AccountId: 011433970860
ContactId: 7dedae67-f25e-4015-a835-e9519c055e4e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 449339 ms
Total Talk Time (AGENT): 205614 ms
Total Talk Time (CUSTOMER): 183533 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/7dedae67-f25e-4015-a835-e9519c055e4e_20250407T21:16_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. Um, I have been a customer of Mirrors for a very long time, um, but I recently switched companies, and my new company also has you.
[CUSTOMER][NEGATIVE] Um, after I switched to the new company, though, I went to an urgent care center, um, and I gave them the new card, and they are, I just went back, that was in January, and I just went back over the weekend, and they made me pay them $100 cause they said you didn't cover anything, uh, that you denied the claim, um, that saying that for whatever reason.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Um, and so she told me she couldn't give me any other information, and then I needed to call you guys. So I called my insurance agent right then and there because I've used the same policy a billion times at the same place. And, um, so he said that MD now is a big giant issue with you guys, and they suck and
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, yes.
[CUSTOMER][NEUTRAL] So, um, they asked me to call the APL claims department, um, give you my policy number and my birthday, and ask them if MD now ever sent in a claim for the urgent care in January.
[AGENT][NEUTRAL] Are you still there?
[CUSTOMER][NEUTRAL] Yeah, I'm here. Can you hear me? Hello? OK, now I hear you.
[AGENT][POSITIVE] OK, yes, our phone cut out a little bit. Um, I'm gonna, I'm gonna get your callback number just in case this phone call does drop. I'll be able to call you right back.
[AGENT][NEUTRAL] up on you, OK, what is your, what is your callback number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you and what's your name?
[CUSTOMER][NEUTRAL] [PII] and the last name is [PII]
[AGENT][NEUTRAL] OK, Ms. [PII]. And what is your new policy number that you have with us now?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, the policy is 2581476.
[AGENT][NEUTRAL] OK, and we're looking to see if MD now sent in a claim for you, is that correct?
[CUSTOMER][NEUTRAL] In January, yeah.
[AGENT][NEUTRAL] In January, OK.
[AGENT][NEUTRAL] All right. I'm going to pull that policy up real quick.
[AGENT][NEUTRAL] OK, I'll need for you, Miss [PII], just to verify your policy for me. Um, what is your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can you also give me your address, phone number and email address that we have on file for you?
[CUSTOMER][NEUTRAL] For sure it's [PII] [PII] and [PII].
[AGENT][NEUTRAL] OK, I'm gonna add that email address in. So it's [PII] you said?
[CUSTOMER][NEUTRAL] No, there's no [PII].
[AGENT][NEUTRAL] Now.
[AGENT][NEUTRAL] Can you hear me, Ms. [PII]?
[CUSTOMER][NEUTRAL] No, I can.
[AGENT][NEUTRAL] OK, perfect. Oh, good. OK, I get myself worried sometimes.
[AGENT][NEUTRAL] Alright, so I do see that we did receive a claim. Um, let me see if it's from MD now we, we did receive one from MD now, um, it was for data service [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And
[CUSTOMER][NEGATIVE] But they're telling me that for whatever reason you guys did not, you guys like denied it.
[AGENT][NEUTRAL] Oh, we didn't
[AGENT][NEUTRAL] We did because they did not send in the explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] Huh?
[AGENT][NEUTRAL] So they need to send in the explanation of benefits for us to be able to reprocess the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so now the explanation of benefits, do I, where do I get that? Do I get that from the original insurance company or do I get that from MD now?
[AGENT][NEUTRAL] You get that, well, you can get it from your major medical insurance. Whoever you have your major medical insurance with, you can get that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So just call them and ask them for a copy of it and then oh my [PII], and then what do I do with it? Do I just email it?
[AGENT][NEUTRAL] Uh, don't email it because it's not, it's not safe to email. Um, you can send it in by fax. Would that be easy for you?
[CUSTOMER][NEUTRAL] Or what do, how do I
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK. I don't have a fax machine.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, OK, well you can sign up for our, our online service center.
[CUSTOMER][NEUTRAL] OK, I'm gonna put you on speaker really quick so I can put some notes down. OK, go ahead.
[AGENT][NEUTRAL] Um, let me give you that website.
[AGENT][POSITIVE] OK. It's [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And when you go in there, you're gonna sign up as a new user.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You're gonna say you're a new user and then the next option is you're an individual with an APL policy.
[AGENT][NEUTRAL] You'll choose your username and password and you can upload that EOB from there.
[CUSTOMER][NEUTRAL] OK, hang on.
[AGENT][NEUTRAL] And then just reference, let me give you the claim number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 355.
[AGENT][NEUTRAL] 9462.
[CUSTOMER][NEUTRAL] OK, now let me ask you one more question, um.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Once I do that, I had to give them $100 when I was there the other day to be seen. So how do I get that $100 back then? And once they put it through, will I get a credit from you guys or?
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] Well, we can
[AGENT][NEUTRAL] Once you send in your, your, your EOB for this one, then the claims examiners are gonna reprocess the claim, um based on what the EOB is from your primary insurance and the other day that you were seeing, you'll have to send in another claim for that date of service.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] 2 additional claim, OK.
[AGENT][NEUTRAL] And you can do that online service center also you can submit claims through there.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][POSITIVE] All right great thank you so much for your help I really appreciate it.
[AGENT][POSITIVE] You're welcome, Ms. [PII], and if you find yourself getting stuck or you need any more help, just please call us back and we'll help you through it, OK?
[CUSTOMER][POSITIVE] Thank you so much. I appreciate it.
[AGENT][NEUTRAL] You're welcome, Ms. [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] Nope, that's it. Thank you.
[AGENT][POSITIVE] You're welcome you have a good day and thank you for calling APL.
[CUSTOMER][NEUTRAL] Yeah bye bye.
[AGENT][NEUTRAL] Bye-bye.