AccountId: 011433970860
ContactId: 6c5aeb03-a309-4e3e-915d-338920d4275c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1031219 ms
Total Talk Time (AGENT): 608504 ms
Total Talk Time (CUSTOMER): 344579 ms
Interruptions: 13
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/6c5aeb03-a309-4e3e-915d-338920d4275c_20250122T14:22_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 [PII], uh, I had, uh, faxed over an explanation of benefits and, uh, I was just kind of checking on the status of that. You need the claim number?
[AGENT][NEUTRAL] Well, first off, so you're just wanting to verify if the fax was received or check status to see if the claim's been processed with.
[CUSTOMER][NEUTRAL] Well, it, it was the whole process, uh, I was checking to see, uh, why that, uh, bill had been paid.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, yes, I can help you. I can help you with this. And who am I speaking with?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] This is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And Mr. [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] Thank you. And your policy number, please?
[CUSTOMER][NEUTRAL] Policy number where uh
[CUSTOMER][NEUTRAL] Oh, OK, um, it's uh 0025666464.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Thank you. One moment for me to get your information all pulled up. Once I do, Mr. [PII], I will have to verify several things with you first for security.
[AGENT][NEUTRAL] So just one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What uh first off is your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And your home mailing address, please?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] Thank you. The phone number we have for you is the same as the one you gave me, so that is your best contact number, is that correct?
[CUSTOMER][POSITIVE] Uh, yes, that's correct.
[AGENT][NEUTRAL] Thank you and lastly, Mr. [PII], do you have an email address because we do not have one on file for you.
[CUSTOMER][NEUTRAL] It's uh [PII]
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so I have gotten your email added Mr. [PII] and I'm also going to be emailing you a an instruction guide for our portal it's a user guide and it explains how to set up your profile and the different ways that you can use our portal um this is just a convenience for our customers it gives you access to the claims we have on file for you you can upload information from a computer to us for review.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You have access to your ID cards and also your policy information in this portal. Now when did you and that email will come to you, you know, in just a few minutes, and the email will be sent from care team at [PII] and I will put a PO in the subject line for you so that that's easy for you to recognize.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so just 1 2nd.
[AGENT][NEUTRAL] OK, and Mr. [PII], when did you send your fax to us? Cause I don't see anything at this time on your profile. Well, it doesn't appear that we have received it.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It'll be uh
[CUSTOMER][NEUTRAL] It's been uh last [PII].
[AGENT][NEUTRAL] So yes sir anything that we would have received last week would already be in your.
[AGENT][NEUTRAL] Should be on your profile.
[AGENT][NEUTRAL] And I don't see that we have received anything. Do you know the fax number that you sent it to? So we can verify that you have it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII].
[AGENT][NEUTRAL] Yes, sir, that is the correct fax number for our claims division. Did you receive a confirmation?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, I put uh
[CUSTOMER][NEUTRAL] Yeah, it says OK that went through. I, uh, put, I, I did like a cover sheet and, uh, attention to [PII] because that was the young lady that gave me this information and then and, uh, the, the reason I put that claim number on there.
[AGENT][NEUTRAL] OK, let me look at it some other in give me just a moment to look at another um.
[AGENT][NEUTRAL] Oh, I think I, OK, give me one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that policy number that you gave me, you also have that policy, you have another policy number, so I'm gonna cross reference and see if it was received under the other policy because policy number 01986340.
[AGENT][NEUTRAL] Is a policy that has been active for you since [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Was your date of service between [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The what I got billed for you mean?
[AGENT][NEUTRAL] Mhm, yes, sir.
[CUSTOMER][NEUTRAL] It, yeah, it was in September of last year.
[AGENT][NEUTRAL] Oh, OK. Well, then let me look, OK, so we, it may be on that policy number, so give me just a moment.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Yeah, I got my new card here that uh the one I got on the the first.
[AGENT][NEUTRAL] And that one went right, and that one went into effect [PII]. So it's gonna be probably under your other policies. Just one moment, please.
[CUSTOMER][NEUTRAL] Wouldn't have it on that, would it? OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the data service, Mr. [PII] for the claim that you submitted the information for?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And how much was the bill amount?
[AGENT][NEUTRAL] Cause we have multiple things. Uh-huh.
[CUSTOMER][NEUTRAL] It was uh 200.
[CUSTOMER][NEUTRAL] Yeah, it's $214.62.
[AGENT][NEUTRAL] OK. So I do see that we received information on the [PII] and it was also processed the same day. This is for the AHS Oklahoma physician Group. Is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] OK, so yes, so we have processed that claim with a benefits payable to them in the amount of the 21462.
[AGENT][NEUTRAL] And that was issued on the process date. So they just haven't had time to receive that yet.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK, y'all, y'all did pay that then.
[AGENT][POSITIVE] But yes sir it was received, uh huh and once you set your profile up in that portal that I was referring to, you're gonna be able to see that information and you will also be able to see the uh claim number and everything and a copy of your explanation of benefits will be accessible from there as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh OK oh OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, well, uh, let me ask you something. Whose responsibility was it to, to send you all that explanation of benefits?
[AGENT][NEUTRAL] Whoever I mean anyone can send it. It's just because this is a supplemental policy.
[AGENT][NEUTRAL] We will always have to have a copy of that. And um along with the claim for review.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And I can see since the provider filed this, they just didn't send that with it, um, you know, a lot of times they may not know that they need to do that, but it can always be submitted. So for example, if we have reviewed this but we didn't have that, and that was why it was denied, you know, once you submit it, then the claim just continues to be processed because with APL Mr. [PII], we do not have a timely filing limit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Like other insurance companies, a lot of them do. But on our claim form,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For this type of policy, if you ever have to file your own claim completely, if for some reason, a provider doesn't file your supplemental coverage, you can file your claim. And
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On our main web page at [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] When you click on that page.
[CUSTOMER][NEUTRAL] Alrighty, because I got another bill on my uh my chart thingy this morning.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] Mhm. Uh-huh.
[CUSTOMER][NEUTRAL] So I'm gonna have to probably send that one to y'all.
[AGENT][NEUTRAL] Well, the claim form what I was gonna say if you go to our web page and click on the claims and forms tab and scroll down the page, you're gonna see a little box that says filter by product with a green drop down arrow click on that drop down arrow. It gives you a list of different things. You're looking for the word med link like it's on your card.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] And if you click on that link, then it's going to out to the right, you should see a blue button that says download form.
[AGENT][NEUTRAL] That's the claim form that you would need to submit, but on the top of the first page of that claim form, it gives you the instructions for what we need in reviewing this type of claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But, but y'all did take care of the 21462.
[AGENT][NEUTRAL] Yes, sir. We have issued a payment to the provider. Yes, sir.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, I'm not getting enough information on this other one. it says the same day except to the [PII], but I know it wasn't in two places that day, so I don't understand what they're, they're doing here. So I'll get a hold of them and have them send me something about the actual date and stuff because it wasn't the [PII], so.
[AGENT][NEUTRAL] Oh, OK. So you need to verify that. OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, because it didn't even make, yeah, I mean, I know I went to places that day, yeah, so.
[CUSTOMER][NEUTRAL] Anyway, I'll, I'll try to get this figured out. I'll give them a call and I can sort it out, but it is it actually the people that want their money like uh the uh AHS, uh, Oklahoma physicians group, it's kind of their responsibility because I make them aware of my secondary insurance APL.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, isn't it kind of a responsibility to send that to y'all?
[AGENT][NEUTRAL] Right. And it's up to the pro well, it's up, it's, it's up to the provider, you know, we, we don't determine any form of patient responsibility or who's responsible for filing the claim. For example, if you had submitted this claim in full, you know, and we were able to pay this benefit, you know, the, the payment would have been issued to you. Um, so it's really whoever's filing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, if, if I, if I pay it, if I pay it, then y'all will reimburse me if it's if, if y'all can, I mean.
[AGENT][NEUTRAL] If you had filed the claim, if you filed the claim.
[CUSTOMER][POSITIVE] Yeah, OK, I got you.
[AGENT][NEUTRAL] Mhm, mhm. So it's just whoever files the claim, really.
[CUSTOMER][POSITIVE] OK, alrighty.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, OK. All right, this is all new to me. I'm trying to get it sorted out, so I appreciate all your help though. You're making it a lot, a lot clearer, so I appreciate that, so.
[AGENT][POSITIVE] Sure, OK. Well, I'll be happy to.
[AGENT][POSITIVE] Oh, well, well, you're very welcome. [PII], do you have any other questions that I can try and help you with?
[CUSTOMER][NEGATIVE] No, uh, you're gonna send me the email and I'm gonna get, uh, signed up for that. I tried to sign up for it the other day, but it wouldn't let me go past the, uh, Social Security number, and I really didn't wanna put that on there, and I was putting my policy number and says they didn't want that, and so I didn't know what to put on there, yeah.
[AGENT][NEUTRAL] Yes, sir. I have.
[AGENT][NEUTRAL] Yeah, and if you'll notice, right. The secure, yeah, you have to use your social security number for the one time. Uh-huh. You won't ever have to put that in again, but the, for the initial setup due to the level of security um within our system, it is required for that first setup.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Yeah, I'm getting real I'm older and I'm getting leery of putting my social security number out there for any reason, you know, I mean like this scary.
[AGENT][NEUTRAL] Yes, sir. I, I know, I under I understand, um, but that's the only, that's the one and only time because that's how, that's one of the critical pieces of information that we receive for enrollments, so.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, so
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I bet y'all had it already anyway I just been kind of silly but you know.
[AGENT][POSITIVE] Uh, no, I, in this day and time, I, no, sir. I totally understand. I'm the same way, you know, in a lot of, a lot of times that, you know, I can assure you that this site for our portal is extremely secure. It it is and, and.
[CUSTOMER][NEUTRAL] Uh, anyway,
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, well, I was, I was on a computer. I didn't completely trust, you know, that I, you know, I got all the, you know, uh, software I mean the, you know, malware stuff on, so I I didn't do it, so.
[AGENT][NEUTRAL] Mhm. Yeah, I would definitely do it from a, you know, something that you feel obviously secure and all of that and doing it from. And another thing too, um, once you do set it up, the you can log in from your mobile device to look at things, but if you have to submit something to us for review, you will have to do that from a computer. It does not support mobile functionality.
[CUSTOMER][NEUTRAL] Yeah, I got that.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] At this time, the portal doesn't.
[CUSTOMER][NEUTRAL] OK. uh, now let me ask you one more thing, [PII]. Uh, I, I have a deal with uh Blue Cross Blue Shield, so I can, if y'all need the explanation of benefits, I can download that. I mean, I can, uh, save that stuff and just email it to y'all without doing the fax or do I have to do a fax? OK, I fax it.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] You can email it. Well, you can't email it. We, we do not accept claims due to security. We don't accept any type of medical information like that via email. It either has to be uploaded to that secure portal or faxed to the secure fax line that you already have or mailed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] But, but I can upload it to the portal that I'm, uh, if I have it open. Oh, OK, OK, yeah, I think that's what I'm mean. Heck, I don't know what I'm talking about emailing it, so, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And yeah, and when you upload it, you know, you can even though you got your fax confirmation and we did receive it, you know, sometimes fax can be a little tricky, but, and that takes a little longer to process as far as getting into the system, whereas when you upload.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mr. [PII] into that portal, you get a confirmation number and then you can actually see that that's if you log into your portal you can see that um it was received and it's in line for processing. And then once we've been reviewed once it's been reviewed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, cool. Well, that's the way to do that then.
[AGENT][NEUTRAL] Then you would see a claim number assigned to it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, OK. All right. All right. I thank you so much. That, that made everything so much clear. [PII] was real nice the other day, but I was just like trying to figure out, OK, OK, I had all these scribblings and stuff I was trying to sort for you today, so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, well,
[CUSTOMER][POSITIVE] Alright, well I appreciate you, [PII] you're very, very helpful.
[AGENT][POSITIVE] Well, well, you are very welcome. It was my pleasure. So if that's all at the moment that I can help you with, thank you again for calling APL.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] Not accurate.
[CUSTOMER][NEUTRAL] Oh no, not at all. So have a wonderful day, OK.
[AGENT][POSITIVE] So, well, I hope you have a wonderful day too, and thank you again for calling.
[CUSTOMER][NEUTRAL] Hi yeah bye bye.
[AGENT][NEUTRAL] Yes sir, bye bye.