is later paid by your major medical insurance, please send the explanation of benefits showing benefits were paid. So do you have your
[CUSTOMER][NEUTRAL] I send that
[CUSTOMER][NEUTRAL] I think that because the thing is what happened with my previous other I had another insurance before.
[CUSTOMER][NEUTRAL] Last year in the beginning and when I get this insurance in [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] They get it, but after that they noticed they had another insurance and they put in another insurance like a primary and the other insurance was term terminate um Terminated um Auss and this and Florida Blue is starting on with me, um.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the only thing has to meet the claim is for the MRI.
[AGENT][NEUTRAL] Yes, ma'am, but we have to have the explanation of benefits from your primary insurance.
[AGENT][NEUTRAL] That shows any amounts that they pay towards your co-pay, deductible, or co-insurance amount.
[CUSTOMER][NEUTRAL] OK, so I have to submit it again with that information.
[AGENT][NEUTRAL] Yes, or just your, you can submit just the explanation of benefits. You can actually upload that into your portal. You don't have to submit everything again, just your primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] It's what it's asking for.
[CUSTOMER][NEUTRAL] But they they.
[CUSTOMER][NEUTRAL] Yes, because I called my insurance and the insurance sent me that thing that's what I put it there with the which one says [PII]. I called them and they send me via email.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And they say it's cover.
[AGENT][NEUTRAL] OK, if you
[CUSTOMER][NEUTRAL] I get that information from the Florida Blue.
[AGENT][NEUTRAL] OK, if, so you do have the explanation of benefits from your primary insurance company?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so you just need to send us that for this data service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And when I'm going to email you, give me just a moment so I can do that. I'm gonna email you the user guide so that you can set up your profile.
[AGENT][NEUTRAL] And you can actually just upload that document.
[AGENT][NEUTRAL] Your primary insurance company's explanation of benefits, you can actually just upload that directly into your portal.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So give me just one moment to do that for you.
[AGENT][NEUTRAL] And I want to just verify your last name is [PII]?
[AGENT][NEUTRAL] Is that correct? OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK [PII], so you should have that email from me just any time and again it's also gonna come from that email I gave you a while ago, the care care team at [PII].
[CUSTOMER][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] And it went to your personal email that I added for you.
[CUSTOMER][NEUTRAL] Yeah, let me see.
[CUSTOMER][NEUTRAL] OK, I received it.
[AGENT][POSITIVE] OK, good, and the user guide is attached.
[CUSTOMER][NEUTRAL] OK, so I have to create a password and all of that.
[AGENT][POSITIVE] Yes, ma'am, cause you're gonna set it up a little different. Yes, ma'am. You'll set it up as an individual.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you'll use your information.
[AGENT][NEUTRAL] Your personal email, your zip code, your date of birth, your social. Now we did not verify your full social and that is something you will have to use so if you could go ahead and verify that with me.
[CUSTOMER][NEUTRAL] What you need to verify?
[AGENT][NEUTRAL] Your social security number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you. All right. So that is all of your information is verified, so you should not have any difficulty in setting up your profile.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I said to me that how long they take it.
[AGENT][NEUTRAL] Uh, it's typically a 5 to 7 business day turnaround for review.
[CUSTOMER][NEUTRAL] OK, and do I receive it what how long they take?
[AGENT][NEUTRAL] You, when you set up your profile in that user guide, it gives you instructions to where you can opt in for text notification alerts and you can also opt in for direct deposit. So if you enter your direct deposit information and we are able to pay benefits to you, it would be electronically deposited instead of a paper check being mailed, and typically that takes 2 to 3 business days once the claim has been processed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right thank you.
[AGENT][POSITIVE] OK. Well, you're very welcome. So is there anything else I can help you with, [PII]?
[CUSTOMER][NEUTRAL] How we doing
[CUSTOMER][NEUTRAL] And the fee is also, um,
[CUSTOMER][NEUTRAL] Uh, for my, for my other, um, employees.
[CUSTOMER][NEUTRAL] Uh, you can send me the.
[CUSTOMER][NEUTRAL] The form for clients payment?
[AGENT][NEUTRAL] I'm sorry, for what?
[CUSTOMER][NEUTRAL] To have it on record?
[CUSTOMER][NEUTRAL] For having a record at the office, can you send me the form for accidental, uh, claim form?
[AGENT][NEUTRAL] I'm sorry, what type of claim form?
[CUSTOMER][NEUTRAL] The form I, you know, the claim form that which one I submit, can you send me one?
[AGENT][NEUTRAL] Yes, ma'am, and, yes, ma'am, you can actually print it directly, [PII], from our portal. I mean, not our portal, our public website. If you go to [PII].
[CUSTOMER][NEUTRAL] To have it on record for the office?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] When I log in, you say?
[AGENT][NEUTRAL] No, ma'am. No, you don't have to log in for this. You're just gonna go to [PII].
[CUSTOMER][NEUTRAL] Oh, OK. So.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let me know when that page pulls up and I'll show you where to get the claim form.
[CUSTOMER][NEUTRAL] OK, uh huh, I log in. I was, I think so. I find so mhm.
[AGENT][NEUTRAL] OK, so at the top.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You see where it says claims and forms, click on that. OK, click that, scroll down the page.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And about middle ways down the page, you're gonna see a small box that says filter by product with a green drop down arrow.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right, what did you say?
[CUSTOMER][NEUTRAL] All the way to see you mean you can uh via fax by mail paper form.
[AGENT][NEUTRAL] Come, come on down a little more.
[CUSTOMER][NEUTRAL] OK, I claim form?
[AGENT][NEUTRAL] And you, you too.
[AGENT][NEUTRAL] No. Do you see where it says right above, no, ma'am. Right above it, it says filter by product and it has a little green drop down arrow.
[CUSTOMER][NEUTRAL] That one?
[CUSTOMER][NEUTRAL] Before the the forms you say?
[AGENT][NEUTRAL] OK, do you see where you're looking and you said you saw accident claim form?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right above that.
[AGENT][NEUTRAL] You should see a small box that says filter byproduct.
[CUSTOMER][NEUTRAL] Uh, reset filters.
[AGENT][NEUTRAL] Do you see where it says filter by product? Click on the green arrow.
[CUSTOMER][NEUTRAL] Uh, filter by product, uh huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it gives you a list.
[AGENT][NEUTRAL] The type of policy that you have is a Medlink.
[CUSTOMER][NEUTRAL] Yeah, mhm.
[AGENT][NEUTRAL] So you will just click on the word med link.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] And now you should see a button out to the right of your screen that says download form.
[CUSTOMER][NEUTRAL] Mhm OK.
[AGENT][NEUTRAL] And that's how you download the Medlink claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I, I, I download this one before, but it's not saying on the which one you you have it before, so that's why I make sure it.
[AGENT][NEUTRAL] That's the form that, yes, ma'am. That's the correct claim form that anyone within your group would use for this type of policy.
[CUSTOMER][NEUTRAL] Oh OK, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that claim form has the instructions on it also.
[CUSTOMER][POSITIVE] Alright perfect thank you yeah.
[CUSTOMER][NEUTRAL] Yeah, yeah, it was not looking the same on the which one you have it before. That's why I make sure it's the same.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Sure, sure. No worries. OK. Well, is there anything else? Yes, ma'am. You're very welcome. OK, [PII]. Well, it was my pleasure in speaking to you. I hope you have a good day as well. And thank you again for calling APL.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] That's all.
[CUSTOMER][POSITIVE] Have a good day.
[CUSTOMER][POSITIVE] All right no problem have a good day.
[AGENT][NEUTRAL] All right, bye bye. You too. Bye-bye.