AccountId: 011433970860
ContactId: 666fee79-a7ea-4a42-a9d0-205a7b29e583
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 429200 ms
Total Talk Time (AGENT): 134003 ms
Total Talk Time (CUSTOMER): 192560 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/666fee79-a7ea-4a42-a9d0-205a7b29e583_20250429T16:50_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi, good afternoon, [PII]. I just needed some assistance with uh with a claim. Uh, I tried to do it online, but I don't know if I did it right and then I have another claim today that I need to process.
[AGENT][NEUTRAL] With the
[AGENT][POSITIVE] I'll be happy to assist. May I have your policy number, please?
[CUSTOMER][NEUTRAL] As the group number or pay is that what you're looking for?
[AGENT][NEUTRAL] Um, no, it would say inpatient or outpatient, um, cert number.
[CUSTOMER][NEUTRAL] Yeah, I've, yeah, they're both of them. It's, it's I guess it's outpatient general, uh, it's 025.
[CUSTOMER][NEUTRAL] 937
[CUSTOMER][NEUTRAL] 64 M as in Mary, L as in Lima, the number 8.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, if you could verify your date of birth and email address.
[CUSTOMER][NEUTRAL] It's [PII]. I'm sorry, it's uh [PII], and I don't know if it is my employer email or it's my personal email I can.
[AGENT][NEUTRAL] Uh, this is a, it looks like a personal one to me.
[CUSTOMER][NEUTRAL] Yeah, so it's, it's probably [PII] or just [PII]. I'm, I'm not sure which one I used.
[AGENT][NEUTRAL] OK. [PII]. OK.
[CUSTOMER][POSITIVE] Yeah, that's it. I just found it OK.
[AGENT][NEUTRAL] So you wanted information on how to submit a claim?
[CUSTOMER][NEGATIVE] Yeah, I, it, it just wasn't letting me do it online. I, it just kept loading and loading. I've tried on multiple computers.
[AGENT][NEUTRAL] Hm, that's odd.
[CUSTOMER][NEUTRAL] And um it's I had a claim for, for it was a.
[CUSTOMER][NEUTRAL] A specialist visit for a co-pay. I'm not sure if that's something that's covered or.
[AGENT][NEUTRAL] Um, it looks like the.
[AGENT][NEUTRAL] The physician's charges was denied, but the treatment or services that you received at the visit.
[AGENT][NEUTRAL] Is covered, but we needed the diagnosis code.
[AGENT][NEUTRAL] For the visit.
[CUSTOMER][NEUTRAL] Yeah, I'm not sure what it was, it was, it was an ENT visit.
[CUSTOMER][NEUTRAL] I'm not sure what the diagnosis code would be.
[AGENT][NEUTRAL] Yeah, so you would.
[CUSTOMER][NEUTRAL] Was it your neck and throat doctor?
[AGENT][NEUTRAL] OK, so you would contact them and let them know that you need the diagnosis code for that data service.
[CUSTOMER][NEUTRAL] OK and then how, how to resubmit it? Do I just uh upload the file?
[AGENT][NEGATIVE] Well yeah, you should be able to just upload the file but you're saying it's not working.
[CUSTOMER][NEUTRAL] Like, and the benefit?
[CUSTOMER][NEGATIVE] Yeah, I was, I was having a difficult time.
[AGENT][NEUTRAL] Um, I, the only other way I can give you a fax number where you could fax it over.
[CUSTOMER][NEUTRAL] I'll, I'll try to do it online.
[CUSTOMER][NEUTRAL] And um for the, I just went to my primary care today. Um, is there a specific code for that I need to choose or?
[AGENT][NEUTRAL] What do you, what do you mean by a specific code? I'm sorry.
[CUSTOMER][NEUTRAL] Mhm. Uh, how would I submit that?
[AGENT][NEUTRAL] The same way you would upload it.
[AGENT][NEUTRAL] Uh, you said you were gonna use the online?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right then.
[CUSTOMER][NEUTRAL] I gave it a shot.
[AGENT][NEUTRAL] OK, do you wanna take down the fax number just in case?
[CUSTOMER][NEUTRAL] Like because it asks for it, it asks for a reason code usually, and I'm, I'm not sure what for primary care it would be.
[AGENT][NEUTRAL] You said a recent call?
[CUSTOMER][NEUTRAL] Yeah, I think it it asked last time for a reason code.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Yeah, it's like X-ray and there was just nothing that was applicable.
[AGENT][NEUTRAL] Just as a bit of clean?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] There's nothing that was really applicable.
[AGENT][NEUTRAL] That
[CUSTOMER][NEGATIVE] That's what I was having trouble with.
[AGENT][NEUTRAL] I'm sorry, uh, so it's not allowing you to just.
[AGENT][NEUTRAL] Upload the documents? Oh.
[CUSTOMER][NEUTRAL] No, I can upload the PDF. I can upload the document and then on the next screen it's gonna ask you for like which, like what kind of event was it? Was it like an X-ray, a blood screening, there's just nothing clickable?
[CUSTOMER][NEUTRAL] That related to the treatment.
[AGENT][NEUTRAL] And you're not falling under the wellness, are you?
[CUSTOMER][NEUTRAL] No, following under Med link select group med supplement.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The policy ends in 764.
[AGENT][NEUTRAL] OK, I'm sorry I just didn't know that they asked you that question.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Well, how did you, because we received a claim from you, the last time you did it, it didn't ask you that?
[CUSTOMER][NEGATIVE] Yeah it looks like it was denied.
[CUSTOMER][NEUTRAL] It did ask me for that. I chose whatever was the closest reason to it.
[AGENT][NEUTRAL] So the
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] There was nothing for like a specialist visit.
[AGENT][NEUTRAL] Oh, OK, well, however you got it to go through when you submitted it on the [PII], do that again because we manually look at it. The, the system is not gonna process the claim. We actually manually look at the documents that you send in and process.
[CUSTOMER][NEUTRAL] Yeah, I know, I, I, I figured that I uploaded the explanation of benefits from the uh insurance this website. I, I just uploaded that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And it was, it was denied.
[CUSTOMER][NEGATIVE] I, I, I just, that's what I was having trouble because everything is listed on there the copay, how much they pay, how much I, I was responsible for paying and I was denied.
[CUSTOMER][POSITIVE] It's pretty detailed.
[AGENT][NEUTRAL] Right, and we asked you what, it didn't have the diagnosis, so we asked you, we were asking you for the diagnosis code.
[CUSTOMER][NEUTRAL] It says the treatment
[CUSTOMER][NEGATIVE] There's just nowhere to upload that. That's what I'm trying to say. There's nowhere to even write that.
[AGENT][NEUTRAL] No, you're gonna upload the documents.
[CUSTOMER][NEUTRAL] When I submit it.
[AGENT][NEUTRAL] You're gonna upload the documents.
[CUSTOMER][NEUTRAL] I, I just might just let this go. This is even more hassle and it's worth it at this point for $60.
[CUSTOMER][NEGATIVE] The websites are not very intuitive.
[CUSTOMER][NEUTRAL] I'll, I'll give it another shot. I'll see what happens.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Sounds good.
[CUSTOMER][NEUTRAL] I'll see if I can get a diagnosis code, but there's just nowhere to put it even if I.
[CUSTOMER][NEUTRAL] Uh, I requested from them. There's nowhere to input it, so I'm not sure where this is really going.
[AGENT][NEUTRAL] You're not
[AGENT][NEGATIVE] You're supposed to, it's supposed to be a document. It's not something that you're gonna write in.
[AGENT][NEUTRAL] On the thing.
[CUSTOMER][NEUTRAL] OK, because I thought the um.
[CUSTOMER][POSITIVE] The explanation of benefits has everything.
[AGENT][NEUTRAL] And it doesn't have the diagnosis, your medical diagnosis.
[CUSTOMER][POSITIVE] Alright, I'll see if I can log into the provider's website if there's anything and I'll upload that. Alright, thank you. I appreciate it.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you for calling APO you have a good day.