AccountId: 011433970860
ContactId: 7fe1e871-b273-44cd-bda9-b9028df0bd1f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 688340 ms
Total Talk Time (AGENT): 348261 ms
Total Talk Time (CUSTOMER): 388965 ms
Interruptions: 14
Overall Sentiment: AGENT=1.3, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/7fe1e871-b273-44cd-bda9-b9028df0bd1f_20250109T15:24_UTC.wav
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[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh yes. My name is [PII]. I'm here with the HR department at 360 Energy Solutions.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yes, ma'am. On [PII], I feel, I had knee surgery.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] I did. I was not aware of how to do the uh claims process. Um, they wouldn't proceed and do it without me making a payment. So therefore now because I have the uh gap insurance, I'm trying to retrieve this stuff and I've been refused like 4 times. I'm super stressed out and flat broke.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright, [PII] um first can I please get your call back number just in case our call gets disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, sir. And then what is your policy number with APL?
[CUSTOMER][NEUTRAL] The policy number is
[CUSTOMER][NEUTRAL] Hold on 241-9768.
[CUSTOMER][NEUTRAL] I said no and drive.
[AGENT][NEUTRAL] OK, let me look that policy up for you real quick.
[CUSTOMER][POSITIVE] Thank you. I like your energy.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Yes, my date of birth is [PII].
[AGENT][NEUTRAL] Thank you. OK, [PII], can you please verify your date of birth for me, sir?
[AGENT][NEUTRAL] Thank you I appreciate that and then we also for security reasons can you please verify your address, your phone number and your email address that we have on file for you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] interesting
[CUSTOMER][NEUTRAL] OK, [PII]. Uh, my phone number is [PII]. My email is, um, I guess that would be [PII].
[AGENT][NEUTRAL] OK, thank you sir and I do show that we have a different address for you uh have you recently moved?
[AGENT][NEUTRAL] Moved and we need to update your address.
[CUSTOMER][NEUTRAL] No, 2, I have, I just have a couple of properties. No, you could keep either [PII], is it [PII]?
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] [PII]. OK, yeah.
[AGENT][NEUTRAL] Yes, sir. That is correct. OK. So you're calling because you have
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Sent in some claims and your claims were denied and you just wanna follow up on that is that correct? OK, so what is.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, I will.
[CUSTOMER][NEUTRAL] Go ahead, I'm listening.
[AGENT][NEUTRAL] What is the claim number? Do you have the claim number that you're in question about? OK, can I get that from you please?
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, the number is.
[CUSTOMER][NEUTRAL] O as in Octopus. S as in Sam. C as in Charlie. 91442. That's.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's the one I just submitted.
[AGENT][NEUTRAL] OK, I do see that we did receive that claim we we did receive the claim that you just submitted and it's in line for process.
[CUSTOMER][NEUTRAL] You want the older one?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so,
[AGENT][NEUTRAL] So once you once you submit a claim, it takes 7 to 10 business days for them to process the claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] So that you've just you just submitted it this morning so give it 7 to 10 business days for it to be processed and if you wanna call back then and check in on it, I will be more than happy to help you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What, what's your, what's your name? I'm sorry, what's your name?
[AGENT][NEUTRAL] Yes, sir. My name is [PII]
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] [PII], I'm stressed out and, and I'm really in need of your help. So I got a question for you. If you look at, if you're looking at the same thing and I'm probably looking at my upload documents, you'll see why I process 3 different times actually look like 4 different, I got 4 different uh confirmation numbers.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Could you, could you tell me if I did everything the right way?
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] Uh, let me look real quick at the claims that you submitted previous to this one on [PII], uh, your OSC confirmation number ends in 86897.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do, do you see that one? OK, so that one was.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 86889.
[AGENT][NEUTRAL] 86897.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Mm yeah, I see.
[AGENT][NEUTRAL] OSC 90,820.
[AGENT][NEUTRAL] 86897.
[CUSTOMER][NEUTRAL] No, I don't see that.
[AGENT][NEUTRAL] OK, the claim was submitted through the online service center on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] You can blow it up. Yeah. Oh, OK, yeah.
[AGENT][NEUTRAL] And I can give you the, OK, and I can give you the claim number. It's 354-594-1.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, you see that one? OK, good. All right, so looking at that claim it was processed and I do see remarks on it and let me give you uh.
[CUSTOMER][NEUTRAL] Oh, yeah, I got it. OK, I see that, yes.
[AGENT][NEUTRAL] What the remarks state.
[CUSTOMER][NEUTRAL] Those are the numbers they send you the screens up.
[AGENT][NEUTRAL] One is that it was a duplicate claim.
[AGENT][NEUTRAL] And that durable medical equipment is not covered under the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Duplicate, um.
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] like uh.
[AGENT][NEUTRAL] We need an itemized bill with the diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I, I think I may have provided that this time. Now you're saying procedure codes. I, I don't, I don't know if I have procedure codes. They don't know. OK, alright, yeah, I submitted the procedure code.
[AGENT][POSITIVE] OK, good.
[AGENT][NEUTRAL] It, it would be on your itemized bill. Yes, sir.
[CUSTOMER][NEUTRAL] Alright, cool. OK, so [PII], what I did was this I want to, I got the information for advanced, um, surgical advanced, um, medicine and orthopedics, and I also have the stuff from the, uh, surgery center Aventura. So I'm just hoping that all of this stuff will get us to a place so I can extrieve this funds.
[CUSTOMER][NEUTRAL] OK, let's do, let's do the, can you do the last one though? It was, um, oh, that was, oh that was the last one. OK, I got a question for you.
[AGENT][NEUTRAL] Right. OK, so, so when you
[AGENT][NEUTRAL] Yes, sir. That was the last one.
[CUSTOMER][NEUTRAL] OK [PII], I got one more for you. To, is there any way possible that you can confirm that my um direct deposit and all that stuff is in in uh good standing?
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Yes sir I can do that for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, I do show that you have an active direct deposit. Let me give you the last four digits of the account number.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] let me
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's [PII]. That's the last 5, I guess.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, yes, that's it. That no, that's it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then the bank routing number, the last three digits of the bank routing number is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] OK, and I do show that we have that.
[CUSTOMER][POSITIVE] Alright, so we're good.
[CUSTOMER][NEUTRAL] OK, perfect. So, so what, so if, if everything goes through, what'll happen next? Do I have to sign papers or they just send me the they just deposit the funds?
[AGENT][NEUTRAL] They'll just deposit it for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh, OK, well, [PII], I think that you have gotten me to, um, um, a better place, so I appreciate you, OK?
[AGENT][POSITIVE] It's no problem I'll lay on and look if you have any other questions.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEGATIVE] So, I'm just stressed out.
[AGENT][NEUTRAL] I know you have. It's a hard, it's a hard thing to do. It's a lot of paperwork, I know. But, you know, as you know, if you don't send something in that we need, we send you letters to let you know what we need. If you ever.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][POSITIVE] What we need, OK, perfect.
[AGENT][NEUTRAL] Yes sir, if you ever um are ever in question, let me tell you what with this Medlink policy, the gap insurance, you always have to have the EOB from your primary insurance.
[CUSTOMER][NEUTRAL] See
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You'll always have to have an itemized statement with procedure codes and diagnosis codes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you'll always have to have a claim form.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Alrighty, OK, so I've submitted everything.
[AGENT][NEUTRAL] So those 3 things.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Did, did, did I submit the claim form because I did it earlier, but I don't know if I had to do another one. I just sent the stuff through and I don't know if I did the new claim form. So every time I send the item out do I need to send a claim form too?
[AGENT][NEUTRAL] Every time you have a new claim.
[CUSTOMER][NEUTRAL] Oh no, this isn't new, this is the one from this is, I, you see I've got like 3 of them, so this is the same claim. I just needed to be. I just need to give me the money.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Right, I understand, but I was just trying to help you so you'd know in the future and also we have a website in case you forget because you know life happens, uh, we have a website it's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Hold on, let me get that. Hold on.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] That also has all the claim forms on it and it has a really neat feature so if you need to file a claim and you go in there and you get your medling claim form.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] That very first page of the claim form tells you exactly what you need to send in your claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Alright, cool beans.
[CUSTOMER][POSITIVE] Thank you so much. I appreciate you, OK.
[AGENT][POSITIVE] You're so very welcome and hopefully you'll be getting that direct deposit soon and uh like I said, give it 7 to 10 business days.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] You know what? I like the way you think.
[AGENT][POSITIVE] Yes sir, I'm very positive.
[CUSTOMER][POSITIVE] I know that's right.
[CUSTOMER][POSITIVE] Alrighty now, OK, so I appreciate you so much, OK?
[AGENT][POSITIVE] You're very welcome, [PII]. You have a blessed day. Thank you so much for calling APL.
[CUSTOMER][POSITIVE] You have a good day.
[CUSTOMER][POSITIVE] OK. I'll be blessed all day today. Thank you. And you be likewise, OK? OK, OK, bye.
[AGENT][POSITIVE] Yes, you will.
[AGENT][POSITIVE] Yes, sir. Thank you.
[AGENT][NEUTRAL] Bye-bye, [PII].
[CUSTOMER][NEUTRAL] Bye.