AccountId: 011433970860
ContactId: 5a4d9c47-fd69-4df3-beb9-c8b28284fedb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 712900 ms
Total Talk Time (AGENT): 347435 ms
Total Talk Time (CUSTOMER): 188683 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/5a4d9c47-fd69-4df3-beb9-c8b28284fedb_20250521T13:14_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] Hey, hi, good morning. Uh, I'm calling because I made a, a claim, uh, like a month ago for a visit to the urgent care.
[CUSTOMER][NEGATIVE] And I'm trying to see the status, and they told me to wait 30 days to see the the status, but I went online to see and there's nothing there.
[AGENT][NEUTRAL] OK, so you have filed a claim with APL and you're wanting to check to see if it was received, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, I can help you with that. And you're the insured, is that correct?
[CUSTOMER][POSITIVE] Yeah, correct.
[AGENT][NEUTRAL] OK, and who am I speaking with please?
[CUSTOMER][NEUTRAL] Uh my name is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And Mr. [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] The call number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] Uh policy number.
[CUSTOMER][NEUTRAL] Um, where do I see the policy number?
[AGENT][NEUTRAL] On the front of your ID card, it just depends on the type of policy you have with APO Mr. [PII] as to how it would be worded. You may see an in hospitals or an outpatient number.
[CUSTOMER][NEUTRAL] OK, so I have the, I have both.
[AGENT][NEUTRAL] You may
[AGENT][NEUTRAL] OK. What is the outpatient number?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Our pension number is 02 [PII].
[AGENT][NEUTRAL] OK, thank you. So give me a moment please to get your information pulled up. Once I do, Mr. [PII], I will have to verify several things with you first.
[AGENT][NEUTRAL] For security and maybe, let me, give me just one moment. And you said your policy number is 02486575. Is that correct?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The first part of the number. OK, thank you. One moment.
[AGENT][NEUTRAL] Yes sir, again, any information that I will provide for you today 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] It's [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address?
[CUSTOMER][NEUTRAL] I'm sorry, um, can you repeat that? Sorry.
[AGENT][NEUTRAL] What is your home mailing address?
[CUSTOMER][NEUTRAL] Oh, my home is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. The phone number that is on file for you is the same as the one that you gave me, so that is your best contact number, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Thank you and the last thing to verify is your email address and this does appear to be your work email that is on file.
[CUSTOMER][NEUTRAL] And yeah, that's fine it's um [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so Mr. [PII], what is the data service that you went to the urgent care because we do not have any claims on file for you.
[CUSTOMER][NEUTRAL] Oh yeah, I want uh the um.
[CUSTOMER][NEUTRAL] 326 [PII].
[AGENT][NEUTRAL] OK. Let's see.
[AGENT][NEUTRAL] And you submitted this claim to us. Is that correct, Mr. [PII]?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I mean, I, I told the lady in the urgent care, I gave my card and, and I guess.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, she, she was supposed to uh put the claim and then I called back.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, here to you guys and I guess I spoke with somebody and they told me, yeah, yeah, we're gonna do it and you just have to check back in 30 days.
[AGENT][NEUTRAL] Some, OK.
[CUSTOMER][NEUTRAL] And, and
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Someone here told you to call back in 30 days?
[CUSTOMER][NEUTRAL] No, no, that I could check the status, like, it takes up to 30 days to get reimbursed or something like that.
[AGENT][NEUTRAL] OK, so let's see.
[AGENT][NEUTRAL] OK, so yes sir we haven't received it. I, if I can see where you did speak to someone, uh, a week or so ago here and they sent you a claim form along with the that had the instructions on it and also the information about the portal but as of now if the provider was to be filing the claim we haven't received that yet you may want to follow up with the urgent care facility that you went to.
[AGENT][NEUTRAL] Mr. [PII] to see if they are indeed going to file it and then if they don't or they're not going to, you can submit it by using that claim form.
[AGENT][NEUTRAL] That was sent to you.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Where was it sent? I, I didn't see anything.
[AGENT][NEUTRAL] On [PII] you were sent an email from care team that had the user guide.
[CUSTOMER][NEUTRAL] Does it show?
[AGENT][NEUTRAL] For the online service center.
[CUSTOMER][NEUTRAL] To to my work email?
[AGENT][NEUTRAL] Yes, sir, because that's the one we have on file.
[CUSTOMER][NEGATIVE] I, I, I don't, I didn't receive anything. Can it, can it be resent to me?
[AGENT][NEUTRAL] Yes, sir. Just a moment.
[AGENT][NEUTRAL] OK, so I have just sent it to you and the email that you will be receiving will come from [PII].
[AGENT][NEUTRAL] And I did put APL in your subject line along with online service center portal user guide and meddling claim form.
[AGENT][NEUTRAL] So if the provider is, once you check with them if they are not going to file it that met that claim form does have the instructions on page one at the top of what other additional documents you will also need to submit to us along with the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] So it will be easier if they will file it for you, but if for any reason they do not, then yes, sir, you absolutely can.
[CUSTOMER][NEUTRAL] OK, but uh can I ask you something?
[CUSTOMER][NEUTRAL] And so I have.
[CUSTOMER][NEUTRAL] Just so I understand the, the.
[CUSTOMER][NEUTRAL] Like the benefits from, from this APL insurance.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] My main insurance covers a part and this is supposed to cover the rest of of the
[CUSTOMER][NEUTRAL] Of the, like the difference, correct?
[AGENT][NEUTRAL] OK, so again, any information regarding benefits will be a verification of benefits and not a guarantee of payment. So this policy, Mr. [PII], is designed to help you with co-pays, deductibles, and co-insurance amounts of covered services.
[AGENT][NEUTRAL] Under this supplemental policy, office visits are not covered. That is not a covered benefit under this policy. However, if you receive
[CUSTOMER][NEUTRAL] Well, what, and what is not?
[CUSTOMER][NEUTRAL] Of basic you said?
[AGENT][NEGATIVE] Office visit, yes, is not covered.
[AGENT][NEUTRAL] If you go
[CUSTOMER][NEUTRAL] What is that, sorry? I don't know what that means, sorry.
[AGENT][NEUTRAL] That means if you go to the doctor and they charge you a visit for your office, for going to see the doctor, an office visit fee, that would not be covered by this policy.
[AGENT][NEUTRAL] If you received some type of treatment in the office, then that could be reviewed for benefits. Urgent care is something that we can review for potential benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you were to have
[CUSTOMER][NEUTRAL] You can't or you can't?
[AGENT][NEUTRAL] Can and there's a copy of your policy information, Mr. [PII], in your portal. I can see that you did set up your profile where you can log in.
[AGENT][NEUTRAL] And there is a copy of your policy information and your benefits in that portal.
[AGENT][NEUTRAL] Under your policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So always present, I recommend that you always present your APL ID card.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Along with your primary healthcare insurance card when you go for medical services.
[AGENT][NEUTRAL] Most providers will call us to verify that your policy is active and that you're eligible.
[AGENT][NEUTRAL] And request benefit information.
[AGENT][POSITIVE] And take care of filing everything for you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But as I said before, if they don't, for some reason, file supplemental coverage or whatever, then yes, sir, you can most definitely file your own claim.
[AGENT][NEUTRAL] And you should have that email for me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I just saw it, yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I will call them, uh, now to see if they're gonna file it.
[AGENT][NEGATIVE] Yes, sir, because, uh, yes, as of now, we haven't received it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Well, do you have any other questions for me at the moment?
[CUSTOMER][POSITIVE] Uh, no, that's it for right now. Thank you very much for your help.
[AGENT][POSITIVE] Oh, well, you're certainly very welcome. And thank you again for calling APL Mr. [PII]. I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Thank you, you too.
[AGENT][POSITIVE] Yes, sir. Thank you very much.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.