AccountId: 011433970860
ContactId: 4e1d64e4-ea93-49aa-8007-3a9da228db2a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 4103350 ms
Total Talk Time (AGENT): 2009518 ms
Total Talk Time (CUSTOMER): 1653177 ms
Interruptions: 43
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/4e1d64e4-ea93-49aa-8007-3a9da228db2a_20250618T19:50_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] Hey, [PII], this is [PII]. And I've had some claims turned into APL and I'm on your website in my account and it's saying that there are no claims, and I know, um I'm just calling just to, just to make sure that they've been filed and all that good stuff.
[AGENT][NEUTRAL] OK, so you're the subscriber and you're trying to check for some claim statuses online, is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm, please.
[AGENT][POSITIVE] Yes, ma'am. Well, I can try.
[CUSTOMER][NEUTRAL] Yeah, and I'm trying to, I'm trying to do.
[AGENT][NEUTRAL] Uh-huh. Go ahead.
[CUSTOMER][NEUTRAL] And um and it just, it's not, it's saying um there's been no claims filed.
[AGENT][NEUTRAL] OK, yes, ma'am.
[CUSTOMER][NEUTRAL] And another there.
[CUSTOMER][NEUTRAL] I know there's at least 5 or 6, but maybe you could help me.
[AGENT][POSITIVE] Sure, and I'll be happy to help you. And so, um, who again am I speaking with?
[CUSTOMER][NEUTRAL] Um, [PII]. It looks like it's under [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. And Ms. [PII], um, what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And what is your policy number?
[CUSTOMER][NEUTRAL] Hmm, get out my pocketbook and I'll, I, I was ready to give you my date of birth and um hold on, let me grab that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I give that to you just.
[AGENT][NEUTRAL] Now, if it's easier, uh, [PII], I can look it up with your full social.
[AGENT][NEUTRAL] Just whichever is easiest.
[CUSTOMER][NEUTRAL] OK, um, [PII].
[AGENT][POSITIVE] Alright thank you one moment please.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] So first off, yes ma'am, um, I will need to, first off, verify all of your information with you for security purposes, and then also any information that I do provide for you, [PII] will be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] Sure. Sure.
[CUSTOMER][NEGATIVE] Gotcha.
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you provided for me, so that is the best number that we should have, is that correct? OK.
[CUSTOMER][NEUTRAL] The same as wine, right.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] And then lastly your email address and this does appear to be your work email that is on file.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][POSITIVE] OK, thank you very much. So, Miss, um, I'm gonna call you [PII], if that's OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It's, it's a double name, [PII]. I go by and I can tell from your accent, you know what a double name. I go by my first and middle name.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I do know what a double name is. Oh, OK. All right, but your last name is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] [PII], but I go by my first and middle name, [PII].
[AGENT][NEUTRAL] So Mayor [PII]. OK. All right. So first off,
[CUSTOMER][POSITIVE] Yeah, you said, even said it right.
[AGENT][NEUTRAL] So first off, I did want to make sure on the name, um, that [PII] wasn't a double last name, so that was my next question, but you already answered that.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yeah, it was, yeah, it was a a grandmother's maiden name.
[AGENT][POSITIVE] Oh, OK, nice.
[CUSTOMER][NEUTRAL] You know, you know, you know this, uh, uh, the southern names.
[AGENT][NEUTRAL] Yes, ma'am. I'm in
[AGENT][POSITIVE] Uh, I, I do because I am from [PII], so I definitely know what the double name is all about. Yes, most definitely.
[CUSTOMER][NEUTRAL] So you know.
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] So, OK, so first off, the
[AGENT][NEUTRAL] The dates of service, the policy number that is currently active for you, Ms. [PII], um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Just went into effect [PII] and we do not have any claims on file for you.
[AGENT][NEUTRAL] On that policy are the dates of service you're looking for?
[CUSTOMER][NEUTRAL] OK, what before, yes.
[AGENT][NEUTRAL] Before that, OK, so you should be able to see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] In your portal, are you logged in there now?
[CUSTOMER][NEUTRAL] I'm in, I'm in there and I'm under, I'm under the dashboard.
[AGENT][NEUTRAL] OK. So you should see different policy numbers. OK, so you should see different policy numbers on your profile.
[CUSTOMER][NEUTRAL] And um tell me where to go.
[CUSTOMER][NEUTRAL] OK, it's so in the dashboard it says favor up states and then it tells you who to contact and then it says members go to group. Do I do that?
[AGENT][NEUTRAL] Mm, OK, let me ask you one question. Are you the are you the group administrator for this group? for your employer? No.
[CUSTOMER][NEUTRAL] No, I'm the, I'm, no, I'm just, um, yeah, so that's why I'm thinking I'm, I'm in um.
[AGENT][NEUTRAL] OK, are you logged in? I'm not sure that you are, OK. So first off, let's make sure that we're signed in where you should be.
[CUSTOMER][NEUTRAL] As uh
[AGENT][NEGATIVE] Because this, you should not be able to see anybody else's information other than yours in the portal.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Right. And, and, yeah, and I'm thinking I have too much access right now, because it says go to group, and then it's, um, let's see, and then it says employees, and it has everybody's name and um
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Alright, so let
[AGENT][NEUTRAL] Yeah, you
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, so let me give me another second to look at something else. Hold on one second.
[CUSTOMER][NEUTRAL] And like
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So you can see all employees who work for Favor Upstate.
[CUSTOMER][NEUTRAL] Mhm. Now, let me see if I can click on them. Mhm.
[AGENT][NEUTRAL] You can see all of their names?
[CUSTOMER][NEUTRAL] If I go under group details invoicing employees and I can see.
[AGENT][NEGATIVE] Oh, you shouldn't, no.
[CUSTOMER][NEUTRAL] Mhm. And I can see their cell phones and then when I, and then I can click on them, but I can't see, you know, I can just see the type of coverage that they have. I can't, well, hold on. Yeah, I can, I, I, I, I have too much access.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so first off, you're, I don't know how you even um and did you set up your profile with your work email address?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] I said, I said, yeah, yeah, and I set it up through our administrator. She helped me set it up.
[AGENT][NEUTRAL] That's the problem. OK, so did she give you access do you help her with the billing and invoicing does.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm mm mm mm.
[AGENT][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] I mean I could say to her, I can say to her, look, I have too much access. Um,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I don't.
[CUSTOMER][NEUTRAL] And I can show it, uh, we're, we're at different, uh, we're at different offices, so I can show her tomorrow.
[AGENT][NEUTRAL] OK, so what I need to try to do is just even see.
[AGENT][NEUTRAL] How to
[AGENT][NEGATIVE] I if it's gonna even allow you to set up your own profile because, yes, ma'am, that is not.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I don't even know how you did that, really, to be honest with you. I'm just being honest with you, Ms. [PII], how that's.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh, I know, I know. Well she, she, it said, no, you have to go through this and so she sent me the link I clicked on the link and it just led me to here.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] Mm. OK.
[AGENT][NEUTRAL] Um, OK, so this may be way above anything that I can help you with, but we're, I'm gonna try. First off, we're gonna try.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] What I'll do is I can reach out to.
[AGENT][NEGATIVE] Well, she's not gonna be able to undo what's been done. She can't undo this.
[CUSTOMER][NEUTRAL] Yes, you can fix it, but
[CUSTOMER][NEUTRAL] Is it, well, let me ask you this, can you look and see um uh old claims so you can't.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I can, uh, well, I, I can look for that, but first off, we need to try to get this fixed for you to see, because otherwise, you're not gonna be able to access any of your information.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm mm, right, right, right.
[AGENT][NEUTRAL] OK. So, um,
[AGENT][NEUTRAL] OK, so sign out of that completely for the moment.
[CUSTOMER][NEUTRAL] OK, so I'll close out of it. Got it. So I'm out.
[AGENT][NEUTRAL] Uh-huh. OK. So let's go back to your very, OK, to the, just pull up another tab and go type in secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hold on, I'm gonna, I'm gonna, um, I'm gonna call, I'm gonna put you on is it's OK, I'll put you on speakerphone. OK, all right, so you said, OK, all right, go ahead, secure.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] With a D on it secured.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] SE OK, sure. [PII].
[AGENT][NEUTRAL] Public. Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] Alright, so when that screen pulls up, you should see where it says create an OSC account.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It says welcome to the online service center. The online service center size 24 and it says create OK it says create your OC account, OK.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEGATIVE] Right, come on.
[AGENT][NEUTRAL] Click there
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Then on the next screen, you're gonna select insured.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] And click next.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] OK, on this screen, OK, so on this screen, there's 5 different boxes, but you're only gonna fill in the box with the last name, the email, and the date of birth because that is the, those 3 should have asterisks beside them red asterisks.
[CUSTOMER][NEUTRAL] And put do it in.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, and uh date of birth. OK, I'm with you [PII] and [PII].
[AGENT][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] 1.
[CUSTOMER][NEUTRAL] OK oops.
[CUSTOMER][NEUTRAL] OK, next.
[CUSTOMER][NEUTRAL] Error we could not create your account with this information. Reach out to the insured. OK, hold on, let me see. I might not have done. OK, last name.
[AGENT][NEUTRAL] Uh-huh. [PII].
[CUSTOMER][NEUTRAL] Email.
[AGENT][NEUTRAL] And that's gonna be your work email.
[CUSTOMER][NEUTRAL] [PII] and date of birth.
[CUSTOMER][NEUTRAL] Mhm. The hair's favorite [PII] and then when I hit next I put [PII]. Then when I hit next it comes up with an error that says we could not create a new account with this information reach out to the insured admin.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Or contact customer service at [PII].
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And you're using the [PII], is that correct? OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so when you created the other profile that you said the your group administrator helped you with.
[CUSTOMER][NEUTRAL] Uh-huh. She just sent me a, she just, she just sent me a link.
[AGENT][NEUTRAL] After
[CUSTOMER][NEUTRAL] And um and and gave me authorization and I just logged in that way.
[AGENT][NEUTRAL] OK, so you didn't you didn't set anything up you just.
[CUSTOMER][NEUTRAL] Mhm clicked.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, I don't know which.
[CUSTOMER][NEUTRAL] She sent me an email.
[AGENT][NEUTRAL] So it sounds like she gave you access on an admin level which.
[AGENT][NEUTRAL] OK, let me, let me just try something.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Yeah she doesn't need to do that for all employees. That's not what she needs to do, um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, give me, give me a second. Just let, I'm gonna try to test something here.
[AGENT][NEUTRAL] So like you didn't click set up a profile create an OSC account or make a selection from that second screen that you went to that had like agency.
[AGENT][NEUTRAL] Agent or broker group and insured. You didn't do any of that, correct? OK.
[CUSTOMER][POSITIVE] Yeah, no, I didn't mess with it. Yeah, I didn't mess with, mm mm.
[AGENT][NEUTRAL] [PII] is your date of birth, correct?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm old.
[AGENT][NEGATIVE] No, you're not.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, I'm not, I'm not I'm not sure even OK, which browser are you using, Ms. [PII]?
[CUSTOMER][NEUTRAL] Mm, I'm using, hold on, I'll get, um, is it OK if I get out of all this, uh, and on Google.
[AGENT][NEUTRAL] Uh yes, ma'am.
[AGENT][NEUTRAL] Mhm. You're on Chrome? OK.
[CUSTOMER][NEUTRAL] Google Chrome.
[CUSTOMER][NEUTRAL] Mhm. Do you want me to do Microsoft Edge?
[AGENT][NEUTRAL] No, no, no, no, Chrome is the preferred, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I just need to make sure that I know exactly what happened, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Isn't that weird?
[AGENT][NEUTRAL] So you
[AGENT][NEUTRAL] So you reached out to the group administrator, correct?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm. [PII] and she sent me an email that said here do this.
[AGENT][NEUTRAL] And what did
[CUSTOMER][NEUTRAL] I click here and I click there.
[AGENT][NEUTRAL] OK. Yeah, I was gonna say, I am gonna have to, um, I'm gonna have to get some pretty detailed information from you, Miss [PII] um.
[CUSTOMER][NEUTRAL] Let's see, let me get back to that.
[AGENT][NEUTRAL] Ms. [PII], let's see if we can.
[CUSTOMER][NEUTRAL] Let's see, it says.
[CUSTOMER][NEUTRAL] It said.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Welcome to APL's online service center. Favor Upstate has added you as oh, favoritestate has added you as an authorized user under this account. Please follow the instructions to complete your account set up.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] C
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct. OK.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Should I email her and say you've you've given me, OK, let me.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, you'll need to, you need to email her. She's going to have to
[CUSTOMER][NEUTRAL] And I'll say, OK, I'm gonna.
[CUSTOMER][NEUTRAL] Hold on, you wait, let, let me do this. OK, so uh should I copy you? Can I copy you?
[AGENT][NEUTRAL] I actually you need to copy the um I'm gonna give you the email to copy in this email because you're gonna need to explain what happened.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so we can see what needs to be done.
[AGENT][NEUTRAL] To get your access granted back to for your personal account.
[CUSTOMER][NEUTRAL] OK, so, all right, so tell me who to copy.
[AGENT][NEUTRAL] OK, so send it to [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. So [PII].
[CUSTOMER][NEUTRAL] Mhm, got it. OK, I'm gonna send.
[AGENT][NEUTRAL] Now what I need for you to also do.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I I need for you to.
[CUSTOMER][NEUTRAL] I'm gonna say I'm on the phone with the.
[CUSTOMER][NEUTRAL] But I'm, I, I'm gonna say this first. I am on the phone with the APL folks, um, you gave me access.
[AGENT][NEUTRAL] To the entire group. OK.
[CUSTOMER][NEUTRAL] To see every.
[CUSTOMER][NEUTRAL] The, the entire group.
[CUSTOMER][NEUTRAL] Of all insured.
[CUSTOMER][NEGATIVE] I am unable to log into my own personal.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Account but can see all employees.
[CUSTOMER][NEUTRAL] And I'll just, I'll just um I'll just highlight the part where it said.
[CUSTOMER][NEUTRAL] Um, added you as an authorized user.
[CUSTOMER][NEUTRAL] I'll, I'll highlight that. I'll just say you added me as.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] As and and then I'll read it to you again as an authorized user. I'm unable to, so as you said AM on the phone with APL you gave me access to see the entire group of all insured as an authorized user. I'm unable to log into my own personal account but can see all employees the and then I will say the person assisting me.
[AGENT][NEUTRAL] Yeah, that's fine.
[AGENT][NEUTRAL] Yes, ma'am. Mhm.
[CUSTOMER][NEUTRAL] Ask me to ask you.
[CUSTOMER][NEUTRAL] To see if you can resend me.
[AGENT][NEUTRAL] Yes, she needs to deactivate your uh huh, as a user unless she's wanting you to have access to all of that. That's why I was asking you earlier because she doesn't need to assign right she doesn't need to do that for every employee because the way she did it for you unless she's wanting them to have access to the group invoicing and.
[CUSTOMER][NEUTRAL] A log in
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh uh uh uh uh um.
[CUSTOMER][NEUTRAL] As a
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All employees' information.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, um,
[CUSTOMER][NEGATIVE] Not, not, um, and delete.
[CUSTOMER][NEUTRAL] My account as a OK, here's what I said the person assisting me asked me to ask you to see if you can resend me a log in and delete my account as a supervisor.
[AGENT][NEUTRAL] Or as an, as an authorized, yeah, I mean, that access is on a
[CUSTOMER][NEUTRAL] How's that sound?
[CUSTOMER][NEUTRAL] As an authorized
[CUSTOMER][POSITIVE] Authorized user OK awesome.
[AGENT][NEUTRAL] These are for the group for the entire group.
[CUSTOMER][NEUTRAL] Authorized
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] User slay.
[CUSTOMER][NEUTRAL] She'll know she'll know how to do. OK, I'll read it to you one more time on the phone with APL, you gave me access to see the entire group of all insured as an authorized user.
[CUSTOMER][NEUTRAL] And I'll highlight that.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And I'll just say see below.
[CUSTOMER][NEUTRAL] Hello, I'm gonna able to log into my own personal account that can see all employees. Per assisting me asked me to ask you to see if you can resend me a log in and delete my account as an authorized user.
[AGENT][NEUTRAL] Well, she, she, yeah, she can't resend a login to you. That is out of her purvey to be able to do that, except to give you the same.
[CUSTOMER][NEUTRAL] Well, how am I, how am I?
[AGENT][NEUTRAL] I'm not sure how we're gonna get around that. I've got, that's what we've got to figure out. I just,
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEGATIVE] Yeah, she can't, she can't create your login.
[AGENT][NEUTRAL] She can only do what she did on a group level.
[AGENT][NEUTRAL] So if she were to try to do that for every employee, that's gonna give every employee that she does that for the same access that you have at this moment.
[CUSTOMER][NEUTRAL] OK, I'll say the care team will.
[AGENT][NEUTRAL] Does that make sense? OK, but I, before you send that.
[CUSTOMER][NEUTRAL] Mhm. I said the education will have to.
[AGENT][NEUTRAL] Yeah, before you do that though, I need for you to try this, is there a way that you can screenshot the error message that you got when you were trying to set up your personal account with me where it said that about your um.
[AGENT][NEUTRAL] Gave you that error we could create a new account with this information.
[CUSTOMER][NEUTRAL] Um, oh yeah, let, let's see. Oh, I might have, um, oh dang it, I deleted out of it, but I can, I can go do it again.
[AGENT][NEUTRAL] Yeah, if you could, if you could walk through those steps until you get to that screen and before you send that email to the care team, let me, um, because this is the first time that this has happened, so do you mind letting me place you on a brief hold for just a minute.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Yeah, give me, uh, give me the, um, give me that thing that you, uh, that I'm, that I will give me the, the, the thing I'm supposed to put in the Google real quick, mhm, just the first couple of letters.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The website
[AGENT][POSITIVE] Secured.
[AGENT][POSITIVE] Yes, ma'am, secured.
[CUSTOMER][POSITIVE] OK, got it I got it.
[AGENT][NEUTRAL] [PII]. OK, so I'll be right back with you, OK? Thank you, Ms. [PII]. OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, sure, take your time and I'll take a picture of this. Thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Girl, I'm sorry. Put yourself on a team's call for a second.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Because I've got OK.
[AGENT][NEGATIVE] This is a mess and I don't know what to do with this one.
[AGENT][NEUTRAL] Oh God, I hadn't had one like this. So, a group administrator.
[AGENT][NEUTRAL] Gave access.
[AGENT][NEUTRAL] To an insured.
[AGENT][NEUTRAL] But at the group level.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] She was like doing all the leg work for.
[AGENT][NEUTRAL] So,
[AGENT][NEGATIVE] Which she should not have access to the group level, this, this caller I have on the phone. Well, now, so she called because she.
[AGENT][NEUTRAL] Can't see her information her claims information that she was looking for so that's how we discovered what the admin has done.
[AGENT][NEUTRAL] And I was like oh god, she doesn't and I told this lady this I said the admin doesn't need to grant all employees access like she did with you and just send them an email with a verification code because they're gonna have the same access that you have right now which is to you know the billing and everything, OK so.
[AGENT][NEUTRAL] Let me share a screen. Let me share this with you for a second because I was in the process of sending you a message, but then I decided I would back out. So I tried to set up the lady's profile, and this is the error message and the information is right she's on Chrome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] But her email, her work email is what is on file.
[AGENT][NEUTRAL] And that is the one that the admin used and gave her access so she can't set up her profile again because that's what it's saying.
[AGENT][NEUTRAL] So do I need to see if she wants to put her work or her personal email on file and see if we can set it up that way and then I've already told her she needs to tell the admin to resend I mean to.
[AGENT][NEUTRAL] Like deactivate that and not to.
[AGENT][NEUTRAL] Do that for any other employees that she doesn't want to have access and I'm probably gonna call that admin myself.
[AGENT][NEUTRAL] I'm gonna call that I'm gonna call them.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] So, OK, so.
[AGENT][NEUTRAL] Yeah, well, I could change her email that's on file with [PII] if she wants to do that to her say right now it's got her work email.
[AGENT][NEUTRAL] See, so if I change it to our personal, then we'll try to do it like that, um, and see if we get that, but.
[AGENT][NEUTRAL] That's the same, uh, that's what I wanted to verify to her before I went to that sheet is that
[AGENT][NEUTRAL] I
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Oh, OK, wow.
[AGENT][NEUTRAL] Well, I didn't see that even when I looked back at whatever, I didn't see an email because I didn't know we're getting emails anymore. It was all going into the
[AGENT][NEUTRAL] Anyway, it doesn't matter. I'm trying to help this like that up, OK, so yeah, I did not see that though if, if you happen to locate that or know where that is and could forward it to me or that would be amazing because yeah, I didn't know that.
[AGENT][NEUTRAL] Yeah, yeah, that's fine.
[AGENT][NEUTRAL] That's fine.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. OK.
[AGENT][POSITIVE] Yeah, let me try that then, [PII]. Thank you. I'm glad I called you instead of just messaging you. So, and then I will reach out to that admin. OK, girl. All right, bye.
[AGENT][NEUTRAL] OK, Ms. [PII]. So let me, um, thank you very much. So what we need to do.
[CUSTOMER][NEUTRAL] Yes, I am.
[AGENT][NEUTRAL] Temporarily, um, would you, we need to change, let's update your, do you have a personal email address?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well I, I, I do, but I don't ever use it. Should I just, hey, should I go ahead and send, uh, let me ask you this.
[AGENT][NEUTRAL] OK. Well, you got, OK.
[AGENT][NEGATIVE] Well, you're not.
[AGENT][NEUTRAL] Uh, no, don't send that yet, but, yeah, can you hear me?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] You there?
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, yeah. I, I was just going to tell you what I've written so far, um, and I, I copied down the air.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Well, don't
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] Um, that I got and I just said I'm, I just don't want her to send out, start sending this out and create a bigger problem.
[AGENT][NEUTRAL] Right. Don't, you don't necessarily need to copy the care team is what I was just, for the moment because we're gonna try to,
[CUSTOMER][NEUTRAL] Um, I said Amazon.
[CUSTOMER][NEUTRAL] Oh, OK, so I'll take that off, take that off.
[AGENT][NEUTRAL] Yeah, take that all for the moment and we're gonna see if we can.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Change your email to your personal email.
[AGENT][NEUTRAL] Because what she has done, we can't undo that in the new portal if an email is assigned to one area that's.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's the only one profile that can be set up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, we will have to change it to your personal email.
[AGENT][NEUTRAL] And see if we can set it up that way.
[CUSTOMER][NEUTRAL] OK with not.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then she
[CUSTOMER][NEUTRAL] I'm gonna I'm just gonna tell her what we're doing.
[AGENT][NEUTRAL] Yeah, and then she just needs to remove your access.
[CUSTOMER][NEGATIVE] OK, I'm gonna say I'm on the phone. You gave me access to see the entire group as an authorized user. I'm unable to log into my own personal account. The person assisting me asked me to ask you to see if you can delete my account as an authorized user slash supervisor. The care team here is helping me figure out how to get an account to access. They can't do it through my work email address, so they are you are trying to do it.
[CUSTOMER][NEUTRAL] With my.
[CUSTOMER][NEUTRAL] With my personal email.
[CUSTOMER][NEUTRAL] How's that?
[AGENT][NEUTRAL] Right. OK. Don't hit send yet. Oh, you can, and I was gonna actually, if she's available to try and call her myself so that she doesn't um want you and if you and I are able to set up your profile and just explain to her that.
[CUSTOMER][NEUTRAL] So I'm gonna go ahead and send her this so so she doesn't do it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, I'm gonna say she, she said if you are available, please you are available please call her. How's that?
[AGENT][NEGATIVE] That I will call her, yes, or she doesn't need to call me because she won't be able to reach me directly.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I would, I would need to call her.
[CUSTOMER][NEUTRAL] Um, and I'll give you her number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, tell me, I'm sorry, tell me your name again.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] is going to call you either today or tomorrow.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, what time, because you're an hour ahead, say it's [PII] where I am. So you're at [PII]. If she's available, I can, yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII] and she
[CUSTOMER][NEUTRAL] And I'll just um do you, can I copy you in this email or no?
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It doesn't matter I'll just.
[AGENT][NEUTRAL] Well, the only reason I'm saying uh there's some hesitation there is because
[AGENT][NEUTRAL] I don't get an opportunity to look at the emails like because of my, just my job description and being on the phone and helping callers when they call in, it's, it's routed to a different place, but you can let her know. I don't know what time she leaves today, but as soon as you and I are done, if we're able to set your profile up and look at your stuff, then I will call her today before I leave, because I leave at [PII] my time, which is [PII] your time.
[CUSTOMER][POSITIVE] Got you, got you, got you. Don't worry about it, uh.
[CUSTOMER][NEUTRAL] Uh, OK.
[AGENT][NEUTRAL] She just, just ask her to please, right. Yeah, just ask her to please not um provide other employees the same type of access that she gave you.
[CUSTOMER][NEUTRAL] She gets off the phone with me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] She said to not give the same access.
[CUSTOMER][NEUTRAL] To others.
[AGENT][NEGATIVE] That she does not want to have, yeah, that she does not want to have access to the entire group's information.
[CUSTOMER][POSITIVE] And I'm gonna say hope this makes sense.
[CUSTOMER][NEGATIVE] Yeah, she, yeah, I, uh, OK, here's what I said. I'm on the phone. You gave me access. I'm unable to log in. the person assisting me asked me to ask you if you can delete my account as an authorized user supervisor to, um, and I'm gonna say.
[AGENT][NEUTRAL] How are you wanna word it.
[CUSTOMER][POSITIVE] She is figuring out how to get me an account, she is figuring out.
[CUSTOMER][NEGATIVE] [PII] is trying to get figure out how to get me account. She can't do it through my work email and she's trying to personal email. [PII] is gonna call you when she gets off the phone with me. She said not to give the same access to others had this makes sense.
[CUSTOMER][NEUTRAL] I was like, OK, I'm gonna send it right now. Just, just that she hadn't start giving anybody ask it. She's gonna be like, what?
[AGENT][NEGATIVE] She's yelling at me like, what?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Yeah, I don't want her to.
[CUSTOMER][NEUTRAL] She's gonna be like
[CUSTOMER][POSITIVE] OK, I just sent it. I just sent it. OK, it's gone right now, now, um, now you, you work your magic.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] So let's change your email. OK, so we need to change your email to your personal. So what is your personal email?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um [PII], it's my last name, [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's my name in reverse [PII] [PII] and then my initials [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] Yeah, with an uh and you said [PII]
[AGENT][NEUTRAL] Is that correct?
[AGENT][NEUTRAL] Correct. Is that not right? Yes, that is what I said, [PII].
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] [PII] [PII] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] OK, so now let's go back to that website, the [PII].
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][POSITIVE] And we're gonna try this again.
[AGENT][NEUTRAL] I'm gonna select create.
[CUSTOMER][NEUTRAL] And it's gonna work, create your own account.
[AGENT][NEUTRAL] Uh-huh, create the account then you're gonna select correct.
[CUSTOMER][NEUTRAL] Go insured.
[CUSTOMER][NEUTRAL] Alright next, last name.
[AGENT][NEUTRAL] Uh-huh, and then.
[AGENT][NEUTRAL] And then your personal email.
[AGENT][NEUTRAL] And your date of birth?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] [PII], next.
[CUSTOMER][NEUTRAL] OK, complete your account set up.
[AGENT][NEUTRAL] OK. Here we go. So there, there we go.
[CUSTOMER][NEUTRAL] Yes, he
[CUSTOMER][NEUTRAL] OK, so I go, oh, now it's gonna send my verification code so I can look it up on my phone. OK, so I say send verification.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Yeah, it's
[CUSTOMER][NEUTRAL] Let me, I've got you on, let me go look in my.
[CUSTOMER][NEUTRAL] Email to what would we do without um do without our phones?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] You know,
[AGENT][MIXED] Oh, I think, yeah, it's questionable these days. Some days I would love to be without my phone.
[CUSTOMER][NEUTRAL] I know, and I mean,
[AGENT][POSITIVE] On most days, I would love to not be so dependent.
[CUSTOMER][NEUTRAL] Years ago, years ago we didn't even have a.
[AGENT][NEUTRAL] No, we didn't.
[CUSTOMER][NEUTRAL] OK, I still hadn't gotten the.
[CUSTOMER][NEUTRAL] Haven't gotten the code yet.
[AGENT][NEUTRAL] It may take it, so don't, yeah, just wait cause it can take a.
[CUSTOMER][NEUTRAL] Oh he, oh, let's see.
[CUSTOMER][NEUTRAL] No that, no.
[AGENT][NEUTRAL] It can take a minute to get that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's not my senior perks.
[AGENT][NEUTRAL] No, and it should, it, yeah, give it, sometimes it takes a few minutes and if you like,
[AGENT][POSITIVE] Try to tell it to send you another one too. It gets it bogged down even further and will time out on you. So we'll just be patient and give it a, a few minutes.
[CUSTOMER][NEUTRAL] It, yeah.
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] And while we're waiting on that to come through, um, I'm going to also I'm gonna email you a couple of user guides. One of them is talking about setting it up, setting up the profile and then the other one is more about using it, how to use the portal.
[CUSTOMER][NEUTRAL] Oh, I got it.
[AGENT][NEUTRAL] You got your code.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's the code. Mhm.
[AGENT][NEUTRAL] OK. So you're gonna
[CUSTOMER][NEUTRAL] Well if it would ever come up.
[CUSTOMER][POSITIVE] It's just all it's doing is, is doing some good turning.
[AGENT][NEUTRAL] Yeah, it's thinking.
[AGENT][NEUTRAL] Like I said, it's gonna take a minute.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It's just loading, loading loading.
[CUSTOMER][NEUTRAL] And you don't need it. I mean, it, uh, um.
[CUSTOMER][NEUTRAL] You don't need to send me that other stuff on on how to set up. I could I could probably figure it out.
[AGENT][NEUTRAL] Well, it's no, it's no problem. I have it pulled up. I was just about to hit the send button just for reference, and this would be, like I said, this is creating ones on creating and logging into.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it has information like for different whether it was an insured a provider or almost create creating part and then on the using that is specifically for insured, so that's like about uploading documents and and that type of thing. So I'll send it to you. It's gonna come from [PII] at [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and you'll, you should get that in just a minute or two as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, here we go.
[CUSTOMER][NEUTRAL] 143 084
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 14.
[CUSTOMER][NEUTRAL] 3084 and then I hit verify code.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then it says um.
[CUSTOMER][NEUTRAL] It gives me the option to change my email.
[AGENT][NEGATIVE] No, so you're not gonna, you're not gonna do that.
[CUSTOMER][NEUTRAL] Um, OK, your email is verified. You can now continue, so I put in a new password.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then it's gonna send you another, right, it will send you another verification code to your email and a few more steps as well so that's essentially like a two factor or multi-factor authentication.
[CUSTOMER][NEUTRAL] It's by name.
[CUSTOMER][NEUTRAL] The surname is your last name, correct?
[AGENT][POSITIVE] Correct, yes, and you did, yes, you can put that there. Mhm.
[CUSTOMER][NEUTRAL] OK, it says please wait. OK. OK. I agree, I agree.
[CUSTOMER][NEUTRAL] Continue.
[CUSTOMER][NEUTRAL] OK, so, so it says go to your dashboard now it's gonna make me log in again, correct? So welcome to the online service log in.
[AGENT][POSITIVE] Mhm. Correct.
[AGENT][NEUTRAL] And then it should send you another code.
[CUSTOMER][NEUTRAL] And then and then it's gonna ask me it asked me for a verification code again.
[AGENT][NEUTRAL] Mhm. Right. So give that a second to come to you.
[CUSTOMER][POSITIVE] But I think this is, I think this one's gonna work.
[AGENT][NEUTRAL] Yeah, oh yeah.
[CUSTOMER][NEUTRAL] And then how do once I uh once I get in how it will will it let me access previous years um.
[AGENT][NEUTRAL] Yes, now it's, it will go back 24 months online. It's gonna be as far back as that will go. So if there's something that you ever need that would, you know, to be, because you've had a policy since [PII] with APL.
[CUSTOMER][NEUTRAL] Information
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Multiple, I mean, like there's been, you know, like slight policy changes or some things, so you were issued new policy numbers, but I can see that, you know, you've had consecutive coverage with no gap in it since [PII], so you wouldn't be able to see them that far back.
[CUSTOMER][NEUTRAL] Can you tell me
[CUSTOMER][NEUTRAL] That's OK. I'm just, just, uh, all I'm worried about is from December and January. Does it show anything being paid in December and January?
[AGENT][NEUTRAL] OK, so December of 24 in January of 25. Is that what we're looking for? So I need to pull up that policy. OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Cause I think
[CUSTOMER][NEUTRAL] Yeah, I think um what I'm this was the whole reason I was still waiting on my.
[CUSTOMER][NEUTRAL] Um, and I'm not go ahead send you code.
[AGENT][NEGATIVE] Yeah, no, don't do that. Yeah, cause that'll that'll cause it to really hang up on you.
[AGENT][NEUTRAL] OK, so, and again, any information, Ms. [PII] on the claims will be a verification of benefits and not a guarantee of payment. So what is one of the data services um that you would like for me to specifically look for?
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Um, there was an anesthesiology, um, bill, and then there was a bill for Bon Seco Saint Francis.
[AGENT][NEUTRAL] Yeah, but for what?
[AGENT][NEUTRAL] Yeah, but what's the data service that you?
[CUSTOMER][NEUTRAL] Oh gosh, um.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, it, it, you know what, I don't have the dates in front of me. I'm so sorry, um.
[AGENT][NEUTRAL] Yes, see, I won't be able to.
[CUSTOMER][NEUTRAL] OK, well I'm almost in I've got the number 90.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 64.
[CUSTOMER][NEUTRAL] 52 OK verify code.
[CUSTOMER][NEUTRAL] OK, I'm in. Welcome.
[AGENT][POSITIVE] Great, OK.
[CUSTOMER][NEUTRAL] Yeah, and let's see, let's see if this oh now this says my policy, so this one's different.
[AGENT][NEUTRAL] say yes. That one's different.
[CUSTOMER][NEUTRAL] OK, it says and then it says hello you can receive claim status updates enter your phone number. OK, let me enter my phone number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, just like in the um other portal once we process a claim, you should receive a text alert letting you know that you may not instantly be able to see the status of it in the portal, Ms. [PII], because um.
[CUSTOMER][NEGATIVE] Gotcha.
[AGENT][NEUTRAL] It has to go through overnight processing for you to be able to see the explanation of benefits, but you would still get that text alert.
[CUSTOMER][NEGATIVE] Gotcha.
[AGENT][NEUTRAL] Before you could use the.
[CUSTOMER][NEUTRAL] Got you. OK, now I'm at that now I'm at a different it said would you like to review coverage details or?
[AGENT][NEUTRAL] EOB.
[AGENT][NEUTRAL] And that's where you can go and look at your policy information. Mhm.
[CUSTOMER][NEUTRAL] Do you need access
[CUSTOMER][NEUTRAL] OK, the policy details.
[AGENT][NEUTRAL] Um, you should also see a button for ID cards.
[CUSTOMER][NEUTRAL] And then how to.
[CUSTOMER][NEUTRAL] And then where do I go to look at old claims.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] This is OK got you OK good it it will tell me it'll just say claim number but it won't necessarily tell me who it says paid.
[AGENT][NEUTRAL] Right, so that's what I was saying.
[CUSTOMER][NEUTRAL] Oh this is way back when.
[AGENT][NEUTRAL] Uh, so that's what I was saying about the date, like when you had your procedure or whatever, you know, then I can search it and be able to tell you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What we've received for a specific data service.
[CUSTOMER][NEGATIVE] Gotcha.
[CUSTOMER][NEUTRAL] So, 00, OK, I'm with you. So now I see it. OK, and I'm um in.
[AGENT][NEUTRAL] Cause you might have, you know, for example, if you were admitted to the hospital on today, you know, and we might have several claims for you from different providers since, you know how everybody bills separately. You might have a hospital, you might have the radiology or anesthesiology, but I just need to know what date I'm looking for to
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Otherwise
[AGENT][NEUTRAL] We would just have to click on, I will have to.
[CUSTOMER][NEUTRAL] Got you. Oh, so this is, and, and this is what I was looking for [PII].
[CUSTOMER][NEUTRAL] There was a claim for 1,128 and that's what they paid and that's that's actually the one I was looking for so.
[CUSTOMER][POSITIVE] Thank you. You've it's answered my question. Well, the bill is, the bill is for 1,124.80, and they paid 1,128.91.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Does that
[CUSTOMER][NEUTRAL] How do I find out who, who it was?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] So you should be able to click on that claim number.
[CUSTOMER][NEUTRAL] It's the
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that claim number
[CUSTOMER][NEGATIVE] It's still churning.
[CUSTOMER][NEUTRAL] It won't let me it won't let me click on the claim number.
[AGENT][NEUTRAL] OK. Now, that may.
[CUSTOMER][NEUTRAL] But maybe it's because it's still turning.
[AGENT][NEUTRAL] Oh, it is, if it's still thinking. But that was for Saint Francis Hospital.
[AGENT][NEUTRAL] And that was for
[CUSTOMER][NEUTRAL] This is, uh, no, it's just.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It this is Palmetto anesthesiologist I've, I've got the bill in front of me. It says Palmetto Anesthesia Associates of Greenville.
[CUSTOMER][NEUTRAL] And um,
[AGENT][NEUTRAL] OK, so the claim.
[CUSTOMER][NEUTRAL] It has the bills say, let's see.
[CUSTOMER][NEUTRAL] It's for 124.
[CUSTOMER][NEUTRAL] [PII] and um.
[AGENT][NEUTRAL] And what's the total bill? 124 for what the bill?
[CUSTOMER][NEUTRAL] And it's yeah.
[CUSTOMER][NEUTRAL] The total deal is.
[CUSTOMER][NEUTRAL] $1,124.80.
[AGENT][NEUTRAL] OK, just a moment.
[AGENT][NEUTRAL] So I don't.
[AGENT][NEUTRAL] The claim that we, we have a claim on file.
[AGENT][NEUTRAL] For that data service from Palmetto, let's, well, one second, we have multiple um.
[AGENT][NEUTRAL] So there is a claim on file for you from Palmetto Anesthesia Associates for Data Service 124. Now the billed amount, the total billed amount on that claim was $5,695.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What we, what we received. Now this claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Was denied.
[AGENT][NEUTRAL] And the reason for the denial stated that, well, all benefits were applied to the policy deductible.
[AGENT][NEUTRAL] So on here because this particular plan.
[AGENT][NEUTRAL] Ms [PII], the outpatient benefit had a, a deductible that you had to meet first.
[AGENT][NEUTRAL] So let me
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So all of the benefits were applied to that.
[CUSTOMER][NEUTRAL] OK, all the $5,695.
[AGENT][NEUTRAL] No, not all of that. No. See, this policy only helps you with your co-pays, deductibles, and co-insurance amounts. So on this particular claim, um, $269.56.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Was applied
[AGENT][NEUTRAL] Let me go to a different screen, make it a little easier. One second.
[AGENT][NEUTRAL] So there were 3 different
[CUSTOMER][NEUTRAL] Yeah I'm wondering if this is.
[AGENT][NEUTRAL] There were 3 different line items on this claim.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, one of the line items was $774.27.
[CUSTOMER][NEUTRAL] Gotcha, yup.
[AGENT][NEUTRAL] That went to your deductibles. The next line item was $80.97.
[AGENT][NEUTRAL] That was also applied to your deductible and then $774.27 was applied to your deductible on this policy.
[CUSTOMER][NEUTRAL] OK, I'm so sorry, say it again 774.
[AGENT][NEUTRAL] 27.
[CUSTOMER][NEUTRAL] Was applied.
[CUSTOMER][NEUTRAL] 027 and then what was the other?
[CUSTOMER][NEUTRAL] It was applied.
[AGENT][NEUTRAL] $80.97 and $774.27.
[CUSTOMER][NEGATIVE] Gotcha.
[AGENT][NEUTRAL] So that's a total of 112,480.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All went to your calend your deductible on this policy.
[CUSTOMER][POSITIVE] Gotcha. Got you, got you, got you.
[AGENT][NEUTRAL] And that claim number in the system.
[CUSTOMER][NEUTRAL] OK, so that total.
[AGENT][NEUTRAL] Um, for that claim is 355.
[AGENT][NEUTRAL] 0226.
[CUSTOMER][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] And the weird thing about it is I thought I had already made the deductible by this point, but what I could do is I could call, I could get in touch with my insurance agent.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Because
[AGENT][NEUTRAL] OK. So let, OK.
[CUSTOMER][NEUTRAL] Does that make sense?
[AGENT][NEUTRAL] I'm looking to see what the deductible had been. So on here.
[AGENT][NEUTRAL] On this policy, you had a $1500.
[AGENT][NEUTRAL] Outpatient deductibles to be met.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] On your supplemental coverage.
[CUSTOMER][NEGATIVE] Gotcha.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] That figure that I just gave you on this claim did go towards that.
[AGENT][NEUTRAL] Deductible.
[CUSTOMER][NEUTRAL] And, and, and, and I have it in my records that I had already paid $1500 before that's what the my insurance agent had we figured out that we'd already that I'd already made the deductible, so I'll, I'll just call him.
[AGENT][NEUTRAL] Are you talking about on this policy or your primary healthcare insurance?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, the way I understand it is if I make a $1500 total deductible.
[CUSTOMER][NEUTRAL] Then it gets paid and um.
[AGENT][NEGATIVE] And we did not receive, yeah, we've received claims.
[CUSTOMER][NEUTRAL] And so we have worked.
[AGENT][NEUTRAL] Since that point.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] That they came back and provided this information for.
[AGENT][NEUTRAL] So, let me make sure this deductible was satisfied. It looks like it was.
[CUSTOMER][NEUTRAL] But how do you keep all this stuff straight?
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So you did meet your deductible on this policy, but it wasn't just with one claim.
[AGENT][NEUTRAL] You had, you know, multiple claims. So like on this one, like we just said.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Oh, I see it's a minute.
[AGENT][NEUTRAL] 11 moment
[AGENT][NEUTRAL] OK, so the deductible had been satisfied on that policy, but we were still processing and we have still been processing claims on this right up until, I mean, there's one that's going through nightly processing tonight as a matter of fact.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To Saint Francis Hospital because some of the ones that were submitted by your providers, Ms. [PII], we were missing information. Either an explanation of like one of them filed a claim with us that we got in January, the initial claim for Bond Secures Medical, for Bond Secures Medical Group. OK, but they didn't send us your primary insurance explanation of benefits. Um.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] Gotcha.
[CUSTOMER][NEUTRAL] Oh Lord have [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh Lord have [PII].
[AGENT][NEUTRAL] And there was, you know, I mean, we've received several, but some of them, which you should be able to see these remarks.
[CUSTOMER][NEUTRAL] So should I just sort of wait till the dust settles in your opinion?
[AGENT][NEUTRAL] Well, I don't know what dates of service, you know what I mean? I don't know what dates of service we're missing information for or that you're questioning if you can.
[CUSTOMER][NEUTRAL] Well what do you think I should do?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Gotcha.
[AGENT][NEUTRAL] You know, get the date, for example, we have paid Saint Francis Hospital recently.
[AGENT][NEUTRAL] We processed the claim for them um um it was received [PII], OK, from the facility.
[AGENT][NEUTRAL] Saint Francis submitted a claim. We processed it on [PII], but it was for date of service [PII].
[AGENT][NEUTRAL] We just got that claim and we did pay them a benefit of $1,128.91.
[CUSTOMER][NEGATIVE] Gotcha.
[CUSTOMER][NEUTRAL] And how much was
[CUSTOMER][NEUTRAL] How much was that
[AGENT][NEUTRAL] And that was on claim number 360.
[AGENT][NEUTRAL] 9356.
[CUSTOMER][NEUTRAL] Gotcha. OK.
[CUSTOMER][NEUTRAL] Oh yeah that's the one I'm looking at that's so that is not the one I'm asking about so.
[CUSTOMER][NEUTRAL] In my opinion, so you don't, so you do have this one, this one that I'm talking about, the, the one from 124.
[AGENT][NEUTRAL] And we
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] But you're saying I had not met the $1500 deductible.
[AGENT][NEUTRAL] Right, the, the benefits.
[AGENT][NEUTRAL] That would have gone to provide were applied to your deductible to be satisfied.
[CUSTOMER][NEUTRAL] Got you. And, and my records sort of show different that and maybe I'm misunderstanding my insurance uh broker said you will pay a one time deductible of $1500. Well I'd already paid that.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And you know maybe I'm not um yeah so maybe maybe I'll call him and see if he can help me sort it out.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Because it has to do with Blue Cross.
[AGENT][NEUTRAL] OK, so see that would be different. That would be a, you would have a deductible with your primary and then your particular plan that your group opted for does have a deductible also with APL.
[CUSTOMER][NEUTRAL] So crazy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then you have your maximum benefits.
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEUTRAL] So your deductible has to be satisfied on this policy just like it does with your primary insurance. Some of the gap plans do not have deductibles, but your group selected one that does. So that's why that 1100 or and what did I say, 112,480, it was a
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Gotcha.
[CUSTOMER][NEUTRAL] So the
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Applied to your deductible when we receive the claim for the Palmetto Anesthesia Associates.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got you, so you're saying.
[CUSTOMER][NEUTRAL] Separately, like, like I have to pay 1500 with Blue Cross Blue Shield, but you're saying an additional 1500 with APL.
[AGENT][NEUTRAL] This supplemental policy has its own deductible to be met as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got you. I um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that's what he said I've only had to pay one deductible of $1500 so either I misunderstood or I'll call him and see if I'm straight and if he can set me straight. But the good news is you've got me in, uh, you got me in my account.
[AGENT][POSITIVE] Well that's perfect then so now you can see all of your information and you have your user guides and um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah you are so wonderful and I'll um and let's see if I can click on it still won't let me click on the um oh no no it does it it'll let me download documents so um.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK. And just make sure that you can
[CUSTOMER][NEUTRAL] So I will
[AGENT][NEUTRAL] Cause that should, I wanna make sure, go ahead, since we've, we've taken this much time, as Edwards to make sure that, that you can actually view what you're downloading. Was that the explanation of benefits from the Palmetto anesthesia or the Saint Francis that you were trying to download?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see, you gave it to me, um.
[CUSTOMER][NEUTRAL] The 5s, 0, actually won't let me for some reason it won't let me do this one, but it'll let me do the, well, every once in a while to have a download documents but not on all planes just like on every 3rd 1.
[CUSTOMER][NEUTRAL] So, um.
[CUSTOMER][NEUTRAL] Maybe, maybe it does it in bunches.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let's see download documents. I'm calling it up. Oh yeah, yeah, I see, um.
[CUSTOMER][NEUTRAL] Yeah, hm, I'll have to monkey with this because it's, it, it, um.
[CUSTOMER][NEUTRAL] I'll hit
[CUSTOMER][NEGATIVE] Yeah, it won't let me download certain ones.
[CUSTOMER][NEUTRAL] So maybe they're still processing or something.
[AGENT][NEUTRAL] It, I mean, for example, what's, what's one of the claim numbers that you're trying to and can't?
[CUSTOMER][NEUTRAL] Like the one from
[CUSTOMER][NEUTRAL] The, the, the one that we're talking about the $1,124.80 for Piedmont.
[AGENT][NEUTRAL] Piedmont, Oh, I wasn't looking at.
[CUSTOMER][NEUTRAL] um, anesthesia.
[AGENT][NEUTRAL] Palmetto anesthesia?
[CUSTOMER][NEUTRAL] Tameto, sorry, yeah, and you said that was the one that ended in 56, so I found it, but there's not a.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, 20, no, that one ends in, uh, it ends in 26.
[AGENT][NEUTRAL] 86
[CUSTOMER][NEUTRAL] Oh, OK. The Palmetto anesthesiologist that ends in 26 uh.
[AGENT][NEUTRAL] It's, uh, that one is 35355.
[AGENT][NEUTRAL] 0226 is that one.
[CUSTOMER][NEUTRAL] OK, 355.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] See if I can find that one.
[CUSTOMER][NEGATIVE] It doesn't look like it's in any order.
[CUSTOMER][NEUTRAL] Oh yeah, no, I found it. Let's see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK, deductible.
[CUSTOMER][NEUTRAL] So all of this went towards um.
[CUSTOMER][NEUTRAL] So this, uh, this whole 1,124 went towards a deductible.
[CUSTOMER][NEUTRAL] That's what you're saying.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alright, and you know what I'm glad you, I'm glad you showed me how to download it because uh what I'll do is I'll send this to him.
[CUSTOMER][NEUTRAL] Mm and um
[CUSTOMER][NEUTRAL] And see what
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] See, uh, see what I'm, I'm either doing wrong or not understanding.
[CUSTOMER][NEUTRAL] And he'll explain it to me.
[AGENT][NEUTRAL] Yes, ma'am. He would probably be a better person to explain. I mean, I've, I've tried to explain the best that I can, but, you know, given
[CUSTOMER][NEUTRAL] Cause, uh, so because you're.
[CUSTOMER][POSITIVE] You did a great job.
[AGENT][NEUTRAL] I don't know
[AGENT][NEUTRAL] What he told you, I don't wanna, you know, I don't wanna give you any incorrect information.
[AGENT][NEUTRAL] I can only just explain that, you know, this supplemental policy also has a deductible to be met. So those benefits went towards that and the last several claims that we've been able to process and pay benefits on, once that was satisfied, then yes, payment has been issued like that one that we talked about to Saint Francis Hospital. That was the claim number ending in 56.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][POSITIVE] Wonderful.
[CUSTOMER][POSITIVE] Got you. I'm, I'm, I'm, I'm with you now. Well, thank you so much. I really, really appreciate and, and let me see if um.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Well.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I'm gonna see if [PII] is gone, let's see.
[AGENT][NEUTRAL] Yeah, has
[AGENT][NEUTRAL] Cuz I don't know it.
[CUSTOMER][NEUTRAL] She didn't.
[AGENT][NEUTRAL] I she.
[AGENT][NEUTRAL] If she, if she leaves at [PII].
[CUSTOMER][NEUTRAL] I don't, I think she's probably.
[AGENT][NEUTRAL] OK. Well, I'll just, um, if you,
[CUSTOMER][NEGATIVE] Yeah, yeah, she didn't get.
[CUSTOMER][NEUTRAL] Oh, let me give you her do you have her number?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well, I have just, I have a phone number on the group's information, but if you have one that you can give me, that would, that'll be fine and I'll try to call her um first thing in the morning.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, and her name is [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And her number is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. All right. That was [PII]. No, ma'am, I already have that on file. Um, give me just a second though and we can verify that what I
[CUSTOMER][POSITIVE] And I can give you her email too if that helps.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, I have AP at favor [PII] because she's.
[CUSTOMER][NEUTRAL] Yeah, that's that'll get to her.
[AGENT][NEUTRAL] Yeah, yeah. OK, and then the phone number.
[CUSTOMER][NEUTRAL] That'll get to um that'll get to.
[AGENT][NEUTRAL] You gave me is actually what we also have on file for her.
[CUSTOMER][POSITIVE] OK, wonderful, wonderful, yeah, that's goes to her town at the AP but that'll that'll work too.
[AGENT][NEUTRAL] Mhm. So
[AGENT][NEUTRAL] OK. And then do you know, does she, what time does she come to work in the morning? Do you know about what time she usually arrives?
[CUSTOMER][NEUTRAL] About [PII].
[AGENT][NEUTRAL] About [PII], OK.
[CUSTOMER][NEUTRAL] Around [PII]
[AGENT][NEUTRAL] That's about 8 hour time.
[AGENT][NEUTRAL] OK, so I will, I'll try to reach out to her in the morning, but hopefully she will see your email to know to um to not you know, for any other employees.
[CUSTOMER][NEUTRAL] And she'll go what? And I'll I'll see you.
[AGENT][NEUTRAL] Access like that.
[CUSTOMER][POSITIVE] I'll see her in the morning and I'll say something to her. Well, thank you so much. I really appreciate all your help.
[AGENT][NEUTRAL] OK, yeah, just.
[AGENT][NEUTRAL] You're um.
[AGENT][POSITIVE] Oh, it was my pleasure in helping you and I'm glad that we were able to work through some of those issues today, Ms. [PII].
[CUSTOMER][NEUTRAL] I know, yeah, and I'll, I'll, I'll reach out to the other and see if I can uh understand the other, and I'm sure it's just something I'm not catching on to.
[AGENT][POSITIVE] Well, and if you have any other questions on our end that we can help you with, please give us a call and we'll be more than happy to help you.
[CUSTOMER][POSITIVE] I will and you've been so much help, so thank you so much.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] Well, you're very welcome and it was my pleasure. I'm just glad we were able to get your profile set up and you can have access now. OK, Ms. [PII], well, you're very welcome.
[CUSTOMER][POSITIVE] Sure do sure do appreciate it.
[CUSTOMER][POSITIVE] Yeah, you're wonderful. Well, thank you so much. I appreciate it. Thank you, [PII].
[AGENT][POSITIVE] You're welcome. Yes, ma'am. Yes, ma'am, anytime, and I hope you have a wonderful evening. OK. Bye-bye.
[CUSTOMER][POSITIVE] Yay that.
[CUSTOMER][POSITIVE] You too. Thank you. Bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Yes, ma'am.