AccountId: 011433970860
ContactId: 8de414a2-9574-4b0a-b042-41f1a7575df1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1159140 ms
Total Talk Time (AGENT): 330171 ms
Total Talk Time (CUSTOMER): 437106 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/8de414a2-9574-4b0a-b042-41f1a7575df1_20250415T13:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] You said [PII], is that right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] in [PII], and how are you doing today?
[AGENT][POSITIVE] I'm good. How are you doing?
[CUSTOMER][POSITIVE] I'm doing well, thank you. Look, I have an insured on the line, um, the policy number 19756887.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Sorry, what was her name?
[CUSTOMER][NEUTRAL] And I, I got a [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and I verified her information, um, and her callback number ready for it is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] She's calling about a claim that was denied. She's stating she had surgery and she paid out of pocket $500. She gave me the claim number.
[CUSTOMER][NEUTRAL] Do you know that?
[AGENT][NEUTRAL] OK, yes, please.
[CUSTOMER][NEUTRAL] Yes, ma'am. It's 358.
[CUSTOMER][NEUTRAL] I believe that's 8675. It's it's not 8675, it's 0. I'm sorry, I can't read my writing.
[AGENT][NEUTRAL] OK. 358-067-5.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Got it. OK, and she wants to know why it was denied?
[CUSTOMER][NEUTRAL] OK, would you be able to upload that?
[CUSTOMER][NEUTRAL] Yes, and she said she's just been having trouble getting that paid. She just, she's, she's confused because she takes out of pocket $500 before the surgery and she's wanting to know.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, well, that was the no.
[AGENT][POSITIVE] OK, you can send her my way.
[CUSTOMER][NEUTRAL] OK, this is my first time transferring. Do I do leave calls?
[AGENT][NEUTRAL] No, it's OK. I'm still kind of new too, so it's fine.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] I just noticed what about do you? Oh my God, is it swamp?
[AGENT][NEUTRAL] We're
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I always do, I always click join and then I like leave I in the in the call once um the.
[CUSTOMER][POSITIVE] And I know that I have you on the line. OK, let me do that. I'm sorry. Hang on one second, OK? [PII], you have a good day too.
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] Miss [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yes ma'am, I have [PII] on the line. She's gonna be able to assist you, OK?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome. Have a great day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Hey, how are you doing today?
[CUSTOMER][POSITIVE] I'm good how are you?
[AGENT][NEUTRAL] I'm good, [PII]. So you were looking at, uh, why your claim was denied?
[CUSTOMER][POSITIVE] Yeah, I'm just, oh boy.
[CUSTOMER][NEUTRAL] Um, I'm just trying to figure out everything here, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm on your website, the APL website.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So I sent, I sent him a a claim.
[CUSTOMER][NEUTRAL] And I have a confirmation O as in Oscar S as in Sam, C as in Cat 96472.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But now that I'm on this website I don't see that claim number here.
[CUSTOMER][NEGATIVE] I'm a little confused.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] The confirmation number and the claim number that I just printed out doesn't show up either. I don't know what's going on here.
[AGENT][NEUTRAL] OK, let me see if I can find that claim number in my system, so.
[CUSTOMER][NEUTRAL] Oh wait, wait, wait, wait, wait.
[CUSTOMER][NEUTRAL] Oh wait, wait, I got, I got it now. I got it now. OK, so the claim number, yeah, I, I don't know. I have so much paperwork in front of me. I'm, I'm a little overwhelmed here.
[AGENT][NEUTRAL] Oh, did you find it?
[AGENT][NEUTRAL] Oh, I get it.
[CUSTOMER][NEGATIVE] Um, I don't know. I'm submitting claims in the APL, and they're always getting denied, and I, I don't know what's going on. Maybe I'm doing something wrong. They always want more information and I can't give any more information than what the, what they sent to my, my first, um.
[CUSTOMER][NEUTRAL] My first uh UMR and then I send what.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK. Um, so the claim number that [PII] gave me was 358-067-5.
[CUSTOMER][NEUTRAL] 58
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] 8675.
[AGENT][NEUTRAL] OK, I see it on here. Um, let me look at this really quick.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so it looks for, it looks like for this claim, it says in order to provide further consideration of this loss under this policy, we will need supporting documentation to evidence the accident or sickness. Um, so,
[AGENT][NEUTRAL] Looks like we need.
[CUSTOMER][NEUTRAL] OK, what does that mean?
[AGENT][NEUTRAL] So so it lists the.
[CUSTOMER][NEGATIVE] I don't understand.
[AGENT][NEUTRAL] So it lists the exact uh documents that you need and I can list those for you.
[CUSTOMER][NEUTRAL] Where am I supposed to get this? I mean, the doctor that I had surgery with, send it to my first medical, um,
[CUSTOMER][NEUTRAL] Company
[CUSTOMER][NEUTRAL] And then whatever the, the, that, that those forms that the doctor sent to my United Healthcare, those are the forms that I sent to you.
[CUSTOMER][NEGATIVE] So, uh, I mean, how am I supposed to get all these additional information? Every time, every time I submit something, you always want more information. Well, what information am I missing?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It says that
[CUSTOMER][NEGATIVE] It's got the claims details and the, and the explanation of benefits. That's what I was told to submit and I'm getting denied on all my, on my claims.
[AGENT][NEGATIVE] Yeah, I can see how that can be really frustrating. It just says on here that we're needing itemized bills with the diagnosis codes, super bills, office notes, hospital admission and discharge summary.
[AGENT][NEUTRAL] Along with the diagnostic testing, um, you should be able to get this from your doctor.
[CUSTOMER][NEGATIVE] OK, I could read. I want to understand what you're asking me. Where am I supposed to get all this information? Isn't the information that I got you? I got the code on there. I got the service dates. I got the amount that they billed me, the amount that I paid out of pocket, which is the $500. That's what I'm looking for to be reimbursed to me. What do I need from who do I go back to to the doctor's office?
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] To get all this information?
[AGENT][NEUTRAL] Yeah, the doctor's office should provide all of this information. Just one moment. There's another remark code. I'm not sure if you can see this one. it says this policy does not provide a benefit for services in which no charges were incurred.
[AGENT][NEUTRAL] Um, let me ask my colleague about this one. that's confusing. OK.
[CUSTOMER][NEUTRAL] Yes, I see that.
[CUSTOMER][NEUTRAL] Because the $500 that I'm looking for, I spent out of pocket. I could give you a copy of my credit card that I put $500 before I had the surgery to the doctor.
[CUSTOMER][NEUTRAL] That's all I'm looking for is the $500 that I paid out of pocket. How do I get, I, I, I, I don't know. There's the only thing I have to back that up is my credit card statement that I that I had to put on my credit card $500 before they would do surgery.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Right, so you're looking for reimbursement for that out of pocket. OK.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Um, OK, I just want to provide you with the correct information, so let me ask my colleague to be 100% sure and why this remark code and exactly what it means.
[AGENT][NEUTRAL] Um, and let her know that you did pay the $5 out of pocket and you just want reimbursement for that, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Yeah, and like I said, I have a credit card statement I could show you. I don't, you know, that's all they're gonna give me my, my doctor's office. They're not gonna give me anything else but the credit card, um, that I paid on that in order to get surgery because I also have $1100 that I had to pay before my surgery to the to the actual surgery center that I want to get reimbursed cause I, you know, I, I, with co-pays and everything else, I paid over $2000 out of pocket.
[AGENT][NEUTRAL] Yeah, but.
[CUSTOMER][NEGATIVE] And that's the whole reason why I thought we have secondary health insurance. That's their medical insurance, and that's what APL is supposed to pick up anything that the my first insurance doesn't pick up and I'm having.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] The darndest time every time I submit, I keep getting denied denied denied and I I don't know what else to do.
[AGENT][POSITIVE] Uh, I'm so sorry.
[CUSTOMER][NEGATIVE] I, I called her. I called back and I, I can't, I don't have the time to, to, to be doing all this leg work. I don't know why it has to be so difficult.
[AGENT][NEUTRAL] Yeah, I get that. um, let me ask my colleague really quick, OK?
[CUSTOMER][NEUTRAL] That's why they say.
[AGENT][NEUTRAL] Yeah, right. OK, just a second, [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey.
[AGENT][NEUTRAL] OK. I don't know.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Um, so I went to CORM and there was.
[AGENT][NEUTRAL] Um, so there's for that claim number, there's 3 or there's 2 or mark codes, uh, the bottom one.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I wasn't
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You be what?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, um,
[AGENT][NEUTRAL] And then she just sends it to the claim address we have.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, or she can fax it, OK.
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] OK, bye.
[AGENT][POSITIVE] Hey, [PII], thank you for holding sorry about that.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] OK, so we cannot process uh your claim with a receipt, but I have good news. We just need the itemized bill and that should have the diagnostic codes on there just from your provider.
[CUSTOMER][NEUTRAL] OK, let me see if I guess I hope I, uh, you know, I need the itemized bill.
[AGENT][NEUTRAL] Yes, ma'am, and it should have the facility charge on there and it has, it should have the diagnostic code as well.
[CUSTOMER][NEUTRAL] OK, let me see what I can do. I, I just didn't know this had too much leg work to do, so.
[AGENT][NEUTRAL] Yeah, um
[CUSTOMER][NEUTRAL] And they have your information. I don't know. I don't understand why they're not doing it, why I'm doing it. I don't know. So alright, well thank you for your help. I'm sorry. I'm just a little frustrated and, and, and I don't understand insurance and it's always been a problem, so.
[AGENT][NEUTRAL] Oh, no, that's OK. Before this, I, I didn't understand it either, honestly. Um, I do have a fax number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's so much.
[AGENT][NEUTRAL] If you, if you wanted to fax it over or I do have um our address as well.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] I can't submit it to the um online.
[CUSTOMER][NEUTRAL] Like upload the file?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] You should be able to. Yes. Do you have a scanner? You can scan it in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Scan it to where? Where do I scan it?
[AGENT][NEUTRAL] Uh, let me see.
[CUSTOMER][NEUTRAL] Or I can scan it and upload. I don't like how would you know that it's pertaining to this already.
[CUSTOMER][NEUTRAL] Claim number that I've submitted.
[AGENT][NEUTRAL] It should, it should give you an option.
[AGENT][NEUTRAL] To put in the claim number.
[AGENT][NEUTRAL] Let me double check.
[CUSTOMER][NEUTRAL] I could just write it the claim number, the confirmation number just so you have all that information.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah, I don't have a fax and I don't even have a fax at my office, so it was kind of an obsolete scanning and.
[CUSTOMER][NEGATIVE] Mailing that will take too long. I really need this money back in my pocket.
[AGENT][NEUTRAL] Yeah. OK.
[AGENT][NEUTRAL] OK, so yes you can upload it online. It says you will go to my claims on the user dashboard.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And then you should be able to, it says to upload claim documents from there.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Yeah and then you know you're you'll be able to check the claim status once you upload and we review this so yeah it's just going to be under my claims and you'll upload it from there.
[AGENT][POSITIVE] And it'll give you step by step instructions too.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Did I click on the claim number in order to upload the additional documentations?
[AGENT][NEUTRAL] Let's see, so it says under my claims.
[CUSTOMER][NEUTRAL] How would you know that?
[CUSTOMER][NEUTRAL] Yeah, I see what you're talking about and I see upload files. That's how I've done it, you know, in the past, but how will you know that that, you know, like I wanna make sure that that paperwork is going with the the correct claim that was denied so like everything's all in one file.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I don't wanna open up another because you're you're not gonna know what like what it's pertaining to.
[AGENT][NEUTRAL] So you just want to submit it as a new entry and we will know on our end our end what the claim applies to.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] Yeah. Yeah, you'll be good. Yeah.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thanks for your help I appreciate it.
[AGENT][POSITIVE] Yeah, of course, you're welcome. Is there anything else I can help you with while I have you on the line?
[CUSTOMER][POSITIVE] No, that'll do it. Thank you so much. I appreciate it.
[AGENT][NEUTRAL] Of course, call us if you have any trouble, OK?
[CUSTOMER][POSITIVE] OK, thank you. I appreciate it.
[AGENT][POSITIVE] All right. Yeah, thanks for calling APL. Bye.
[CUSTOMER][NEUTRAL] Mm bye.