AccountId: 011433970860
ContactId: 211270fa-93be-46dd-a631-817bf6d26d9d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 973260 ms
Total Talk Time (AGENT): 460316 ms
Total Talk Time (CUSTOMER): 377676 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/211270fa-93be-46dd-a631-817bf6d26d9d_20250226T13:35_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEGATIVE] Hi, I put a claim in a while back and it keeps saying that my claim is complete, but I don't see, first of all I didn't receive a check or um a direct deposit, and also I don't see anything in my account and I'm trying to log in and it's not letting me.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so you're just trying to log into your portal?
[CUSTOMER][NEUTRAL] I wanted to
[CUSTOMER][NEUTRAL] I'm trying to know what what happened with my with my [PII].
[AGENT][NEUTRAL] OK, yes ma'am. Well, I can check my status for you and who am I speaking with please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, Ms. [PII]. What is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And what is your policy number, please?
[CUSTOMER][NEUTRAL] One second, sorry, let me find it.
[AGENT][NEUTRAL] Mhm. No, you're fine.
[AGENT][NEUTRAL] Oh yeah, we're fine.
[CUSTOMER][NEUTRAL] Well, you know what, I probably have it on the claim form, right? Policy number?
[CUSTOMER][NEUTRAL] What's my social [PII], the letter [PII].
[AGENT][NEUTRAL] OK, thank you. So give me just one moment please to get your information pulled up.
[CUSTOMER][NEUTRAL] Hello, [PII], can you take her to the playground, my love?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Take her to the playground, sweetie. Thank you. I would take your water bottle.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Who am I calling?
[CUSTOMER][NEUTRAL] I work at a school and they're out on the playground.
[AGENT][NEUTRAL] Oh, sweet. OK, Ms. [PII], so I will need to verify several things with you first for security and also any information provided will be a verification of benefits and not a guarantee of payment. So first off, if you would please verify your date of birth?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and also your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Thank you. The phone number for you the on file is the same as the one you gave me, so that is your best contact number, is that correct? OK, thank you. And lastly your email address?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So I don't know which one's on there. I think it's [PII] school [PII].
[AGENT][NEUTRAL] Um
[AGENT][POSITIVE] Yeah, I'm nice.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, thank you and what is the data service that you're calling about today?
[CUSTOMER][POSITIVE] The date of service, that's a very, very good date signed.
[CUSTOMER][NEUTRAL] It is, um, it was back in August.
[CUSTOMER][NEUTRAL] Oh, how do I find that now?
[AGENT][NEUTRAL] Of what year?
[CUSTOMER][NEUTRAL] Hold on, let me look at my calendar, uh, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hold on, I could find it on my calendar when I had the procedure done.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] September. I did it in August.
[CUSTOMER][NEUTRAL] Mhm, mm.
[CUSTOMER][NEUTRAL] I'm not sure.
[CUSTOMER][NEUTRAL] Oh, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I when they billed me.
[AGENT][NEUTRAL] OK, so first off, let me go ahead.
[AGENT][POSITIVE] Ms. [PII], I'm so sorry about that.
[AGENT][NEUTRAL] And let me give you a different policy number. The policy number you gave me was your policy number at one time from [PII].
[AGENT][NEUTRAL] But you have another policy that's now currently active as of [PII].
[CUSTOMER][NEUTRAL] OK, one second, hold on.
[AGENT][NEUTRAL] And mhm. Sure.
[CUSTOMER][NEUTRAL] Let me just find where I'm gonna put it.
[AGENT][NEUTRAL] And when you do log into your portal.
[AGENT][NEUTRAL] You will be able to see the claim number as well that I'm going to give you.
[CUSTOMER][NEUTRAL] OK, one second. OK, so my APL, APL, what is it?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it is gonna be 02152735.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect, is there any way you can send me a copy of it to my email?
[AGENT][NEUTRAL] I can request that your ID cards be mailed and then when you log into your portal um if you need me to help you to get signed into your portal, I'll be happy to do that as well, but there is a copy of your ID cards in there so you can print them directly from your portal.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Oh, there is.
[AGENT][NEUTRAL] Mhm, yes ma'am.
[CUSTOMER][POSITIVE] I did not know that. You learn something every day.
[AGENT][NEUTRAL] Well they.
[CUSTOMER][NEUTRAL] Um, it's not letting me. Let me do forgot password. I don't remember. Let me try one more password.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] Oh, that wouldn't work.
[CUSTOMER][NEGATIVE] I think no, it didn't work, OK.
[AGENT][NEUTRAL] OK, so what is, um, on the claim that you submitted, what was the total bill amount on that claim?
[CUSTOMER][NEUTRAL] I'm, I'm pretty sure 550 if I'm not mistaken.
[AGENT][NEUTRAL] OK, now I don't see a claim on file for you for that date [PII] for that billed amount.
[AGENT][NEUTRAL] Um, let me look at one.
[CUSTOMER][NEUTRAL] So 44 it's it's it's either 450 or 550. I have the claim papers that I um I can't log in by the way, do I have a username or it's my email?
[AGENT][NEUTRAL] No, you would have set up a user name and I can provide that for you.
[CUSTOMER][NEUTRAL] Yeah, what's the usernam[PII]? I'm sorry.
[AGENT][NEUTRAL] Uh, yes, ma'am, you'll have to give me just a moment to get to that information.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I probably have it written down somewhere.
[AGENT][POSITIVE] That's OK. I can give it to you.
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Oh, you know what? I do have it written down.
[CUSTOMER][NEUTRAL] And I also have the password written down.
[CUSTOMER][NEUTRAL] Let me just find it.
[AGENT][NEUTRAL] So your username is all lower case and it's [PII] [PII].
[AGENT][NEUTRAL] But it's [PII] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] OK, so now for your date of service of [PII], I show that the provider is the one who submitted the two claims we have. This is for Doctor [PII].
[CUSTOMER][NEUTRAL] Yes, so I'll tell you what it is. It's an outpatient facility.
[CUSTOMER][NEUTRAL] Which is what they advertise and everything, but the way they coded it now from my understanding is that the way they coded it was in um a regular.
[CUSTOMER][NEUTRAL] Office visit. Now, it wasn't in their office. Their facility is considered an outpatient facility. Now they we were back and forth, back and forth. I told them, you know what, I have to have this procedure done, um, invalid username or password. How is that possible? Um, and we were going back and forth.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But they closed down.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So I'm thinking that that's why they build it that way.
[AGENT][NEUTRAL] Because I can see the total charge that they submitted, yes, we did deny that claim.
[AGENT][NEUTRAL] Ms. [PII], because this service is not covered when performed in a doctor's office or clinic. That is the reason for the denial, according to
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But it
[CUSTOMER][NEUTRAL] But it was done in an outpatient facility.
[CUSTOMER][POSITIVE] And when I spoke to the to the operator last time, the the lady that was helping me submit everything, she was able to see that it was, you know, advertised and put as a outpatient facility.
[CUSTOMER][NEGATIVE] It's just the coding that they put in was wrong.
[AGENT][NEUTRAL] OK, now this claim that I'm looking at the only claim we have for you for this data service shows it was submitted not by you, but by the provider.
[CUSTOMER][NEUTRAL] Yeah, but I submitted a claim, a file, um, claim. I submitted it [PII].
[CUSTOMER][NEGATIVE] And I have no idea how to look on my account to see what is going on.
[AGENT][NEUTRAL] So what we've received.
[CUSTOMER][NEUTRAL] It's the claim form.
[AGENT][NEUTRAL] We received, but that was also.
[AGENT][NEUTRAL] Right, I do see that that was just a claim form that we received, that was received on the.
[CUSTOMER][NEUTRAL] Yeah, because that's what they told me to do.
[AGENT][NEUTRAL] Now, what I can do is I can connect you with one of the examiners that looked at or told you to send that, you know, um, and because according to the remarks on the claim form that was submitted, it says we're in receipt of the claim form that was completed by you. However, there were no charges submitted. If you are needing to file a claim, please submit the itemized charges in order for benefits to be considered.
[AGENT][NEUTRAL] As soon as we receive this information, we will be able to complete the processing of your claim until then your claim will be placed in an inactive status.
[CUSTOMER][NEUTRAL] OK, so what do I need to submit a receipt?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] You would need to submit an itemized bill from the provider for your data service that includes your diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. OK.
[AGENT][NEUTRAL] And also a copy of your primary insurance company's explanation of benefits for that data service because this policy, you know, is designed to help you with co-pays, deductibles, and co-insurance amounts of coverage services. So that's why we have to have the primary insurance EOB. Now, I can give you the claim number. Were you able to get signed into your portal?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, I am signed in. I just have no idea how to use it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the claim, go down to your claims and um the claim number I'm gonna give you is the one that I just read you those remarks.
[CUSTOMER][NEUTRAL] Where do I go to the claims? It gives me contact us, claim forms and help.
[AGENT][NEUTRAL] OK, does it say up at the upper right corner, welcome.
[CUSTOMER][NEUTRAL] That's all it's giving me.
[AGENT][NEUTRAL] And your name?
[CUSTOMER][NEUTRAL] Yeah, welcome, [PII]. Yeah, and it's spelled wrong, by the way.
[AGENT][NEUTRAL] OK, I can, I can correct your name. So give me.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh, just a moment. I'll do that, but let me go to
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Under my coverage.
[AGENT][NEUTRAL] Let's see, wait just one moment.
[CUSTOMER][NEGATIVE] I don't see my coverage.
[AGENT][NEUTRAL] On the top tab.
[AGENT][NEUTRAL] You should see different tabs. You said my coverage, my ID cards, filing a claim.
[CUSTOMER][POSITIVE] Yeah, I'm on the top.
[CUSTOMER][NEUTRAL] No, so none of that is there. I see the contact us. OK, let me go to home. OK, let's go back to home. OK, so now I'm at home. It doesn't give me.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There should be a track claim status.
[CUSTOMER][NEUTRAL] OK, my coverage, I see my coverage.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] My claims.
[AGENT][NEUTRAL] Mhm. That's the way you'll need to go, my claims.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it will show you claims that have been processed in the last 24 months.
[CUSTOMER][NEUTRAL] OK, so which one am I looking for, the OSC?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh, the claim number that you're looking for, which it does show a claim number, there's a column.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh-huh. 354.
[AGENT][NEUTRAL] 36.
[CUSTOMER][NEUTRAL] 354. Uh-huh.
[AGENT][NEUTRAL] Uh-huh. 3656. So again, that's 3543656.
[CUSTOMER][NEUTRAL] 365
[CUSTOMER][NEUTRAL] 3543656. Yeah, OK, so I click that.
[AGENT][NEUTRAL] The claim numbers should be in a.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh, and that will open up the explanation of benefits and those remarks that I just read to you are on the 2nd page. Mhm.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK, so I need the primary coverage and all my itemized um.
[AGENT][NEUTRAL] Bills, mhm.
[CUSTOMER][NEUTRAL] Forms from the procedure.
[AGENT][NEUTRAL] Mhm. Including your diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] I hope I have it because the office closed down.
[AGENT][NEUTRAL] Did they transfer your medical information anywhere else?
[CUSTOMER][NEUTRAL] No, I have no idea what they did. I just know the last time I spoke to them they said, oh we're closing down the office, um, so I asked them, I said, OK, can you send me all my like my file and they did, they sent me like a little uh envelope with the diagnosis, whatever it is. I'm not sure if it's itemized about, you know, the bill or what I paid or whatnot, but I do have my diagnosis and all that.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK. So I would recommend sending that. If that is not sufficient, then, um, Ms. [PII], you always have, you do have 180 days from the date that that claim was reviewed to file an appeal, if you would like, and you can include in there, you know, any information that you feel is pertinent, such as this, you know, the office closing for reviews.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, now, on your name, your first name, is it your first name or your?
[CUSTOMER][NEUTRAL] My first name is correct. It's the [PII] It's supposed to be an [PII] It's [PII]
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so I have gotten that updated for you. Now, it will take overnight before, you know, that will fully go through, but you should.
[AGENT][NEUTRAL] You should be able to see it now if you refresh your portal. I believe it may take it overnight though to do that, but I have gotten it corrected for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. Alright, so I'll upload those, um, and if I have any other issues I'll let you know.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, ma'am, please give us a call. So if that is all that I can help you with at the moment, Miss [PII], thank you again for calling APL and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Yes, ma'am. Thank you.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.