AccountId: 011433970860
ContactId: 61de5270-4472-427d-8284-bb6a36ad3ae0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 610380 ms
Total Talk Time (AGENT): 263928 ms
Total Talk Time (CUSTOMER): 231409 ms
Interruptions: 7
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/61de5270-4472-427d-8284-bb6a36ad3ae0_20250310T13:24_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], uh, calling, and I have a question regarding um how to submit a claim.
[AGENT][NEUTRAL] OK, um, sure, I can assist you with that information, Ms. [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII] God, I'm giving you my work number. [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, thank you. And do you have the policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes, it is 02559263.
[AGENT][NEUTRAL] For security, may I have your date of birth, mailing address and email address?
[CUSTOMER][NEUTRAL] [PII]. Email addressk [PII].
[CUSTOMER][NEUTRAL] And my uh mailing address [PII].
[AGENT][POSITIVE] Perfect, thank you. OK, and you said you have questions about submitting a claim?
[CUSTOMER][NEGATIVE] Yes, I, because I got a statement, well, I had just called and I asked if uh a deductible is covered and I was told that yes. So when I called, because I got an invoice for an MRI that I did back in November, and they told me that they don't accept American public life.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So they don't bill for it, or that I have to do it myself?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] OK. Um, so you need um instructions on what else is needed to add to the claim form?
[CUSTOMER][NEUTRAL] Yeah, like, what do I need, like, how do I submit it? How does it work?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, um, do you have the copy of the claim form?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Do you mean like a HCA or just the invoice that they submit that they sent me?
[AGENT][NEUTRAL] No, the claim form. OK, let me go ahead and give you instructions altogether. OK, so you're gonna need the first, yeah, it's OK. The first document, the first document you're gonna need is a claim form. The claim form you can find it in our website at [PII].
[CUSTOMER][NEUTRAL] OK, but.
[CUSTOMER][NEUTRAL] OK. I'm, I'm on your website, um,
[AGENT][NEUTRAL] OK, so click on claims and forms.
[CUSTOMER][NEUTRAL] OK. I'm sorry, but it, it just asked me to change my password.
[AGENT][NEUTRAL] Oh, OK, well, you don't have to go into your account for the form you go to the home page.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, OK, so then, hold on, I'm not in the right place then. Um, do I go with the one that says?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it's fine. Just go ahead and take your time and change the password. If you want to do that now, I'm not in a rush, so just go ahead and do that and then we can go and get the form.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, so I already changed it.
[AGENT][NEUTRAL] OK, perfect. OK, so now, um, if you are on your account, you're gonna see a uh a link that will take you to the claims and forms so you can go ahead and click click on claims and forms.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, it's not where, where I'm at, it says need to file a claim and a question mark. I guess there?
[AGENT][NEUTRAL] No, um, it's gonna be in the top part. It's gonna say claims and forms in the top part. If you don't see it there, just go to [PII].
[CUSTOMER][NEUTRAL] OK. Because
[CUSTOMER][NEUTRAL] Yeah, because it's asking me for like, if I wanna check claim status, like if I'm a provider.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh Lord.
[CUSTOMER][NEUTRAL] OK, download ID file claims online, view policy documents, and more.
[CUSTOMER][NEUTRAL] I don't see.
[AGENT][NEUTRAL] Um, do file claims online unless you, OK, do you have anything that says um claims and forms?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And I went to the [PII].
[AGENT][NEUTRAL] OK, that's fine. OK, go to the [PII] without secure.
[CUSTOMER][NEUTRAL] OK. Claims and form. OK, now I see claims and forms.
[AGENT][NEUTRAL] Mhm, yeah.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then you're gonna look for meddling claim forms.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I, sorry, I don't see it.
[AGENT][NEUTRAL] You see, OK. It's gonna be, let's see, let me tell you a sec.
[CUSTOMER][NEUTRAL] Uh, OK, claims on forms, it says file claims online. Other ways to submit your claims. It says mail paper, fax documents.
[CUSTOMER][NEUTRAL] Uh, claims forms and policy claims documents.
[AGENT][NEUTRAL] OK, what
[AGENT][NEUTRAL] Mm OK.
[AGENT][NEUTRAL] Um, OK, so, uh, when you see claim forms and policy change documents just keep scrolling down.
[CUSTOMER][NEUTRAL] And then it's
[AGENT][NEUTRAL] And then you're gonna go to the 2nd page.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so hold on, OK.
[AGENT][NEUTRAL] And it's gonna be the 3rd 1.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEGATIVE] Because it starts giving you like hospital loss of life and all that. Oh, Medli, oh God, OK. I no form.
[AGENT][NEUTRAL] Uh, Netlink. Mhm. That's OK.
[CUSTOMER][NEUTRAL] And that's, OK.
[CUSTOMER][NEUTRAL] So, this form, which is 3 pages, uh-huh.
[AGENT][NEUTRAL] 3 page. OK, so that's gonna be the first document you're gonna need, um, just fill that out and then on the first page you're gonna see instructions on what else is needed, which is the itemized bill with the diagnosis code from the provider and the second document is the explanation of benefits from the primary insurance showing how much they apply towards the deductible co-payment and co-insurance.
[CUSTOMER][NEUTRAL] OK, primary EOB.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it's gonna be those 3 documents and that's gonna be a full claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect and then I can.
[CUSTOMER][NEUTRAL] Fax it
[AGENT][NEUTRAL] You can fax it, you can mail it, or if you are you already registered online, so you can just click on um file a claim online on your account.
[CUSTOMER][NEUTRAL] Oh how would I submit it?
[AGENT][NEUTRAL] Um, upload documents, you will go to, yeah, uh, upload documents and you can just upload it.
[CUSTOMER][NEUTRAL] Oh, OK, and I will upload it there, OK.
[AGENT][NEUTRAL] Through your account.
[CUSTOMER][POSITIVE] Perfect perfect.
[CUSTOMER][NEUTRAL] And, and, um.
[CUSTOMER][NEUTRAL] How about if it's a co-pay that they charge me up front uh at the doctor's office, so I don't technically have a bill.
[AGENT][NEUTRAL] Is it a co-payment for the visit or is it a procedure they did in the office? OK. Um, let me check. I don't, I'm not sure if it's covered under the policy. Mhm.
[CUSTOMER][NEUTRAL] Yes, a co-payment for the visit.
[CUSTOMER][NEUTRAL] OK, because I, I asked when I called previously right now, and the girl told me yes, but I'm like,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I, I think I remember when the, when we got this insurance that the gentleman that presented the insurance said that copies were not covered.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm. Yeah. Uh, I believe that's right. Um, let me check just to make sure, let me pull your documents. I know it will cover a co-payment like if you go to an ER visit or a diagnostic center, a surgery center, somewhere like that, yes, um, but the office, um, I don't believe so. Let me check. Yeah.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK. Yes, please.
[CUSTOMER][NEUTRAL] Yeah, like a specialist.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Mm. Yeah, this one doesn't have an office visit benefit. So, yeah, the co-payment for the office visit will not be covered only if it's a co-payment for like again, an ER visit, a diagnostic center, or a, a surgery center.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You too.
[CUSTOMER][POSITIVE] OK, uh, I'm glad I asked again because I was gonna start calling everyone and be like, give me my money back.
[AGENT][NEUTRAL] Yeah, I'm sorry for that. Yeah, but now the office visits are not covered on their co-payments, OK.
[CUSTOMER][POSITIVE] OK, perfect. Thank you so much for your help.
[AGENT][NEUTRAL] You're welcome. Is there anything else I may help you with today, Miss [PII]?
[CUSTOMER][POSITIVE] That's it. Thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.