AccountId: 011433970860
ContactId: 847ec1fd-6044-401b-9e2c-9ca042a24dd1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 819119 ms
Total Talk Time (AGENT): 202841 ms
Total Talk Time (CUSTOMER): 167148 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/847ec1fd-6044-401b-9e2c-9ca042a24dd1_20250313T16:24_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, um, I recently had cataract surgery and I have insurance with the PHCS Limited Benefit plan. I'm calling to check on the status of the claim I submitted.
[AGENT][POSITIVE] OK, sure. I can assist you with claims. And may I have your um name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and may I have the policy number?
[CUSTOMER][NEUTRAL] 682-945-270.
[AGENT][NEUTRAL] Do you have the policy number with APL with the American Public Life?
[CUSTOMER][NEUTRAL] Policy number
[CUSTOMER][NEUTRAL] Policy number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But I don't know what you mean. I just, is that it?
[AGENT][NEGATIVE] No, that's not it. That's, that's not our number. That's too long.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I mean, I don't know, honestly, this is uh.
[CUSTOMER][NEUTRAL] I don't know, isn't there a way you can look it up?
[AGENT][NEUTRAL] Did you
[AGENT][NEUTRAL] Did you receive the card from us, the APL card?
[CUSTOMER][NEUTRAL] APL, I don't know what that means. I mean, I, my, my insurance is with PHCS limited benefit plan and I was told to call this number to get information about my claim.
[AGENT][NEUTRAL] Seems like they um give you probably the wrong number. We're, we're not related to PHTS um I can do a name search, but it doesn't look like you're calling the wrong, the, the right number. Um, what is the spelling of your last name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, and the spelling of your first name.
[CUSTOMER][NEUTRAL] Um [PII]
[AGENT][NEUTRAL] OK. Thank you. One moment.
[AGENT][NEUTRAL] May I have your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The PHS that's your employer, um.
[AGENT][NEUTRAL] OK, and let me have the mailing address and email address on file.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] This is for cataract surgery, um.
[AGENT][NEUTRAL] My mom
[CUSTOMER][NEUTRAL] Yeah, it was a mandatory surgery.
[AGENT][NEUTRAL] Let me see how this works with the clients. One moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, when you send in the the claim, um, did you send it to customer support or you send it to us directly?
[CUSTOMER][NEUTRAL] Um, I sent it to like whatever I was told to send the claim. OK, hold on, I sent it to.
[CUSTOMER][NEUTRAL] The email was um.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] For member services customer support BWA customer support.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Let's see, no, I sent it to hold on.
[CUSTOMER][NEUTRAL] I sent it to [PII] at [PII] [PII]. That was the email I was told to send it to.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK. Let me get a little bit more information about this group because yeah, I do see that's their email, um, but I don't see any claims um here. I'm not sure if they're supposed to forward those to us or um let me check with, let me get a little bit more information, OK? One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so based on the information that I found for this group, um, it looks like the claims, um, needs to be sent out to us and the customer support at 4 members is just to like do terminations, benefit change or just any other information that is not pertaining to claims.
[CUSTOMER][NEUTRAL] Oh, OK, so can you send me the claim form that I need to.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, can you email me the claim form and do you have my email contact?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Can you verify that email for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, I do have that. Um, let me go ahead and get this ready for you right now. One moment.
[CUSTOMER][NEUTRAL] And then if you can tell me like.
[CUSTOMER][NEUTRAL] You know, I'm so I I paid for all of this stuff, so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It was an out of network provider, but it's my long-time ophthalmologist that I've been using for many years and it was a required surgery.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um, and so it was my understanding that all I had to do was submit the claim and you know likely it would be covered because it's.
[CUSTOMER][NEUTRAL] Um, under my, it's a required surgery.
[AGENT][NEUTRAL] OK. Um, you just go ahead and send all the information and let us look into it and see if it's a cover service. Uh, we don't do processing over the phone, unfortunately, but you do have benefits for surgery. So, um, I'm just gonna go ahead and send you the claim form with instructions on what to send together with that claim form and, and we can go from there, OK? Um, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, if you, why don't you, can you do that while we're on the phone here just to make sure I get it.
[AGENT][NEUTRAL] Yeah, I, I'm working, yeah, I'm working on it right now as we speak.
[CUSTOMER][POSITIVE] OK, thanks.
[AGENT][NEUTRAL] OK. You're welcome. OK one moment.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Fantastic.
[AGENT][NEUTRAL] And for future you can always go to our website at [PII], and there is a list of the claim forms including that claim form if you need it later on and you don't know it.
[CUSTOMER][NEUTRAL] OK, so you're telling me that I, I, it's so bizarre to me like how there's confusion around where I submit a claim, but OK, so you, you're gonna email me now?
[AGENT][NEUTRAL] Yeah, I mean, yeah, I'm, I'm working on it. I'm just giving you this information for future.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, all right, I have a call I have to jump to.
[CUSTOMER][NEUTRAL] OK, are we done?
[AGENT][NEUTRAL] OK you wanna check your email and see if you got it?
[CUSTOMER][NEUTRAL] I didn't get it yet. It's just my name, [PII].
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yeah, I did, I did send it. I just kept you on the phone because you said you wanted to make sure you get it before I let you go.
[CUSTOMER][NEUTRAL] Yeah, I don't see it yet, but I'm assuming it'll show up.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] It it's gonna take a minute or two. Yeah, it takes a minute or two for you to get it.
[CUSTOMER][NEUTRAL] Oh, I see.
[AGENT][NEUTRAL] And I just sent it. It's not you got it? OK.
[CUSTOMER][POSITIVE] Yeah, OK, got it OK thanks bye.