AccountId: 011433970860
ContactId: 29283616-fd9d-4556-a963-53bc9267db3b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 990369 ms
Total Talk Time (AGENT): 422030 ms
Total Talk Time (CUSTOMER): 332954 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/29283616-fd9d-4556-a963-53bc9267db3b_20250218T20:53_UTC.wav
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[AGENT][NEUTRAL] Good afternoon thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, I'm calling um to check the status of a claim I submitted.
[AGENT][NEUTRAL] OK, the claim is for yourself and you're wanting to check status, is that correct?
[CUSTOMER][NEUTRAL] It's for my son.
[AGENT][NEUTRAL] OK, yes, ma'am. I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] Sure, my name is [PII].
[AGENT][NEUTRAL] OK, Ms. [PII], what is a good callback number for you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the policy number?
[CUSTOMER][NEUTRAL] OK, you probably would need that, huh? If you give me one second, I, I could probably get that to you.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Um, because
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Are you the subscriber, Ms. [PII] on the policy?
[CUSTOMER][NEUTRAL] I am.
[AGENT][NEUTRAL] OK, I can look it up by your full social, if that's easier.
[CUSTOMER][NEUTRAL] Probably so.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] I'm ready for that number whenever.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you one moment please.
[AGENT][NEUTRAL] And which policy did you file the claim on for your son?
[CUSTOMER][NEUTRAL] Hospital indemnity.
[AGENT][NEUTRAL] OK, so I will need to verify several things with you first, Mr. [PII], for security purposes and also any information that is provided today would be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth and then your son's name and date of birth.
[CUSTOMER][NEUTRAL] My date of birth is [PII]. My son's name is [PII]. His date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Also your home mailing address, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the phone number that we have on file for you is the same as the one you gave me, so that is your best contact number that we should have. Is that correct?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] Thank you and the last piece of information to verify is going to be your email address.
[CUSTOMER][NEUTRAL] Ya [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date, date of service, Ms. [PII], that you're calling about for him?
[CUSTOMER][NEUTRAL] It would be uh [PII] and [PII].
[CUSTOMER][NEUTRAL] 2025.
[AGENT][NEUTRAL] And what is the total bill amount for your 211 data service?
[CUSTOMER][NEUTRAL] Um, I don't know that. I actually sent in an like an uh.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] I sent in a charge report uh like the uh op report should I say or procedure report.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so give me just one moment to look at this claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm not sure how to pronounce this physician's name. It's [PII]. Is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Mhm, that one [PII], yeah.
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] All right, so I do see that that claim was processed and it, it was denied at this point. Uh, the remark on the explanation of benefits, Ms. [PII] states, in order to complete the processing of your claim, we need itemized statements of services provided listing the charges, diagnosis code, codes, and procedure codes.
[CUSTOMER][NEUTRAL] OK, so they need to charge the diagnosis.
[AGENT][NEUTRAL] Mhm they need to I yes ma'am and I can see let's see, are you set up in the online service center portal with APL? OK, so you can actually see this claim number. I can provide you the claim number for that data service and the explanation of benefits is also in there when you click on the claim number.
[CUSTOMER][NEUTRAL] And, OK.
[CUSTOMER][NEUTRAL] I uh
[CUSTOMER][NEUTRAL] I am.
[AGENT][NEUTRAL] So you can see exactly what's needed on page two. The remark that I just read to you, it's on page two of the explanation of benefits, but the claim number for that data service is 356-5245.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you said the other data service was 212. Is that correct?
[CUSTOMER][NEUTRAL] Mhm, exact same thing they're gonna they're gonna.
[CUSTOMER][NEUTRAL] It's probably gonna be the exact same thing.
[AGENT][NEUTRAL] OK, cause I don't have one. Well, I'm so sorry. I don't see a claim for that data service on file.
[CUSTOMER][NEUTRAL] Um, is that.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Um, OK, can you tell me anything about benefits? Do, um, is there a benefit in that, in this, in, in this plan in this policy, it's an outpatient surgery benefit?
[AGENT][NEUTRAL] OK, give me just one moment to get your policy information pulled up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, so on this.
[AGENT][NEUTRAL] plan that you have on this limited benefit plan. You do have an accident and sickness surgery benefit.
[AGENT][NEUTRAL] In a hospital or a hospital outpatient facility or freestanding outpatient surgery center and the benefit is $1000 per day, maximum of 1 day per calendar year per covered person.
[CUSTOMER][NEUTRAL] Did I file it under the right insurance? I'm.
[AGENT][NEUTRAL] Was
[AGENT][NEUTRAL] It's under your hospital.
[CUSTOMER][NEUTRAL] Did I file it under the right?
[AGENT][NEUTRAL] Yes, and this is under your hospital indemnity plan. Mhm.
[CUSTOMER][NEUTRAL] Indemnity.
[CUSTOMER][NEUTRAL] OK, OK, so when I get all this information uh from the doctor, the procedure code, the diagnosis, the itemized charge.
[CUSTOMER][NEUTRAL] Um, do I just, um, how do I send that like.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] You can just upload it. You can upload it into your portal. Exactly. Now you won't be able to tie it to those claim numbers that you're gonna see in the system now, but you will just upload it like you were doing a, a new claim, OK? And then and then we will know, the system will know that those are pieces of information.
[CUSTOMER][NEUTRAL] Just like I did that
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's what I wanted to know, OK.
[AGENT][NEUTRAL] That we were in need of.
[AGENT][NEUTRAL] But on your end, it's gonna look like you're submitting a new claim.
[CUSTOMER][NEUTRAL] So just
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now if you want to write the
[CUSTOMER][NEUTRAL] So I'm sending a new claim, OK.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] No, no, no. Go ahead with your question.
[CUSTOMER][NEUTRAL] Um, so if I want to write what you were saying, if I want to.
[CUSTOMER][NEUTRAL] Reference, should I put a reference is there.
[CUSTOMER][NEUTRAL] Or just do it like a new claim, that's all I need to do.
[AGENT][POSITIVE] Yeah, you're just gonna upload, yes ma'am. Once you get the itemized bills, you're just gonna upload it just exactly like you did these other documents.
[CUSTOMER][POSITIVE] OK, OK, sounds good.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Well, is there anything else, Ms. [PII], I can help you with this afternoon?
[CUSTOMER][NEUTRAL] Well, I don't know if it's something that you can help with or if it would be something I'd have to uh contact um.
[CUSTOMER][NEUTRAL] Like from the previous benefit year, is there a way to see what I personally need had outstanding like what benefits I didn't, I, I don't remember like if I filed.
[CUSTOMER][NEUTRAL] You know, how is that that doesn't pop up right? is that like you could say, well you didn't file your accident you didn't file your
[CUSTOMER][NEUTRAL] You know what I had missing if I had office visits missing, did I file and get all my benefits that I was entitled to for last year, I guess that's my question. Is there a way that your system shows that, or you can tell what I filed on my name actually, right?
[AGENT][POSITIVE] Yes, ma'am. I can look that up for you. Mhm.
[CUSTOMER][NEUTRAL] OK, yeah, I'm going around in a circle here but uh we're getting there.
[CUSTOMER][NEUTRAL] With myself, I mean, OK, so for [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 4, what benefits did I file under [PII]?
[CUSTOMER][NEUTRAL] Cause I have accidents. I have
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, I would have to look at each of your policies.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh yeah, because I have accidents.
[AGENT][NEUTRAL] I mean, they're not all, it's separate. Yes, ma'am, it's separate. Did you have an accident last year?
[CUSTOMER][NEUTRAL] I have
[CUSTOMER][NEUTRAL] No, there are certain things I think that get paid under the accident point policy is what I'm, uh, I didn't.
[CUSTOMER][NEUTRAL] [PII], I don't think I had any. I sure hope I did.
[CUSTOMER][NEUTRAL] But, um, so I think the accident pays like the routine dental or routine vision.
[AGENT][NEUTRAL] OK. So first off, we're gonna have, yes, ma'am. I'll have, but we have to look at each of your policies and then it's not just all under your name. We'll have to look at each policy separately. So on your hospital indemnity plan.
[CUSTOMER][NEUTRAL] And we
[AGENT][NEUTRAL] Did you have any questions on what you filed on that?
[CUSTOMER][NEUTRAL] OK, yeah, do you see 2 visits, uh, for me?
[AGENT][NEUTRAL] I do see, uh, yes. Uh, actually, no, ma'am. Hold on just a second because this claim was filed last year, but it was for the year of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am, you submitted a claim in March for a data service in [PII].
[CUSTOMER][NEGATIVE] Yeah, because that's how I am. See, it's February now. I'm, I'm doing the stuff from last year just always behind.
[AGENT][NEUTRAL] And the best way on these policies, oh, I'm sorry, Mrs. [PII], just may be for you to, um, present your APL information when you go for treatments for doctor's appointments and such.
[CUSTOMER][POSITIVE] I always like
[AGENT][NEUTRAL] And most providers will file for you, but I mean if you prefer to file it on your own, that's entirely, you know, up to you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I
[CUSTOMER][NEUTRAL] Yeah, I don't think my provider would do that, but anyway.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I don't see where you filed any office where we paid any benefits for office visits for you for [PII]. No, ma'am.
[CUSTOMER][NEUTRAL] OK, so I definitely can file that because I definitely had office visits, regular doctor visits, OK, um.
[AGENT][NEUTRAL] So, on all of these, the same things will apply, you know, on the claim form that you submit for your hospital indemnity. It has all of the instructions on the first page. On all of your dates of service, we'll need, you know, the itemized statements including the diagnosis and procedure.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Code.
[AGENT][NEUTRAL] Just like this other claim um for your son.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so that's on hospital indemnity. I know I, I'm pretty sure there's urgent care visits under there, and I'm pretty sure I did. I don't remember going to the urgent care. Do you see any urgent care visits for me in the hospital indemy for [PII]?
[AGENT][NEUTRAL] No, ma'am, I don't. No, ma'am. I just see 2 for [PII], mhm, 2 for [PII], and then 1 imaging exam for him. There is nothing for you for [PII].
[CUSTOMER][NEUTRAL] You see nothing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, alright.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm trying to think of what other uh I think I probably found under my cancer policy that's probably where you'll find mine.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so do you
[CUSTOMER][NEUTRAL] I'll probably filed.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mammogram maybe?
[AGENT][NEUTRAL] In just a moment.
[AGENT][NEGATIVE] I have to make a note on each one of your policies in this rubbish show also before we can go to the next one. So in your hospital indemnity, did you have any other questions on this one?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] No, OK.
[AGENT][NEUTRAL] OK, and then you're wanting to know about your accident policy?
[CUSTOMER][NEUTRAL] Cancer.
[AGENT][NEUTRAL] Oh, OK
[AGENT][NEUTRAL] OK. So I do see that we did, you did file your preventative.
[AGENT][NEUTRAL] On your cancer policy for 2024. We did process a claim for that. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, so that's where it's at.
[CUSTOMER][NEUTRAL] And um the other one was accident.
[AGENT][NEUTRAL] OK, so give me just one moment to complete what my portion of, of your, of what we discussed on your cancer policy. Give me just a moment, please.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][POSITIVE] Yeah, take your time.
[AGENT][NEUTRAL] And all of a sudden my system got very slow. I'm sorry.
[CUSTOMER][NEUTRAL] Oh, it's OK.
[AGENT][NEUTRAL] OK, and for on your accident policy you did file for you and for [PII].
[AGENT][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] OK, so that's where, OK, so that's what I did right now I understand what I need to do.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Well, do you have any other questions? Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, no, ma'am, that is gonna be all.
[AGENT][POSITIVE] OK, then. Well then, thank you so much for calling APO Mer show and I hope that you have a very nice evening.
[CUSTOMER][POSITIVE] You too thank you so much bye bye.
[AGENT][POSITIVE] You are certainly very welcome. Yes, ma'am. Bye-bye.
[CUSTOMER][NEUTRAL] work.
[CUSTOMER][NEUTRAL] Bye-bye.