AccountId: 011433970860
ContactId: 6f7762e5-dccb-47c3-a400-57f8f72133ed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 896400 ms
Total Talk Time (AGENT): 624782 ms
Total Talk Time (CUSTOMER): 245988 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/6f7762e5-dccb-47c3-a400-57f8f72133ed_20250327T13:17_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm trying to uh file a claim.
[CUSTOMER][NEUTRAL] Um, on my APL account I'm the administrator of my company's account, but I want in this case it's a personal.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, payment that I wanna file.
[AGENT][POSITIVE] Yes, I can.
[AGENT][NEUTRAL] I can certainly help with the claim status, [PII]. What's your policy number, please?
[CUSTOMER][NEUTRAL] It's not a status, it's a, it's to file a claim.
[AGENT][NEUTRAL] Oh, to file a claim, I can help with that as well. Um, do you have your policy number there with you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Um, give me one second.
[AGENT][NEUTRAL] It might begin with a 01 or 02, it's one of our medical.
[CUSTOMER][NEUTRAL] Policy number, it's 256-453-2.
[AGENT][NEUTRAL] Oh, I see.
[AGENT][NEUTRAL] OK, thank you. If I could verify your um your name, date of birth and the phone number, please, sir.
[CUSTOMER][NEUTRAL] [PII] um [PII]. It's my date of birth and phone number is [PII].
[AGENT][POSITIVE] Right, I do appreciate that. So I do have your policy up.
[AGENT][NEUTRAL] Now, you're wanting to file a claim for yourself or a member of your family, is that correct?
[CUSTOMER][NEUTRAL] Myself, yes.
[AGENT][NEUTRAL] OK, great. So,
[AGENT][NEUTRAL] In order to do that, um, of course, whenever you, you go into, uh, for any service, um, such as, uh, outpatient hospital, what whatever it is that we're, that we're getting ready to do, you will have the explanation of benefits from your primary insurance and I believe in this case, uh, what is it? Is it Florida Blue that you have, uh,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That is your OK, so you will have the explanation of benefits from Florida Blue for whatever service, whatever data service we are looking at and
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What you can do at that point, um, the best thing that you could do, you, you can mail it to us, you can fax it to us, um, but the best thing that you could do is go online, uh, to file your claim and what the, the documentation that we will need.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] We will need that explanation of benefits from Florida Blue, but we will also need the itemized bill, the walkout sheet, the, the, the super bill, whatever it is that you get from the provider. So, for example, if you go to the uh to the doctor for um for some sort of procedure within the physician's office, X-rays, whatever, uh, they should give you what is called a walkout sheet and what it is is it's, it's a, it's a summary of what they did that day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, and it will list, uh, what they did, what, what, what the, the reason that you came into the office, uh, and their charges for that. And then you will have that and then you will have your explanation of benefits from Florida Blue, and those are what the things that we need. So basically what we're going to need is, is what um.
[AGENT][NEUTRAL] Uh, what the doctor did, of course, the data service, what the doctor did, uh, the charge, um, and then the diagnosis code that the provider will, will give to you along with that EOB. Now, when we go to our website, which is um [PII], you'll see where it says workforce benefits that work for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And uh there is a place to to sign in um are you on our website already or?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I'm I'm signed in right now and I have the documents that I need in hand, mhm.
[AGENT][NEUTRAL] You are.
[AGENT][NEUTRAL] OK, great, now have you already had a chance to make a an account with us or um.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I have my admin account.
[AGENT][NEUTRAL] Uh, OK. Um.
[CUSTOMER][NEUTRAL] No, I think I have my personal because I only see my, I, I, I only see my personal information here, not my company's.
[AGENT][NEUTRAL] That's good. OK, that's where awesome, that's what you're gonna want to do. So when you, when you get logged in, uh, you will see that there is a, uh, um, I don't believe it's on the right hand side it says start a claim and all you'll do is just follow the uh the prompts in order to um scan those documents into the system and, and submit them. So that is what we are looking for um.
[CUSTOMER][NEUTRAL] So yeah I'm logged in right now.
[CUSTOMER][NEUTRAL] I don't have that. I don't have that button here start a claim. I don't have that one, no.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] You don't? OK. Let's see.
[AGENT][NEUTRAL] Hm, OK.
[CUSTOMER][NEUTRAL] I only have log out upper right I only have log out and I have my account when I click on my account, I'll drop down list says policy contact information, notification preference preferences, payment preferences, and then on the left side contact us claim forms help.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then there's a little house.
[AGENT][NEUTRAL] I see, so that may not be.
[CUSTOMER][NEGATIVE] So maybe this is the ads.
[AGENT][NEUTRAL] That might be because if you were, I, I think if you were on, if you were on um your uh if you're on your personal one, it would, it would give you uh how to uh it it would have that information on it, so, um.
[CUSTOMER][NEUTRAL] Maybe this is
[AGENT][NEUTRAL] So, uh,
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Is there any way that you could back out of that, um.
[CUSTOMER][NEUTRAL] Yeah, yeah, you want me to click on new user?
[AGENT][POSITIVE] Yes, please, and then we could.
[CUSTOMER][NEUTRAL] And trying uh a different email because the email that I have is already already registered in.
[CUSTOMER][NEUTRAL] The admin one release.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, let's see what you have on your, on your file. Um, let's see, uh.
[CUSTOMER][NEUTRAL] Known as
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because you'll probably for your own for your own claims you'll probably want to uh have your own so what is your uh it looks like there's a Gmail account that is associated with your personal.
[CUSTOMER][NEUTRAL] Yeah, that's my personal email, yeah.
[AGENT][NEUTRAL] OK, so that's
[AGENT][NEUTRAL] Yeah, so that's probably where you want to start.
[CUSTOMER][NEUTRAL] But I can use another email.
[AGENT][NEUTRAL] Well, do you want to change this email? Do you want to change it from your uh Gmail one because it's
[AGENT][NEUTRAL] It's just that you, you probably want to.
[CUSTOMER][POSITIVE] I can change it, yeah.
[AGENT][NEUTRAL] It's just that you probably want one for your admin, uh, um, uh, you probably want to associate one email with your personal one and one with your, your uh duties as as the admin.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So, uh,
[CUSTOMER][POSITIVE] You're right.
[AGENT][NEUTRAL] Yeah, so when you're signing in on your
[CUSTOMER][NEUTRAL] OK, let me change the email.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm, policy contact information, where do I change the email?
[CUSTOMER][NEUTRAL] But it's weird because I don't see my company's information. I don't see my personal here.
[AGENT][NEUTRAL] Well, what
[CUSTOMER][NEUTRAL] I don't see nobody else I just see my company.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] I mean I just see my my my personal stuff, you know what I mean?
[AGENT][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] So, so, OK, so let's, OK, so we've gone into um.
[AGENT][NEUTRAL] Uh, do you already have a username and a password? Let me put it that way.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and is it for your admin or for your personal?
[CUSTOMER][NEUTRAL] I guess it's for my personal because I'm not seeing my people anymore. I just see my personal stuff.
[AGENT][NEUTRAL] OK, so when you're there on that, on that screen, um, it should say what there should be a screen that says my claims.
[CUSTOMER][NEUTRAL] Mm, yes, there's a list of claims from me and my family, yes.
[AGENT][NEUTRAL] OK, now that there should be a square that says my claims and it says need to file a claim and then there's a a little uh square that says start here.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] No, I only have one green button that says upload files to existing claims.
[AGENT][NEUTRAL] OK, well that that's it, that's it. That's it's the same, yeah. So what you'll want to do is um that is how you're gonna upload the files to, to your uh um to your personal account and uh that is, so what we're gonna be looking for again is the explanation of benefits from uh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][POSITIVE] [PII].
[AGENT][NEUTRAL] [PII]. We're gonna need the documentation from your provider, and that is going to be uh like the walkout sheet and make sure, uh please that it's uh, that on your explanation of benefits, it shows a deductible, co-payment or co-insurance and that also on your um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I got that.
[AGENT][NEUTRAL] The paperwork from your provider that it shows uh a charge and then a diagnosis code or basically an assessment. Sometimes they, they call it an assessment that's basically you came into our office today because of, of whatever hypertension, pinched nerve, whatever it is, um, they will have that listed on there. And then once we receive that, it takes about 8 to 10 business days for us to process that. Now, we'll get these things in real time, um, but, uh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] What's the name of the document from the from photo that I need again?
[AGENT][NEUTRAL] It's called an explanation of the, yes, yeah, and um you will find it on their site as well as uh as well as they're supposed to mail you one but uh you will also find all of your claims on their site or you can call your um claims advocate that will be on the back of your card, your Florida blue card, and they can provide you with copies of, of the ELBs um for the specific dates that you need.
[CUSTOMER][NEUTRAL] Explanation of benefits?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you've got a couple of different ways of doing that.
[CUSTOMER][NEUTRAL] And um and another thing.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Another thing I, I tried to update my payment preferences and I put my um direct deposit information.
[CUSTOMER][NEUTRAL] But the bank that is coming up is not my bank. It's my, it's my routing number is correct, my account number is correct, but the bank, it's not the, it's not my bank.
[AGENT][NEUTRAL] OK, yeah, we've had uh that sometimes comes up. Um, OK, so let's talk to, uh, we can talk to um.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Customer service about that uh.
[AGENT][NEUTRAL] Yeah, so is it, is it just, it's just a totally different bank, right? Is that what?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, well, excuse me just a moment, [PII]. I'm gonna check with our customer service department. I'm not sure that, I mean sometimes that those things will come up and it's very confusing because what they'll do is that they'll have a drop down menu of different banks and then you put in your information and it's just it's.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, sometimes the right bank comes up and sometimes it doesn't. So excuse me just a moment, please. We'll just check and see whether that's, uh, it's gonna be a problem. Excuse me, just one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Yeah, hi, um, this is [PII] in, in the claims department. I'm talking to a gentleman.
[AGENT][NEUTRAL] Uh, and I was helping him, uh, on our, um, online service center and what he's trying to do is he's filling out.
[AGENT][NEUTRAL] The direct deposit slip, uh, so that he can, um, you know, he can turn that in. So he put in his, his routing number and his uh account number, but the bank that's coming up is completely different and um I've had this happen before on other things that I've tried to, to put a, a thing on. I'm just wondering if you've ever heard of something like that or is that gonna be a problem because he's, he's checked and rechecked his routing number and his account number, but when it, you know, when it auto populates the bank, it's coming up with a different bank.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Number. So is that a problem or is that uh
[CUSTOMER][NEUTRAL] Um, all right. I have this happened before and um it doesn't affect anything. It's just how it's listed on the system. Um, I do think that [PII] or [PII] can um get into the system and correct the name.
[CUSTOMER][NEUTRAL] But it, that's only at supervisor um or manager level that they can do that change if it's um making the insured a little bit concerned about it. Um, but it doesn't affect anything.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] OK, that's what I was thinking because um like I said, I've had that happen before, um, and it just, I don't know why it does that, but yeah, that's exactly what I want to tell him, so I really do appreciate that. Thank you very much and I'll just let him know that and then if he has any questions, then, yeah. OK, thank you very much. Thanks.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Mhm. You're welcome.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK great so I talked to our um our uh uh customer service department. It's not unusual for that to happen. So what we do, um, it, it doesn't really mean anything because what we're doing is we're gonna be using uh your, your routing number, which is the most important thing, but as well as your, your account number. But what if for whatever reason it auto populates into, into a certain bank. So what we do at that point is when you turn it in.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We will make uh one of its supervisors goes in and does a uh where we actually go in and we uh.
[AGENT][NEUTRAL] Correct it by hand, so to speak, rather than it just auto populating. So it's not necessarily a problem, it's just, it's just confusing. It, it, it just, and we don't know why it does that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So what we have to do is we have to go in each time that that happens um unfortunately it doesn't happen that often, but when it does, uh, a supervisor goes in and uh um corrects that. So what I'm doing is that if you're turning that in, I will send in a request once that comes through for that to be uh corrected to the name of your bank.
[CUSTOMER][NEUTRAL] OK, my bank is Wells Fargo. I am.
[AGENT][NEUTRAL] But that's it, yeah.
[AGENT][NEUTRAL] Wells Fargo, OK. All right. Wells Fargo, OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, that should come up, but I don't know why it doesn't then it's so they just have to autocorrect them. Now, is there anything else that we need to do besides, uh, that you, you know how to, to file a claim now? Do you, do you have any questions about the documents to be submitted?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm trying to find the explanation of benefits online. I know I get it in the mail all the time. I throw it away. Thank you. Now I need it and I, I can't find it online, but I'll look for it.
[AGENT][NEUTRAL] It
[CUSTOMER][NEUTRAL] I'll find it
[AGENT][NEUTRAL] Yeah, I would never throw away that. I know that it's just one more bit of paper that, you know, that you don't really want to have to deal with, but yeah, that's, but I would really keep those things because, um, you're gonna want those each and every time because we're your secondary, uh, um, uh, insurance, we always will need that and, and uh Florida Blue won't send it to us, uh, you know, directly to us. So, um, you're always gonna want that kind of thing and uh.
[CUSTOMER][POSITIVE] Yeah, it's so much cheaper.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah, so is, um, so if you do have any questions when you do start submitting, uh, just let us know, um, but, uh, but we will certainly get that, uh, your direct deposit thing corrected so that you're when we do, uh, pay out a claim we can get that to you as quickly as possible.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] OK, well, thank you very much for contacting EPL [PII].