AccountId: 011433970860
ContactId: 583f69b5-8951-4343-9865-ba0ab916b2f2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 667849 ms
Total Talk Time (AGENT): 272284 ms
Total Talk Time (CUSTOMER): 291000 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/583f69b5-8951-4343-9865-ba0ab916b2f2_20250131T19:11_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi I was trying to get in touch with [PII]. Is she available?
[AGENT][NEUTRAL] No, you're trying to reach [PII], is that correct?
[CUSTOMER][NEUTRAL] In claims?
[AGENT][NEUTRAL] Sorry, yes, ma'am. She's not available. Is there something I can help you with?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Well, yes, um, I just spoke to her trying to figure out how to look in the portal for a policyholder of mine and you'll have the form that I can get all her information and I was trying to upload like 11 more different claims and I wanted to see if you guys could um see if you have it already automatically that quickly because apparently I did it in [PII] and it didn't upload.
[AGENT][NEUTRAL] OK, so, and who are you in relation to the insured?
[CUSTOMER][NEUTRAL] I am the writing agent years ago but but the form is on file for me to help her.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII], and so you're wanting to verify if some information you uploaded for a member was received?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, like today, like 10 minutes ago.
[AGENT][POSITIVE] Yes. I can help you with that. I can check that for you. And what's a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] It is 728463.
[AGENT][NEUTRAL] OK, thank you. So give me a moment to get the member's information pulled up um [PII] and then I will have to verify some information with you first for security.
[CUSTOMER][NEUTRAL] Sure. Uh-huh.
[CUSTOMER][NEUTRAL] OK. Sure.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and any information [PII] that I provide would be a verification of benefits and not a guarantee of payment. So first off, uh, what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] [PII] and her date of birth is [PII], I'm looking on this 4-54.
[AGENT][NEUTRAL] OK. All right, thank you, one moment.
[CUSTOMER][NEUTRAL] Mm mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me go ahead and, and verify the insured's address with you as well to make sure what we have is correct.
[CUSTOMER][NEUTRAL] Yes, it
[CUSTOMER][NEUTRAL] Yeah, it is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, thank you and do you have her phone number?
[CUSTOMER][NEUTRAL] Yes it is.
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] OK, and then we have another number also it could possibly be maybe her husband since the policy is in his name.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] Do you have another number for them?
[CUSTOMER][NEUTRAL] I just have cell phone number on her claims form.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, but his name is, oh gosh, what is his name? um [PII]. His name is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I don't have a phone number for him.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So yes, I can see that we do have something in line that we did receive something today.
[CUSTOMER][NEUTRAL] Is it like 11 different uh attachments maybe?
[AGENT][NEUTRAL] Uh, I'll have to, I can't fully see all of the pages that are included. I can just look at that. I can just see that we received something uploaded through the portal.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Today, so just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this shows a total of 23 pages.
[CUSTOMER][NEUTRAL] Well, I just uh
[CUSTOMER][NEUTRAL] Oh well maybe it's 11 different.
[CUSTOMER][NEUTRAL] It might be 23, but 11 different.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The total number of pages and that includes the um you know the.
[CUSTOMER][NEUTRAL] Well, um,
[AGENT][NEUTRAL] Cover sheet for the portal, but the total document is 23 pages.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, when do those, when does that show up on the portal? The do they have to have a claim number, have to wait to get a claim number and all that before you actually.
[AGENT][NEUTRAL] Uh, once it has been reviewed, it will be assigned claim number.
[CUSTOMER][NEUTRAL] And then it goes on the portal?
[AGENT][NEUTRAL] Yes, then you would be able to have access to the claim number in the portal and then also the explanation of benefits itself will be there and I see that um now just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right. OK.
[AGENT][NEUTRAL] And I do see that this.
[AGENT][NEUTRAL] Profile has is set up to receive a text alert when a claim has been processed to that other phone number that you weren't able to verify that I'm assuming is for mister um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Could be. Yeah, she calls me when she and I, I'm looking at her portal right now. Um, well, another question I have is when there is a claim that says uh that has relationships files, coverage type policy number, they receive claim number, amount paid, they completed and the upload information sometimes it says no files and sometimes it has view files. What does that mean? Why does it say no files?
[AGENT][NEUTRAL] For Mr. G.
[CUSTOMER][NEUTRAL] When it's been paid and then when it has been paid has view files.
[AGENT][NEUTRAL] OK, so you're saying, uh, so you see it from a different perspective than I do, [PII]. So you're saying that like on the one that you just uploaded it doesn't have that there where you can view the files, but.
[CUSTOMER][NEUTRAL] No, no, no, no, no, I'm talking about y'all just recently paid $80807.75 completed on [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And to the right of it, it has view files in blue, which means I can click on it. It's like I guess you're you you kind of your ELB I guess. But then, OK, then there was one paid 730 2024 claim number amount paid $3,0083.94 but then it has no files in black.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] That is right. Mhm.
[CUSTOMER][NEGATIVE] Why are some I can see and some I can't is it only available to be seen for a certain amount of time then it goes to no files?
[AGENT][NEUTRAL] Mm, that's a very good question. I don't honestly know the answer to that. What was the claim number that you say you cannot see where it says no files?
[CUSTOMER][NEUTRAL] Oh my
[CUSTOMER][NEUTRAL] Yeah, cause I might
[CUSTOMER][NEUTRAL] It is 343490506.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Just wanna look at that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You know, it, it must just stay open for a certain period of time because all of these you paid on it says no files.
[CUSTOMER][NEUTRAL] So it must just be since it's brand new.
[AGENT][NEUTRAL] I'm going to say that that is probably accurate and it would just have the explanation of the benefits then viewable once it has been processed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right. OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Well, I have one last question. I'm not sure you know the answer to this. She seems to think she has a policy that uh pays for prosthesis for breast.
[CUSTOMER][NEUTRAL] And um she thought this 807-75 which she's fixing to get was for that.
[CUSTOMER][NEUTRAL] And so apparently it's not, but um,
[CUSTOMER][NEUTRAL] Do you know what her benefit is for prosthesis? And she's getting 2, so I guess she had a double mastectomy.
[CUSTOMER][NEUTRAL] How can I find that out, that benefit?
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] I would have to just look at her policy certificate if there's a copy of that, um, in the, for me to view, it would be in her policy certificate itself, which
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. She
[AGENT][NEUTRAL] Should be in her portal, um, but just a moment.
[CUSTOMER][NEUTRAL] She, she can see in her portal?
[AGENT][NEUTRAL] The policy, mhm, she should be able, I mean.
[CUSTOMER][POSITIVE] OK, I bet I can.
[CUSTOMER][NEUTRAL] I bet I can see it. Can you tell me how?
[AGENT][NEUTRAL] You just click on the, yeah, she can see that. It's um under, if you click on the policy number, there's a PDF icon that says download mhm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Policy number. OK. OK. OK.
[AGENT][NEUTRAL] This downloading file or whatever and that is for her policy. Yes, ma'am, that's her policy certificate.
[CUSTOMER][NEUTRAL] It's downloading now.
[CUSTOMER][POSITIVE] OK, well, I will try to find that then. Thank you very much.
[AGENT][POSITIVE] Well, so, um, you're so very welcome. Um, let's see.
[AGENT][NEUTRAL] I was just gonna look and see.
[CUSTOMER][NEUTRAL] I try to log out of here and go back into my files and download.
[CUSTOMER][NEUTRAL] See what I've got
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Oh yeah
[CUSTOMER][NEUTRAL] Well, where did all that go?
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, they're under the under prosthesis benefit which is under
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Letter I
[AGENT][NEUTRAL] There is a paragraph regarding that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] That's on page 12 of the total of 37 pages, not looking at the page numbers themselves but of the total document.
[CUSTOMER][NEUTRAL] OK, OK, page 12. All right.
[AGENT][NEUTRAL] Um, that's there and then the, that's the.
[AGENT][NEUTRAL] definition of the term.
[AGENT][NEUTRAL] And then it would also correlate with the same thing on her schedule of benefits page.
[AGENT][NEUTRAL] Under prosthesis benefit which is also, uh, cause it has a non-surgical and a surgical benefit.
[CUSTOMER][NEUTRAL] Schedule benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, yeah, she's had both. Oh, OK. Yeah. I'm surgical.
[CUSTOMER][POSITIVE] And it's surgical. OK. Well, I'll, I'll research that later. Thank you very much now that I've downloaded it.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Well, you're certainly so very welcome. So again, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that's it so far. Thank you so much. OK.
[AGENT][POSITIVE] OK. Absolutely. Have a wonderful weekend and thank you again for calling APL.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] Mhm. Bye-bye.
[AGENT][NEUTRAL] Bye.