AccountId: 011433970860
ContactId: 47b13d53-38a0-4e5d-9eec-ec318d1133c3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 541979 ms
Total Talk Time (AGENT): 301933 ms
Total Talk Time (CUSTOMER): 173785 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/47b13d53-38a0-4e5d-9eec-ec318d1133c3_20250303T19:14_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][POSITIVE] Yeah, how you doing? I'm trying to follow up on a claim for my daughter. She's sitting here right here with me.
[AGENT][POSITIVE] OK, we'll be glad to help you. Go ahead and give me your name and the member's policy number.
[CUSTOMER][NEUTRAL] OK, my name, uh the claimant is [PII]
[AGENT][NEUTRAL] And your name?
[CUSTOMER][NEUTRAL] Uh, [PII], same last name.
[AGENT][POSITIVE] Alright, [PII], I'll be glad to help you give me a good policy number.
[CUSTOMER][NEUTRAL] Uh, member ID number is what you want?
[AGENT][NEUTRAL] Yes, certificate number.
[CUSTOMER][NEUTRAL] We'll try 683-321-985.
[AGENT][NEUTRAL] Oh, say that one more time, a little bit slower.
[CUSTOMER][NEUTRAL] 683-321-985
[AGENT][NEUTRAL] Oh, that is too many numbers. Is that a social maybe? Let's see, [PII]. That might be a no.
[CUSTOMER][NEUTRAL] No, I, I'm
[CUSTOMER][NEUTRAL] No, we're we're calling about a medical claim for medical insurance claim.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes sir, but our certificate numbers is gonna be like an eight digit number starts with 01 or 02. Do you see anything with that?
[AGENT][NEUTRAL] It's gonna say certificate number.
[CUSTOMER][NEUTRAL] Um hm.
[CUSTOMER][NEUTRAL] How, where would I get that? I have, I filed a claim through APL, but where would I get that number? I don't understand, um.
[AGENT][NEUTRAL] Uh, um, oh, if you are, do you have an explanation of benefit back from APL yet? or do you have your ID card?
[CUSTOMER][NEUTRAL] No, I
[CUSTOMER][NEUTRAL] No, I have an ID card. That's it. I, I filed, shoot, this is the story. My daughter went, my daughter went to the doctor, used it for the first time, and they did, they didn't want to call for verification of insurance because it's a exchange plan that she had to buy off the exchange, and they didn't recognize the type of insurance, so they charged her full price and they I'm trying, I submitted a claim to try to get.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Reimbursement because it should be covered other than the copay and that's where I'm at. I don't have anything else.
[AGENT][NEUTRAL] OK, let me see. Hang on, let me get out of this and I'm gonna.
[AGENT][NEUTRAL] OK, now are you on the plan at all, [PII]?
[CUSTOMER][NEUTRAL] No, I'm just calling for her, but she's sitting right here. No, hello, she's my daughter's right here.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK, go, OK, I need the employee's entire full name.
[CUSTOMER][NEUTRAL] It's, it's [PII]
[AGENT][NEUTRAL] And last name.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, let me just try to see if I can find that by name. So just hold on just a moment for me, OK? Let me see if I can locate it right quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, [PII], I have a few questions for you that I need you to answer due to the HIPALO.
[CUSTOMER][NEUTRAL] Yep, yep.
[AGENT][NEUTRAL] Yeah, I need your I need your birth date and your address.
[CUSTOMER][NEUTRAL] Uh, [PII] and the address is [PII].
[AGENT][NEUTRAL] Alrighty, I, I have found your policy number. Now, do you want to write this policy number down because this is going to be the number that you need every time you call here to APL Cassandra.
[CUSTOMER][NEUTRAL] All right, go ahead. Yeah, that's fine.
[AGENT][NEUTRAL] Uh, it is gonna be 025.
[AGENT][NEUTRAL] 903.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] 89.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. We got it.
[AGENT][NEUTRAL] OK, OK, that's your policy number. OK, that's out of the way. Now, [PII], do you give me permission to speak with [PII]?
[CUSTOMER][POSITIVE] I do, yes.
[AGENT][NEUTRAL] OK, um, alright, uh, because you have to stay on this call as well, OK? I cannot just speak with him without you, OK? Just so you know that. OK, first off, you said you were calling to check status of a claim, is that correct? Something that you submitted.
[CUSTOMER][NEUTRAL] Yeah yeah
[AGENT][POSITIVE] OK, give me a good callback number as well. we're having bad weather here, just in case I lose you, I can call you back. Give me a good return telephone call number.
[CUSTOMER][NEUTRAL] Alright, [PII].
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alrighty, thank you so much for that. OK, let me do some checking. Let's see, how long ago did y'all send that claim in? Do you know?
[CUSTOMER][NEUTRAL] Yeah, I email I emailed it, uh.
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] OK. So [PII], that's been a whole, yeah, that's been a long time ago. OK, let's see.
[AGENT][NEUTRAL] You send it by email?
[AGENT][NEUTRAL] Oh wait, I don't, I don't see anything here keyed in yet, so let me go and see, pull up the file, so hang on just a second.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] OK, I spoke to [PII]. I spoke to [PII] at MBR customer service supervisor. They're the ones who gave me the claim forms to fill out, and she's the one who told me, um, I would receive an EOB by email in 30 days or such, and I haven't gotten anything, and then I called her back today saying what's going on, and she told me I have to call you people.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, because yeah, we don't do anything by email here. You, you're gonna get everything by your regular mail here.
[AGENT][NEUTRAL] So I, yeah.
[CUSTOMER][NEUTRAL] Now would that go out, that would go out to [PII], correct?
[AGENT][NEUTRAL] Yes, it will go to her home address. Everything we do here is in her name. It will go to her home address.
[AGENT][NEUTRAL] So first off, we don't have your claim in. Are there any way that you can uh do you have access to a computer that you can upload this onto our uh online website?
[AGENT][NEUTRAL] We do
[CUSTOMER][NEUTRAL] I'm sitting in front of my computer, yes.
[AGENT][NEUTRAL] OK, well, you can go and set up your account. It's called, uh, it's our OSC website and it's called [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Now one.
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] That is correct. Now once you create your account, you can pick the claim form that you need because you will need to submit a claim form with this, and what her product name is is Hospital indemnity. There's a specific claim form and you're going to see that word hospital indemnity in up under the form section.
[AGENT][NEUTRAL] You choose that and you complete it and upload your claim. Mhm.
[CUSTOMER][NEUTRAL] Why is it?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Why is the hospital indemnity? This is a doctor. This is a doctor visit.
[AGENT][NEUTRAL] It is that's just the name of the the of the product because they all have different claim forms. We have several different um areas, but hers is gonna be hospital indemnity. It doesn't have anything to do with the benefit. That's just what her product name is, OK?
[CUSTOMER][NEUTRAL] Oh, OK, so, so the claim form that I filled out that has APL on the top is the hospital indemnity form. That's what I sent in.
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Yeah, it probably is, but yeah, OK, then that's probably it, yes, sir, but we have not received it. If you send it by email, we have not gotten it.
[CUSTOMER][NEUTRAL] I have it in front of me.
[CUSTOMER][NEUTRAL] So why do you have an email then?
[AGENT][NEUTRAL] Uh, we don't normally accept, um, claims from emails. You can fax it or download it on our OSC or put it in the mail.
[AGENT][NEUTRAL] Those are the 3 ways you can get it here to APU.
[CUSTOMER][NEGATIVE] OK, so I wasted 6 weeks. Nobody told me this, OK.
[AGENT][NEUTRAL] Oh my.
[AGENT][NEUTRAL] Yeah, but the fastest way is gonna be to download it on on our OSC website.
[AGENT][POSITIVE] Of course that's the fastest way because we'll get it if you upload it to say today or tomorrow. We're gonna, it takes about 3 working days for it to show up in my system that we've received it, but that's your quickest way to get it here to APL.
[CUSTOMER][POSITIVE] OK, I wish I knew this. OK, I'll do this. I'll start the process all over again.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes, sir. Was there anything else that I can help you out with?
[CUSTOMER][POSITIVE] And that's it thank you so much.
[AGENT][POSITIVE] All righty. Well, you're so welcome and thanks for calling APO. You have a great rest of your day.
[CUSTOMER][POSITIVE] You too thanks bye bye.