AccountId: 011433970860
ContactId: 5ef44575-b806-4008-bcc1-d57acaae57ef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 795820 ms
Total Talk Time (AGENT): 387151 ms
Total Talk Time (CUSTOMER): 262873 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/5ef44575-b806-4008-bcc1-d57acaae57ef_20250619T12:43_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, my name is [PII]. Um, I work for Saint Anne's Terrace.
[CUSTOMER][NEUTRAL] And I'm trying to create an account, so I'm also in HR so I have the Saint Anne's account.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] But I'm trying to create my own personal account and it's not like and
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh
[CUSTOMER][POSITIVE] My information accurate to to my knowledge.
[AGENT][NEGATIVE] OK [PII], so you're trying to set up your own part you're the group administrator, but you also are trying to set up your personal account and you're having trouble and it's giving you an error.
[CUSTOMER][NEUTRAL] Yes, cause I tried to put in a claim.
[AGENT][NEUTRAL] Yes, well
[AGENT][NEUTRAL] Uh-huh. Oh, no, no, no. I, I can help you with this.
[CUSTOMER][NEGATIVE] Oh sorry.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK, cool, thank you.
[AGENT][POSITIVE] You're welcome. So first off, [PII], what's a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Thank you and do you have your policy number?
[CUSTOMER][NEUTRAL] Oh, hold on.
[CUSTOMER][NEUTRAL] Let me get the
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], if it's easier, I can look it up with your full social. It, it's just up to you.
[CUSTOMER][NEGATIVE] Uh, no.
[CUSTOMER][NEUTRAL] I got you the policy number.
[AGENT][NEUTRAL] I did. Uh-huh.
[CUSTOMER][NEUTRAL] Uh, it's 02 [PII].
[AGENT][NEUTRAL] OK, thank you one moment while I get your information pulled up please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Mhm. You're welcome.
[AGENT][NEUTRAL] OK, [PII], so I will need to verify your information first for security. So first off, if you will please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that is on file for you, which is not the number you gave me, what's another phone number that we would have for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and then your email address?
[CUSTOMER][NEUTRAL] I'm not sure if you have my personal or my work, so it's either [PII].
[CUSTOMER][NEUTRAL] Or it's [PII].
[AGENT][NEUTRAL] OK, so thank you. So right now it is your work email, but let me look at one thing, OK? So one second.
[AGENT][NEUTRAL] OK, so, um,
[AGENT][NEUTRAL] OK and you said that you also have access in the online service center though because you're not listed as the primary admin but one of that you have been given access in that.
[AGENT][NEUTRAL] The group's level.
[CUSTOMER][NEUTRAL] Correct, using that same email using that email address.
[AGENT][NEUTRAL] OK, so what we're gonna have to do, [PII] is to change your email to your personal email address for your personal account because it's the new system is pulling by mhm it's for security it has to do with the email so your email is already tied to your group.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Not
[CUSTOMER][POSITIVE] I got you.
[AGENT][NEUTRAL] So we're gonna have to change that. So what would, what is your personal email?
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] It'd be [PII].
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Alright, so are you where you can try and set up the profile to see if it uh lets you go farther now?
[CUSTOMER][NEUTRAL] It just, it let me.
[AGENT][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] I had it kind of like ready to go um.
[AGENT][NEUTRAL] Oh, OK. All right.
[CUSTOMER][NEUTRAL] So my, my question to you, and you may not be able to answer so if you can't, that's fine. I had put in a claim through the employer portal.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] It's, I don't know, I didn't say it got rejected, but it didn't say that um.
[CUSTOMER][NEGATIVE] I would be reimbursed anything and so then I found out that um.
[CUSTOMER][NEUTRAL] It's because.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I didn't have an EOB.
[CUSTOMER][NEGATIVE] But on the employer account there was no place for me to send that information.
[CUSTOMER][NEUTRAL] Is it my guess that if I create my personal account.
[CUSTOMER][NEUTRAL] They'll have more information.
[AGENT][NEUTRAL] OK, you so you would still upload documents, [PII] the same in your portal and any any information provided on your benefits will be a verification of benefits and not a guarantee of payment. So you would just upload if there's ever missing information, you just upload it just like you do a new claim. There's not a way to tie it to the already existing claim number.
[AGENT][NEUTRAL] But our system will know that that was a missing piece of information for that particular data service.
[CUSTOMER][NEUTRAL] Got you, because I had called, so we have a benefit company that helps us and so she had called and she's the one that told me what I was missing, which was the EOB thing but.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So what is the data service, [PII], because I can't, I can't tell you for sure what was or was not missing. What is the data service that your claim was for?
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] I believe it was [PII].
[AGENT][NEUTRAL] OK, now I don't see a claim on file for
[CUSTOMER][NEUTRAL] Or or when I
[CUSTOMER][POSITIVE] Oh maybe I'm sorry, I put the claim in on Monday. I'm sorry.
[AGENT][NEUTRAL] But when did you go to the doctor or the hospital, or what was your date of service that you were treated, that you were filing a claim for?
[CUSTOMER][NEUTRAL] I'm thinking of the the act.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me open this and see if it tells me.
[CUSTOMER][NEUTRAL] Building I have that done.
[CUSTOMER][NEUTRAL] Oh, I'm sorry, 6:30.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I didn't realize it was so long ago.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, all right, so give me one second.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so that that is gonna be claim number 3614476. Do you see that in your portal, [PII]?
[CUSTOMER][NEUTRAL] Uh, let me see, sorry, this looks slightly my policy claims, yes, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you should only see one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, so yes, mhm, so you can click on that to download your explanation of benefits from there as well.
[CUSTOMER][NEUTRAL] On looks like.
[AGENT][NEUTRAL] And the remarks are on page 2 of that EOB and it does state in order to provide further consideration to this claim, please submit the following.
[AGENT][NEUTRAL] Number 1, explanation of benefits from the primary insurance carrier for this service, and then number 2 is the diagnosis for which treatment was provided on this data service. Once we've received this information, we will continue processing this claim.
[CUSTOMER][NEUTRAL] I got
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so on the employer one that document wasn't available, so now I see the document now so it makes it makes more sense now.
[AGENT][NEUTRAL] That is correct. You're gonna have more access on your personal level because, yes, because you would not be able to see like all other employees medical information, medical claims you can upload it, yes, but you can't see too much detail on that.
[CUSTOMER][NEUTRAL] Um, so
[CUSTOMER][NEUTRAL] Per
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] In
[CUSTOMER][NEUTRAL] Makes sense.
[CUSTOMER][NEUTRAL] Yeah, that definitely makes sense. OK, so and this is maybe a silly question.
[AGENT][NEUTRAL] So it's
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] The, the
[CUSTOMER][NEUTRAL] The Kaiser EOB should that the um, what, what did you say? the oh my goodness.
[AGENT][NEUTRAL] The, the diagnosis code will not be, let me, right. That will be something you're gonna have to get from the provider.
[CUSTOMER][NEUTRAL] Whatever the second one, the.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, I'll have to get it from them. OK, I will.
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] OK, and so in order just to make sure I'm sorry I'm so new to this, but to send that further information I'll have to like kind of start the claim a new claim essentially not a new claim, but that's the way I would do it, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, it's going to, right, you would just write.
[AGENT][NEUTRAL] The traditional claim just upload your information and when we get that, then we'll be able to see that oh OK this is what we were missing for the claim for the same data service because we're gonna be looking at that data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You'll combine them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK cool.
[AGENT][NEUTRAL] Mhm. OK.
[CUSTOMER][POSITIVE] Perfect. Well, I think I got it, so I have the EOB. I'll just have to find the other part of it, and um I will get that to y'all.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, you'll just probably need to reach out to your provider in order to get that because that's not, yeah, uh, the diagnosis for why you were treated is not gonna be on that explanation of benefits.
[CUSTOMER][POSITIVE] Got you. Alright, um, well, wish me luck on that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] And then just one last thing, [PII], in the, um, would this provider not file your APL or did you forget to give them your information for APL?
[CUSTOMER][NEUTRAL] I, I don't know.
[AGENT][NEUTRAL] Is that why you filed your own claim?
[CUSTOMER][NEUTRAL] I found my own claim because honestly I didn't, I kind of forgot that we had y'all and I'm new to Kaiser, so I don't know how Kaiser does things. So honestly, I didn't even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, they wouldn't have.
[CUSTOMER][NEGATIVE] I wouldn't even have known to do that.
[AGENT][NEUTRAL] OK, so my recommendation to you is since this is a supplement, [PII].
[AGENT][NEUTRAL] Always present your APL ID cards along with your primary insurance cards when you go for medical services because most providers will file both of your insurances. Obviously, they have to file your primary health care insurance first.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then with APL since we have to have a copy of your primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] But if the provider will follow up for you, it just makes it a little easier and then you're not having to try to get the diagnosis code and all of that because the
[AGENT][NEUTRAL] You know, they typically the information they submit to us would have that on there.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][POSITIVE] Awesome. Alright, well, I didn't know that, but I'm glad to know that considering my position at Saint Ann's that I can tell other people that because I just, we've never had a service like this. I just didn't know.
[AGENT][POSITIVE] Sure. Absolutely.
[CUSTOMER][POSITIVE] So, I appreciate, I appreciate that.
[AGENT][POSITIVE] Well, you, absolutely. Well, you're certainly very welcome and if you have any other questions, you know, give us a call. But is there anything else at the moment that I could help you with?
[CUSTOMER][POSITIVE] No, no, I think you handled everything. I appreciate that.
[AGENT][POSITIVE] Well, you are certainly welcome [PII], and thank you for calling APL. I hope you have a wonderful day.
[CUSTOMER][POSITIVE] All right thanks you too.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.