AccountId: 011433970860
ContactId: 5fd35a83-9a18-49c4-9a1d-d706f92ed1db
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 487040 ms
Total Talk Time (AGENT): 203228 ms
Total Talk Time (CUSTOMER): 213195 ms
Interruptions: 5
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/5fd35a83-9a18-49c4-9a1d-d706f92ed1db_20250603T13:58_UTC.wav
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[AGENT][NEUTRAL] I assist you?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello, thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], um, I think I have a couple questions for you. I submit, I think APL you guys changed your website because the way I used to sign in is now different and you made me create a whole new account so I can't see my prior claims.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, so yeah, we did do an upgrade and you do have to, you do have to, um.
[AGENT][NEUTRAL] Reset your username and password.
[CUSTOMER][NEUTRAL] Which I did, but now that I've, but I, it wasn't just a reset like it was a create a whole new account like it knows it's me, um, here but I can't find where to check a status on a claim.
[CUSTOMER][NEUTRAL] I mean
[CUSTOMER][NEGATIVE] I don't know where that is anymore. It was like super easy before and now there's no button to check it and when I click the link that you guys texted me.
[AGENT][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] He just asked me to sign in and it brings me back to the home page.
[AGENT][NEUTRAL] OK, so I did just, I did receive an email this morning that they're having issues, so we do apologize and it's the problem has been escalated to the technical team so they're going to.
[AGENT][NEUTRAL] I'm not sure when it, when it will be resolved, but it says that it's escalated.
[AGENT][NEUTRAL] And they're going to um
[AGENT][MIXED] They're fixing it now, unfortunately I do apologize.
[CUSTOMER][NEUTRAL] Can you check the status of my claim just so I know if I need to find more paperwork or anything?
[AGENT][NEUTRAL] Of course, I can check the status of your claim. What's your policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That would be great.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I grab my card.
[CUSTOMER][NEUTRAL] I have let's see, policy number is 02609747.
[AGENT][NEUTRAL] And can I have your name, mailing address, and your date of birth?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII]. Date of birth is [PII] and the address is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the email
[AGENT][NEUTRAL] What's the email address that we have on file for you?
[CUSTOMER][NEUTRAL] So that's the other thing that's weird. You have my work email, which is my [PII], but I just created the account with my personal email, which is my full name [PII]. So I don't know which one you can see.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] The email that you signed up when you signed up for your benefits, did you use your work email address?
[CUSTOMER][NEUTRAL] I didn't think so, but, but when I click on like I'm logged in right now and it says my details is in fact my work email [PII].
[AGENT][NEUTRAL] That's what we have on file.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So would you like to change that or you wanna leave it how it is until the technical team is done working with what they're working on?
[CUSTOMER][NEUTRAL] Yeah, I'll wait right now and and now that you've pointed that out I just found where the claims are but um I still need to talk to you because.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know what else it one, it doesn't tell me why it was.
[AGENT][NEUTRAL] Is it for yourself or for someone else?
[CUSTOMER][NEGATIVE] rejected and
[CUSTOMER][NEUTRAL] For my wife. We're having a kid and I am
[CUSTOMER][POSITIVE] I'm having a bit of a tough time here because I, as we switched insurances with the promise that everybody knows what Gap Insurance and everybody takes gap insurance and don't worry about it, they'll do all the work for you.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] And I am currently sitting in a position where that is not the case and my wife is over [PII], so we have to go to a perinatal specialist every month and it's $500 and.
[CUSTOMER][NEUTRAL] I, I, I, I don't know how this is possible. It's basically what I'm.
[AGENT][NEUTRAL] OK, so,
[CUSTOMER][NEGATIVE] They keep asking for supporting document, but I don't know what other documentation I can provide you. I gave you guys the list, and it just keeps telling me this is the 2nd time that said no we don't cover that, and I understand you don't cover office visits. That's fine. Like that makes sense to me, but I don't know what else I can possibly provide you.
[AGENT][NEUTRAL] Can I have your wife's date of birth?
[CUSTOMER][NEUTRAL] And I'm just
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] And what is your callback number just in case the call is disconnected [PII]?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. So let me see the claims that you're calling about.
[AGENT][NEUTRAL] So, on the, the treatment received in the office for the $812 it looks like we we we are requesting an itemized.
[AGENT][NEUTRAL] Bill from the provider's office with the diagnosis codes because that's what we're requesting the diagnosis codes. So let me see if that was sent in.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I don't even know what that means.
[AGENT][NEUTRAL] The diagnosis codes or the reason for the reason for her being there and itemized.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Itemized bill is like a UB or 1500 whichever place of service she's being seen at that time like which type of facility it is, so you need to contact them, the billing department and ask them for an itemized bill listing the I the ICD 10 codes because that's what your provider is requesting.
[CUSTOMER][NEUTRAL] Alright, see you then.
[CUSTOMER][NEUTRAL] ICD 10 I see.
[CUSTOMER][NEUTRAL] Sorry, say that again. I need to ask them for what?
[AGENT][NEUTRAL] Your ICDT codes, your diagnosis codes.
[CUSTOMER][NEUTRAL] ICD 10 codes.
[AGENT][NEUTRAL] Mhm, which is considered as diagnosis codes.
[CUSTOMER][NEUTRAL] And then I just need to resubmit everything?
[AGENT][NEUTRAL] Um, just the information that we're requesting.
[CUSTOMER][NEUTRAL] Because that's the other one there's no way for me to supplement. It just says I have.
[CUSTOMER][NEUTRAL] It just wants me to like resubmit everything I guess I, I don't know.
[AGENT][NEUTRAL] No, you don't have to resubmit everything all over because we already have it. We don't want you to put you through that much trouble, however, we would need that itemized bill in order to proceed with the processing of the claim that lists the um diagnosis codes.
[AGENT][NEGATIVE] There's 138 pages and no diagnosis code was listed, no information from the provider?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well you guys also asked for my um.
[AGENT][NEUTRAL] The itemized bills, the the EOBs from those dates of services, yes.
[CUSTOMER][NEUTRAL] My uh primary insurance, yes.
[CUSTOMER][NEUTRAL] I'm trying to, I gotta, I gotta ask for it I guess I don't.
[AGENT][NEUTRAL] No, we have that. We just need the dino the um itemized bill with the diagnosis codes listed.
[CUSTOMER][POSITIVE] OK, well I appreciate it.
[AGENT][NEUTRAL] That's all we need for those dates of services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I really appreciate it thank you so much for helping me.
[AGENT][POSITIVE] You're welcome. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Um, do I just, uh, do I, I just start a new claim, right? Like I just click start a new claim and add all this stuff in.
[AGENT][NEUTRAL] Mhm just start the new claim and just add the itemized bill that you received from the providers.
[CUSTOMER][NEUTRAL] OK, do I need to, it says I need to add a form.
[CUSTOMER][NEUTRAL] A claim form, do I still need to do that? I mean.
[AGENT][NEUTRAL] You don't have to add that either. You could just, no, because we already have one from the beginning with the 138 pages, so no, you don't have to do that all over again. You just need to upload the itemized bill once you receive it.
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[AGENT][NEUTRAL] And make sure you express to them that you need the diagnosis codes listed on there for those dates of services because your insurance company is requesting it.
[CUSTOMER][NEUTRAL] I will.
[CUSTOMER][POSITIVE] OK, thank you so much I really appreciate it.
[AGENT][NEUTRAL] You're welcome, [PII]. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] And I think that's it.
[AGENT][POSITIVE] Thanks for calling APL and have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.