AccountId: 011433970860
ContactId: 58c8d848-3791-4102-851a-89426363d2b5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 874270 ms
Total Talk Time (AGENT): 384437 ms
Total Talk Time (CUSTOMER): 365230 ms
Interruptions: 6
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/58c8d848-3791-4102-851a-89426363d2b5_20250228T14:12_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], um, my name is [PII]. I was hoping you can help me. I just wanted to make sure that you guys received, um, like a claim that I received via email.
[CUSTOMER][NEUTRAL] I'm a member.
[AGENT][NEUTRAL] OK, Ms. [PII], so you submitted a claim via email?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes ma'am, I'll be happy to check that for you. Now, um, first off, I'll need to pull up your policy information and verify some things with you for security. So what is a good call back number for you please?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] Thank you, and your policy number?
[CUSTOMER][NEUTRAL] Well, OK, so I, it's very confusing cause I guess you guys are like a second one or I don't even know, but it looks like uh maybe your policy number is 02489849.
[AGENT][NEUTRAL] OK, thank you. So give me a moment please to get your information pulled up.
[CUSTOMER][POSITIVE] OK, thanks.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so first off, um, Mr. [PII], what is your, uh, any information that I do provide for you will be a verification of benefits and not a guarantee of payment. What is your date of birth?
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And the primary insured's name and date of birth?
[CUSTOMER][NEUTRAL] OK. So the insurance is in I guess it's a NovaCare. Oh, the primary insured, you said, uh, my husband, [PII], um, [PII].
[AGENT][NEUTRAL] No, ma'am, who is the, yes, ma'am. Uh-huh.
[AGENT][NEUTRAL] OK, thank you. And your home mailing address, please?
[CUSTOMER][NEUTRAL] Sure. It's [PII], and that is um [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we would have, well, actually the phone number we have on file is your email, so I mean your phone number, your phone number rather is what I meant to say.
[CUSTOMER][NEUTRAL] Probably.
[CUSTOMER][NEUTRAL] Probably yes, uh [PII]. Mhm. Go ahead.
[AGENT][NEUTRAL] OK. And then lastly, uh-huh, [PII].
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] Thank you. And then the email address that we would have on file?
[CUSTOMER][NEUTRAL] You probably have mine as well, which is the [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. And Ms. [PII], is this claim for you? Is that correct?
[CUSTOMER][POSITIVE] I would be the patient, yes.
[AGENT][NEUTRAL] OK, so one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the date of service?
[CUSTOMER][NEUTRAL] OK, so the date of, hold on one second, I'm sorry.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] All right, uh, can you tell her I'll call her right back? I'm sorry. I'll call her right back, tell her. Thank you. OK, OK, bye.
[CUSTOMER][NEUTRAL] I'm sorry about that. Um, so the other, the data service would be [PII].
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] OK, and do you have the total bill amount, Mr. [PII]?
[CUSTOMER][NEUTRAL] Uh yeah, let's see.
[CUSTOMER][NEUTRAL] It looks like the full charge of that day was $300.
[AGENT][NEUTRAL] 300 even. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, yes.
[AGENT][NEUTRAL] OK. All right just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I did not have a claim on file for you for that data service.
[AGENT][NEUTRAL] You did say 829 of 2024. Is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, let me just open up the, make sure I send you the right one.
[CUSTOMER][NEUTRAL] Cause I did receive one from [PII].
[AGENT][NEUTRAL] Now,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Yeah, 8:29. OK, so can I confirm that that I'm, so I sent two emails to you guys already, um, and I did receive one of them, so that means that it did work.
[CUSTOMER][NEUTRAL] Originally for the um so it looks like it was for data service of [PII].
[AGENT][NEUTRAL] 7
[AGENT][NEUTRAL] Yes, ma'am. Now, we did receive that one, that is correct, but we did not receive the [PII].
[CUSTOMER][NEUTRAL] OK. So then I'm gonna forward again or uh-huh.
[AGENT][NEUTRAL] Now,
[AGENT][NEUTRAL] Yes, ma'am. Actually, actually I was about to tell you we are not able to really accept claims via email because of security reasons. I see we did receive that one, but because you all have access to the portal and the portal information that appears is under your information.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You can up
[AGENT][NEUTRAL] OK, so what I can do is I will email the user guide for setting up the portal to the email that is on file for this account and it gives instructions on how to set up the profile in our portal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And once that is done, you can upload the information directly there.
[AGENT][NEGATIVE] From a computer um also it could be faxed or it can be mailed but again we are not supposed to accept claims via email again that's due to security.
[CUSTOMER][POSITIVE] OK. Great.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, this was it's on the paper of where to send that's why I did it that way.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What email did you send it to?
[CUSTOMER][NEUTRAL] OK, so the paper, um, hold on a second.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Let me just open up that.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, so it says here.
[CUSTOMER][NEUTRAL] Page one, let me just go back, try this again.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, let me go get the original paper.
[CUSTOMER][NEUTRAL] The 1st 1st page that I was emailed says we received a request for this claim form attaches the claim packet, please complete it and
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mail, email or fax it to. Email [PII] [PII].
[CUSTOMER][NEUTRAL] As one of the options and then the second option is a fax or the 3rd option is to mail. So I send it to [PII].
[AGENT][NEUTRAL] OK, so according to the ID cards, if you were going to email this claim,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I have a different email address that's on that it says [PII].
[CUSTOMER][NEUTRAL] Is that for, but that would be for the way they explained it to me is that there's a Novacare and then there's you guys.
[AGENT][NEUTRAL] OK, so for
[CUSTOMER][NEUTRAL] You, you're in separate situation.
[AGENT][NEUTRAL] Yeah, OK, so for us, yes, your coverage is um slightly complicated. Um.
[CUSTOMER][NEUTRAL] It sure is. You have no idea.
[AGENT][POSITIVE] Yes, I'm so sorry, um.
[AGENT][NEUTRAL] But our portal will allow you to directly submit a claim.
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] To us. Now, when you're setting up the portal, and again, I'm only able to provide what I'm providing to you because your phone number and your email or what your husband has on file for your account. But when you're setting up the portal, most of the information it's going to ask for.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Is going to be related to your husband like his.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know his social things like that but then yes, since your email is on file that's the one you would use and your phone number. But again, once you get that set up, you can upload it directly there. I can't um I'm not sure about that customer support email address for you honestly so I can just tell you that for us the portal is the best way.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And then regarding what I get back, so like an example, um, I received another bill from
[CUSTOMER][NEUTRAL] The, you know, the data service of [PII] because they want to get paid. I did receive $50 from you guys, so in reality I owe them the additional $50 whatever dollars, um, regarding what I get, see, when I bought the policy they almost made it sound that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Your part of it which should should pay pretty much everything. It doesn't sound like that's accurate anymore.
[AGENT][NEUTRAL] This policy is a limited benefit plan that you all have with us, Mr. [PII], so it only pays specific amounts for certain services.
[AGENT][NEUTRAL] So like with that payment that we made for your 731 data service for treatment in a physician's office, that was the maximum benefit that this policy would pay.
[CUSTOMER][NEUTRAL] OK, fine.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Got you. All right.
[AGENT][NEUTRAL] Mhm. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, um, all right, so then, yes, can you, uh, email me the information regarding the portal and then I, I'll submit again.
[AGENT][NEUTRAL] Uh-huh. Yes.
[AGENT][NEUTRAL] Yes, that I will send that to you in just a moment, and the email that you will receive is going to come from [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I will put APL in your subject line.
[CUSTOMER][NEUTRAL] OK, and regarding how I submit, is it the same way to put that package they send me?
[CUSTOMER][NEUTRAL] To to to email they told me I had to use the cover page and then um
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Let me just, um, and then it has like.
[AGENT][NEUTRAL] Now, I, there's a specific, well, we have a specific claim form for this type of policy.
[AGENT][NEUTRAL] Um, if you'll give me just a moment, I can include that form because it does have your instructions on it as well for filing the claim, um, just one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] This one just, you know, just so that you know on the top it says hospital indemnity and everyday Solutions claim form. That was the name of it.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK. And that may be the same form that I'm going to include for you?
[CUSTOMER][POSITIVE] OK, all right. OK, great. Perfect.
[AGENT][NEUTRAL] Um, because it should, yes, if that's the claim form you have and then the top section, does it have the instruction does it say APL and then have the instructions for the insured or patient with like 4 bullet points?
[CUSTOMER][NEUTRAL] It does, yes. Mhm.
[AGENT][NEUTRAL] OK, so you have the correct claim form. So I don't need to send that to you. That is the, mhm, yes, ma'am. That's, that is what you need.
[CUSTOMER][POSITIVE] OK, great. So I'll send this package.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, great.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 3. OK, perfect. All right, so then I'll wait for you to send that and then I'll create the portal and then I'll upload it.
[AGENT][POSITIVE] Yes, ma'am. And I'll, again, if you have any other questions, please feel free to call us back. We'll be happy to help you. Is there anything else that I can help you with at the moment?
[CUSTOMER][NEUTRAL] Actually, um, now that I have it, should I, the policy number, the APL policy number, is it the one that I told you in the beginning or is it the Enovacare? OK.
[AGENT][NEUTRAL] Yes, 02, no, ma'am, the 0248 number that you gave me. Mhm.
[CUSTOMER][NEUTRAL] OK. All right, so I'll put that cause that, it, I didn't have that on the original. OK, great.
[AGENT][NEUTRAL] OK. Well, again, anything else I can help you with?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Uh, no, thank you.
[AGENT][POSITIVE] Well, you are certainly very welcome and thank you for calling APL today, Mr. [PII]. I hope you have a wonderful weekend.
[CUSTOMER][POSITIVE] Thanks you too.
[AGENT][POSITIVE] Yes, ma'am. Thank you.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Mhm bye bye.