AccountId: 011433970860
ContactId: 3c315af8-5902-4ec9-ac80-447b5c79e05a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 523820 ms
Total Talk Time (AGENT): 248598 ms
Total Talk Time (CUSTOMER): 215269 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/3c315af8-5902-4ec9-ac80-447b5c79e05a_20250319T20:13_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Good morning or afternoon. I received a letter that you need more information on a claim you received on my behalf.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] I'll be glad to help you. Go and give me your name and your policy number, please, sir.
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] All right, [PII], thank you for that. Now your policy number.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Find it here.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, I'm, I'm with, uh, my insurance is PHCS.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] Well
[CUSTOMER][NEUTRAL] That must be where.
[AGENT][NEUTRAL] What I'm needing is your APL certificate number, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Certificate number.
[AGENT][NEUTRAL] Mhm. It's gonna be an eight digit number. It starts with 0102.
[CUSTOMER][NEUTRAL] On my insurance card, I don't have any certificate number or any number that starts with that.
[AGENT][NEUTRAL] Are you
[AGENT][NEUTRAL] Are you looking at the IPO insurance card?
[CUSTOMER][POSITIVE] No, um, but I got this letter from you and I've got one before and they helped me out.
[AGENT][NEUTRAL] OK, well, I'll tell you what, just go ahead and give me your social. I can pull anything you have up by your social here, so just give me that and I'll find you.
[CUSTOMER][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right, Mr. [PII], bear with me just a moment and let me get over to that screen. Let's see.
[AGENT][NEUTRAL] OK, Mr. [PII], I don't see you on my system at all. I don't see the social on my system at all.
[CUSTOMER][POSITIVE] Wow.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] So, I'm not sure. Where'd you get this phone number from if you don't have an APL card?
[CUSTOMER][NEUTRAL] [PII]. Uh, it's on the phone number is on this letter. It says claims department and then it's got the phone number.
[AGENT][NEUTRAL] Alright, tell me what that letter says, so maybe that'll give me some idea of because I don't see you on my system at all crazy.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] It says, Dear policyholder, we received a claim on your policy, and a review of the claim has started.
[CUSTOMER][NEUTRAL] In some cases, additional information must be requested from you or your providers of medical services for the claim to be processed. We'll contact you with more information is needed. Thank you for trusting APL with your insurance needs, as always, feel free to contact us with any questions or concerns. Sincerely claims department, and then the phone number.
[AGENT][NEUTRAL] So it doesn't have your policy number or nothing on that letter?
[CUSTOMER][NEUTRAL] No, there's no policy number or anything.
[AGENT][NEUTRAL] Because I, I'm not even that I'm not even seeing kind of what that letter tells me is that we received something from you perhaps but we can't locate you on our system.
[CUSTOMER][NEUTRAL] I think what happens is uh.
[CUSTOMER][NEUTRAL] Probably my provider sent the claim in because the last time they sent the claim in.
[CUSTOMER][NEUTRAL] You guys had requested the CPT procedure codes and ICD 9 codes or the ICD 10 codes.
[CUSTOMER][NEUTRAL] I'm thinking that's probably what's happened again.
[CUSTOMER][NEUTRAL] And so I had to go get a hold of my provider and have them send me the claims and then I printed them out and mailed them into you.
[AGENT][NEUTRAL] But you had to have a certificate number to even do that.
[AGENT][NEUTRAL] That's what I'm, yeah, confused about.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, I'm just not sure. Spell spell your last name again for me, [PII], just by chance, I'm gonna try that.
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, let me just key that in. [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I do see your name on my system, but that is not your social that we have on our system. That's why I can't find you by your social, hm.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah, and you are with a different department. You have medical and you're in the hospital indemnity, but I'll tell you what I'm going to go ahead and verify your date of birth and your address for me.
[CUSTOMER][NEUTRAL] OK, my date of birth is [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what's your address?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Um, you don't have any other social security number?
[AGENT][NEUTRAL] That's the only social that you have is that you give me because this is not what we have in our system so I will um get somebody to look at that see what if that's been keyed in wrong or what because yeah that's.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Can you, can you read me back what I gave you for social number?
[AGENT][NEUTRAL] Yes sir, I can. [PII].
[CUSTOMER][NEUTRAL] Yeah, yeah, that's my number.
[AGENT][NEUTRAL] Yeah, that's nowhere near what we have. OK, I'll tell you what, do you want to get a pen and write your number down? I'm fixing to give you your policy number and this will be the number you need each and every time you call here or send anything into APL.
[CUSTOMER][POSITIVE] OK. Yeah, so I'm ready.
[AGENT][NEUTRAL] OK, alright, it's 025.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 133.
[AGENT][NEUTRAL] 14.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that's your, that's your certificate number and that is what you need on everything. Yeah, tell your doctors anywhere you go or anything you send in there's that number on it.
[AGENT][NEUTRAL] Yep, OK, alright, so you're calling now that we got that all established, you said you were calling that we requesting some information, is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, do you know, well, let me just look through your file and see what I can see.
[AGENT][NEUTRAL] Let's see one claim on [PII], but it looks like we've already received what we needed on that so.
[CUSTOMER][NEUTRAL] It's probably I would say [PII] maybe.
[AGENT][NEUTRAL] Hang on, let me keep looking.
[AGENT][NEGATIVE] I don't have anything for those dates at all. All I have is [PII] dates.
[CUSTOMER][NEUTRAL] OK. Oh.
[AGENT][NEUTRAL] But it could be that they couldn't enter it, um, without the, without the procedure codes because they can't in nothing, but yeah.
[CUSTOMER][NEUTRAL] OK. Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] That's just would be what I would suggest is probably a, a doctor, yeah, send something in. So maybe perhaps whatever last doctor you went to, give them a call and just tell them to send you the bill.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know, with the code on it, yeah, that, that way you can make sure because you can send it in on the OSC website, so.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All righty.
[AGENT][NEUTRAL] All right. Was there anything else I can help answer for you today, [PII]?
[CUSTOMER][NEUTRAL] No, I should take care of it.
[AGENT][POSITIVE] Well, alrighty then. Well, thanks so much for calling APL [PII]. You have a great rest of your day, OK?
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][POSITIVE] Thank you, sir. Bye-bye.
[CUSTOMER][NEUTRAL] OK. Yup.