AccountId: 011433970860
ContactId: 4351550e-9ec9-49da-8f4d-35122e287631
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1412959 ms
Total Talk Time (AGENT): 327588 ms
Total Talk Time (CUSTOMER): 369800 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/4351550e-9ec9-49da-8f4d-35122e287631_20250623T18:30_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, um, I am a current policy holder, and, um, I wasn't aware that I that I had this, uh, got insurance, and so I have paid some several things out of pocket so I was trying to figure out how to make a claim there, um, on the website, got copies of all my EOBs and and invoices and stuff.
[AGENT][NEUTRAL] OK, sure, I can assist you um with instructions on how to submit a claim. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you. And may I have the policy number?
[CUSTOMER][NEUTRAL] OK, so on my card I've got a payer ID number and a group number.
[AGENT][NEUTRAL] Um, it's gonna be the number at the bottom where it says in hospitals outpatient cert.
[CUSTOMER][NEUTRAL] In hospital benefits certain number OK uh 0244.
[CUSTOMER][NEUTRAL] 6031.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] As in Mary. L as in Larry 7.
[AGENT][NEUTRAL] Thank you. Um, may I have your name and date of birth for security?
[CUSTOMER][NEUTRAL] Uh, [PII], [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] That's the wrong num so that was the number I needed to put into the website too.
[AGENT][NEUTRAL] Uh, no, bear with me. OK, and may I have the mailing address?
[CUSTOMER][NEUTRAL] That was it.
[CUSTOMER][NEUTRAL] Uh, my home address or the.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] My it's uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what is your email address?
[CUSTOMER][NEUTRAL] Um, my work email address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, what about your personal email? We're gonna need your personal email.
[CUSTOMER][NEUTRAL] Oh, that, that's gonna be [PII].
[AGENT][NEUTRAL] OK, let me have that one more time, the first part of it, so I can type that in.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, bear with me. Let me just go ahead and add that information so we can register online. OK, one moment.
[AGENT][POSITIVE] And if you have anything open at this moment just go ahead and close it and we're gonna do this together.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect closed.
[AGENT][NEUTRAL] Before we go in.
[AGENT][POSITIVE] OK, so everything good.
[AGENT][NEUTRAL] OK, so now.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so let's go to our website at [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, you're gonna click on create account and uh huh go ahead.
[CUSTOMER][NEUTRAL] Wait
[CUSTOMER][NEUTRAL] Hold on, was it AM public or?
[CUSTOMER][NEUTRAL] American public?
[AGENT][NEUTRAL] You can go to different ways. You can go to [PII] or you can go to [PII].
[CUSTOMER][NEGATIVE] That's what I'm doing is it's not responding.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Is it [PII] or anything no.
[AGENT][NEUTRAL] Um, no. If you cannot get in like that, yeah, if, if you cannot go in like that, just go to [PII].
[CUSTOMER][NEUTRAL] Well let me just try [PII].
[CUSTOMER][NEUTRAL] OK, did that.
[AGENT][NEUTRAL] OK, go ahead and sign in.
[CUSTOMER][NEUTRAL] That would go to sign in.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, you could create, create account and choose insured. And when you go to the next page, just wait until I give you instructions.
[CUSTOMER][NEUTRAL] No, create account or.
[CUSTOMER][NEUTRAL] OK, I'm here.
[AGENT][NEUTRAL] OK, so, um, the only thing we're gonna need for you to sign up is your last name, email, and date of birth only.
[CUSTOMER][NEUTRAL] That's not
[CUSTOMER][NEUTRAL] Email
[CUSTOMER][NEUTRAL] And date of birth oh my.
[CUSTOMER][NEUTRAL] OK, last name, email, date of birth.
[CUSTOMER][NEGATIVE] This error.
[AGENT][NEUTRAL] OK, and the last name I see you have [PII] So we need the whole thing. [PII]
[CUSTOMER][NEUTRAL] No user
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And the last name [PII].
[AGENT][NEUTRAL] Yes, mhm, that's what we have under the last name.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh no, I do apologize. That's your first name. That's not your last name. [PII] is your last name.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] That's right.
[CUSTOMER][NEGATIVE] Yeah, no that didn't work with my whole name.
[CUSTOMER][NEGATIVE] Oh wait, I know what it is so stupid. Hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's try this one more time.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, um, prior to calling me, how many times did you try?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] 10.
[AGENT][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, uh, get stuck. OK, so, um, we'll have to clear your history, your cookies, and try again.
[CUSTOMER][NEUTRAL] I have to clear my cache, OK.
[CUSTOMER][NEUTRAL] Close it down.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, website is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Say that again.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, now let's try this again.
[CUSTOMER][NEUTRAL] Create an account based on your role insured.
[CUSTOMER][NEUTRAL] Next.
[CUSTOMER][NEUTRAL] Just my last name.
[AGENT][NEUTRAL] The email address is your last name, the number [PII], correct? D the last name.
[CUSTOMER][NEUTRAL] Yes, yes, that's, that's, yeah.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I kept the
[CUSTOMER][POSITIVE] We're gonna get this.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Alright, yes.
[AGENT][POSITIVE] Yes, OK, that sounds good.
[AGENT][POSITIVE] Love when they say yes.
[CUSTOMER][NEUTRAL] And now I need to get a verification code.
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK, verification code.
[CUSTOMER][NEUTRAL] Some
[CUSTOMER][NEUTRAL] OK, verify code.
[CUSTOMER][NEUTRAL] You know just been fine just now.
[CUSTOMER][NEUTRAL] What is display name?
[AGENT][NEUTRAL] Uh, the display name is whatever you want to say if you wanna say gap insurance, Meli, or secondary insurance or you want your full name, you can put that in there.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] uh
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] doesn't like my password that Apple is giving it.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Sorry I'm trying to get out of it. It's not like there.
[CUSTOMER][NEUTRAL] T4 digits.
[CUSTOMER][POSITIVE] OK, account has been successfully created.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now I have to go back and log in let's see.
[AGENT][NEUTRAL] Yes, it's gonna ask you for another code, it's just a security measure.
[CUSTOMER][POSITIVE] I love the codes.
[CUSTOMER][NEUTRAL] Alright, welcome to the online service center. I'm at the dashboard.
[AGENT][NEUTRAL] OK. All right, yes.
[CUSTOMER][NEUTRAL] File a claim
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Asking me for my phone number text messages.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I should go to start your claim.
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][POSITIVE] OK, traditional clean.
[AGENT][NEUTRAL] Yes, you're doing a traditional plane.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, next step.
[CUSTOMER][NEUTRAL] Policy information supporting documents claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, check the coverage policy type.
[CUSTOMER][NEUTRAL] So there's 2
[CUSTOMER][NEUTRAL] Policies on here.
[AGENT][NEUTRAL] Yeah, no, you have the old one and the new one. Based on the date of service, you can choose either or. Um what is the date of service that you're trying to submit?
[CUSTOMER][NEUTRAL] It's actually going, uh, it's here in [PII].
[AGENT][NEUTRAL] OK, so that will be the one ending in 1108.
[CUSTOMER][NEUTRAL] So May May and June.
[CUSTOMER][NEUTRAL] Oh, the one that ends in 031?
[AGENT][NEUTRAL] No, the 108.
[CUSTOMER][NEUTRAL] The 108.
[CUSTOMER][NEUTRAL] Is that the new policy is that the old policy?
[AGENT][NEUTRAL] Yeah, that's the new policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Upload files.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I just see this thing.
[CUSTOMER][NEGATIVE] Mm hold on sorry for this.
[CUSTOMER][NEUTRAL] OK, here you go.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, just the, it's not a claim form, it's just my documentation that I'm uploading.
[AGENT][NEUTRAL] OK, you're also gonna need the claim form, OK? So, um, the claim form you can go to our homepage at [PII] on the claims and forms and you will look for that maling claim form. Um, all we're gonna need is the claim form, the itemized bill, and the explanation of benefits from the primary insurance. Those are the three documents that's also listed on the claim form. The first page will give you instructions.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, so I should not submit this.
[CUSTOMER][NEUTRAL] Until I have the claim form done.
[AGENT][NEUTRAL] You can, you can send uh the claim form separate. We put it all together once we process the claim. It doesn't have to be all together. You can send it separately.
[CUSTOMER][NEUTRAL] Mhm, where did it go?
[CUSTOMER][NEUTRAL] I just clicked out of it.
[CUSTOMER][NEUTRAL] So the claim forms in the resource center.
[AGENT][NEUTRAL] It's gonna be under the [PII]. It's also on the resource center, yes, mhm.
[CUSTOMER][NEUTRAL] Claim support.
[AGENT][NEUTRAL] Same points.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] How uh how to file uh documents.
[CUSTOMER][NEUTRAL] Let me just search current.
[CUSTOMER][NEUTRAL] How to file a meddling claim for providers? No.
[CUSTOMER][NEUTRAL] How to file med like claim form for insureds and providers.
[AGENT][NEUTRAL] Mhm. Your insurance. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I need to fill this out, upload it with my documentation.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that should work.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, um, should I leave you on the phone for all of that, or should I?
[AGENT][NEUTRAL] Um, do you think you need help with that or you think you got it from here?
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Where to get the time no.
[CUSTOMER][NEUTRAL] The instructions on the claim form, not the actual claim form.
[CUSTOMER][NEUTRAL] Is it a wellness claim form?
[AGENT][NEUTRAL] No. Mm mm, meddling claim for.
[CUSTOMER][NEUTRAL] Medling claim form. What's the title of the document?
[AGENT][NEUTRAL] Netling claim.
[CUSTOMER][NEUTRAL] I just need to find the English one.
[CUSTOMER][NEUTRAL] I think I got it. Let's see.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I wanna make sure I get the right number and because I've got the old card.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh let's see.
[CUSTOMER][NEUTRAL] I can put the line first name and last name.
[CUSTOMER][NEUTRAL] Oh, you don't need the, the policy, OK, what's the policy number?
[AGENT][NEUTRAL] OK, so let me go back.
[CUSTOMER][NEUTRAL] For the
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One month.
[AGENT][NEUTRAL] It's gonna be the one ending, well, you can put 2503108.
[CUSTOMER][NEUTRAL] Just those digits 2503108.
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, well, I will fill out this information.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And I'll upload the two forms and then I should be, do I need to itemize anything or you guys will look at the EOBs and say, OK, this is my patient responsibility because then I have.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mm mm. No. We need an itemized bill. The reason we need the itemized bill from the provider of service is because we need to look at the procedure codes and diagnosis code. The diagnosis code is gonna tell us the reason that you have to go to visit the doctor, and the procedure code is gonna tell us what procedures they did. So we need that itemized bill from the provider of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And will those things they're not gonna be in the ELBs from the primary?
[AGENT][NEUTRAL] No, the diagnosis cause is not in the EOB from the primary.
[AGENT][NEUTRAL] Unless you use Blue Cross Blue Shield, that they're the only ones that use them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, right, but I've got like.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] You know, I got a prescription for physical therapy and I've got the bill from the physical therapist for everything that I paid for.
[CUSTOMER][NEUTRAL] So that'll work.
[CUSTOMER][NEUTRAL] I've got the approval for an MRI and I've got the $100 payment that I made.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] You can send what you have and, and let the examiner look at it and see if what we need and then if we need anything else, we'll let you know. But the best thing is to go ahead and send everything that is required on the form.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] On the phone, OK.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Alright, well I think I I should have it from here. I appreciate your help.
[AGENT][POSITIVE] OK. You're welcome.
[CUSTOMER][NEGATIVE] And I'll call back if if something messes up.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, no problem. That's why we're here for it. Well, thank you for calling APL. You have a good afternoon, Mr. [PII].
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you bye bye.