AccountId: 011433970860
ContactId: 852bc750-9f8c-4323-a1c2-7f5892274514
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 830380 ms
Total Talk Time (AGENT): 299991 ms
Total Talk Time (CUSTOMER): 282452 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/852bc750-9f8c-4323-a1c2-7f5892274514_20250408T19:17_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh hello there. My name is [PII].
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Uh, I had done 5.
[CUSTOMER][NEUTRAL] Um, I was in touch last week with benefits in a card.
[CUSTOMER][NEUTRAL] Cause there was a, a doctor I wanted to go see about my back. And um so that wasn't, I guess my name in the system and the whole thing wasn't quite lined up yet. So she suggested that I go see the doctor, um, pay for the visit myself and then submit the claim to APL. So I have a receipt from yesterday. I'm wondering what do I do now?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I can help you with that. Um, can I get your, uh, policy number, [PII]?
[CUSTOMER][NEUTRAL] OK, that's the policy slash certification number?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, that would be 02595525.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And could you give me your full name please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you. And your birthday?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, I just need a few more pieces of information. What is your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then lastly, what is your email address?
[CUSTOMER][NEUTRAL] Email address is [PII].
[AGENT][POSITIVE] OK, perfect.
[AGENT][POSITIVE] And you have a good callback number just in case I lose you?
[CUSTOMER][NEUTRAL] Yes, that's this one it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you so much. OK, so wanting to submit claims, did you, do you know what the, did you need any benefit information on that or?
[CUSTOMER][NEUTRAL] I'm just wondering what the procedure is. I have an electronic receipt and I have a printed receipt from yesterday.
[CUSTOMER][NEUTRAL] And so I called back, uh, benefits in the card and they they asked me to call this number and see what the procedure is. How do, how does this work?
[AGENT][NEUTRAL] OK, so what we will need is we need an itemized bill or something that shows what exactly you were seen for so what procedure you were seen for, whether that was an office visit or some type of procedure, and then the diagnosis, so whatever your diagnosis was for the visit, a lot of the times receipts don't capture that information so um we will need that information.
[CUSTOMER][NEUTRAL] Um, OK, hold on one second please. Where did I put that desktop?
[CUSTOMER][NEUTRAL] So what I have here.
[CUSTOMER][NEUTRAL] The name of the doctor, um.
[CUSTOMER][NEUTRAL] I sent the amount paid, so what other information do you want to have on here? The diagnosis and what else?
[AGENT][NEUTRAL] Uh, the diagnosis and then whatever procedure was rendered, whether that be like an office visit or if they did any type of procedures in office, we just need to know what type of services were performed in the office.
[CUSTOMER][NEUTRAL] Well, it was an office visit to meet the back specialist and for a diagnosis of which part of the spine needs, you know, the physical therapy and things like that.
[AGENT][NEUTRAL] Right, so
[CUSTOMER][NEUTRAL] So there was no
[CUSTOMER][NEUTRAL] You know.
[AGENT][NEUTRAL] Yeah, so we'll need the codes for that. So there's, uh, you could call the provider's office and see if they can provide you a claim. Um, it's called a CMS 1500 claim, and that really encompasses everything that we need, um, otherwise if they can write you some type of letter or you have some type of documentation that again shows specifically this was for an office visit and what diagnosis you were seeing for.
[CUSTOMER][NEUTRAL] OK, on this, uh, what they gave me, there's an authorization code on there.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, yeah, it, it's, it's.
[CUSTOMER][NEUTRAL] Can I
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Can I email this to you so you can take a look at it or no?
[AGENT][NEUTRAL] Uh, we don't have secure email, so email is not an option, but authorization codes, does it, what's the number of it? Does it have a number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 03401 Z as in zebra.
[AGENT][NEUTRAL] OK, yeah, that wouldn't, it wouldn't mean anything to us. There's, there's, it's called CPT codes and then ICD 10 codes. Those are the things that we need. The CPT code is a proceed.
[CUSTOMER][NEUTRAL] OK, let me write that.
[AGENT][NEUTRAL] Sure, yeah, write this down that way they know what you're talking about.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I need you to slowly spell it out so I can write it down. The first one was?
[AGENT][NEUTRAL] First one is CPT, so that's Charlie.
[AGENT][NEUTRAL] P as in Paul.
[AGENT][NEUTRAL] T as in Tom.
[AGENT][NEUTRAL] So CPT
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And then the second thing that we need.
[CUSTOMER][NEUTRAL] People do what?
[AGENT][NEUTRAL] Code
[CUSTOMER][NEUTRAL] I'm sorry, CPT code, OK.
[AGENT][NEUTRAL] And then the second thing that we'll need is an ICD 10 code. So that's I as in India, C as in Charlie.
[AGENT][NEUTRAL] D as in Delta, 10, the letter 10 code.
[CUSTOMER][NEUTRAL] And then what was this other CMS 1500 claim?
[AGENT][NEUTRAL] So that's the that's the claim form um which it it has all of that information on it. I don't know what's easiest for them, so sometimes they'll provide you with that claim form which has the CPT code and the ICD 10 code, um, or if they can give you a letter that has that information that that will also suffice so.
[CUSTOMER][NEUTRAL] OK, so let me reach out to that uh office and ask them for this information, right? And then when I have that I.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] How do I submit this receipt from yesterday plus all this information?
[AGENT][NEUTRAL] So there's a couple of different options. You can fax it, or you can create an an account on our online portal and upload the documents.
[AGENT][NEUTRAL] Um, do you know which one you might be interested in?
[CUSTOMER][NEUTRAL] Which, uh, option?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well, uh, can I go on to the website and take a look and try?
[AGENT][POSITIVE] Yeah, absolutely. Do you want me to
[CUSTOMER][NEUTRAL] So see if I can get in there.
[AGENT][NEUTRAL] Yeah, let me email you the um portal instructions so you can create your account and then if you have any issues with it just give us a call back and we'll help you walk you through it but do you want me to do that? I'll email you our instructions.
[CUSTOMER][NEUTRAL] [PII], please.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK, I'll get that sent over to your email.
[CUSTOMER][NEUTRAL] Uh, just stay with me.
[CUSTOMER][POSITIVE] OK, uh, just stay on with me until like this pops up. I'll feel better.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, this does have to be done on a laptop or a desktop do you are you in front of one?
[CUSTOMER][NEUTRAL] I am.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK, just send it your way.
[CUSTOMER][NEUTRAL] OK, let you know, hold on.
[CUSTOMER][NEUTRAL] OK, care team.
[CUSTOMER][NEUTRAL] Online portal instructions.
[CUSTOMER][NEUTRAL] Overview insured.
[CUSTOMER][NEUTRAL] Oh boy, um.
[AGENT][NEUTRAL] And we can just go to the site. It's [PII], and then I can walk you through it.
[CUSTOMER][NEUTRAL] OK, so I'm sorry, one more time, let you go.
[AGENT][POSITIVE] Uh, [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Probably yeah.
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] Oh, it's already got my name there.
[AGENT][NEUTRAL] Oh, OK, have you created an account?
[CUSTOMER][NEUTRAL] All the
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Enter password, I guess I did.
[AGENT][NEUTRAL] I guess you have created an account and let me see, let me make sure.
[CUSTOMER][NEUTRAL] EL
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Ok let's see here.
[AGENT][NEUTRAL] Do you remember your username?
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] The username is [PII]
[AGENT][NEUTRAL] OK, OK, yeah, that's what I've got. Um, I, I don't know what your password is. If, if you can't remember, you'll have to ask reset for a reset.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Oh, that works. OK, I'm in.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] OK, awesome. So this is where you can upload, there should be a tab on there or something to say claims and then you can upload your receipt along with the information that we just discussed when you get it, so.
[CUSTOMER][NEUTRAL] OK, I see that here upload documents upload files.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Um, OK, this is great, so let me see.
[CUSTOMER][NEUTRAL] Let me call that office and ask for that information.
[CUSTOMER][NEUTRAL] Um, and we'll go from there. Now, I'm wondering, I don't know if you might know this, but they also suggested, I was given a prescription, actually a written prescription for physical therapy.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is that covered through ATL?
[AGENT][NEUTRAL] Um, yes, so this is not a guarantee of payment. It's a basic outline of your policy. Physical therapy, um, you have a $30 per day benefit and a max of 4 days per calendar year.
[CUSTOMER][NEUTRAL] So I'm covered for 4 this.
[AGENT][NEUTRAL] Correct, and it'll pay a maximum of $30 per visit.
[CUSTOMER][NEUTRAL] Hold on a second, um, OK, uh, alright, thank you for all this info and, uh, let's see what happens.
[AGENT][POSITIVE] OK, well thank you for calling APL. I hope you have a great afternoon.
[CUSTOMER][POSITIVE] Thanks bye bye.
[AGENT][NEUTRAL] Bye.