AccountId: 011433970860
ContactId: 8fd75da8-d594-470d-acac-07f411f91665
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 384079 ms
Total Talk Time (AGENT): 127733 ms
Total Talk Time (CUSTOMER): 182237 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/8fd75da8-d594-470d-acac-07f411f91665_20250319T19:21_UTC.wav
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[AGENT][POSITIVE] Yeah, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi, [PII], how are you?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][NEUTRAL] I'm fine, thank you. [PII], um.
[CUSTOMER][NEUTRAL] I'm not, well, do you need my my info first?
[AGENT][NEUTRAL] Your policy number, please?
[CUSTOMER][NEUTRAL] Uh, I'm sorry, could you repeat that? What number?
[AGENT][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] Oh, and the policy number? OK, it's uh 02570837.
[AGENT][NEUTRAL] OK, and if you can verify your name, date of birth, and email address.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[CUSTOMER][NEUTRAL] And the email address [PII].
[CUSTOMER][NEUTRAL] If that's not it, then let me know.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mr. [PII], how can I assist today?
[CUSTOMER][NEUTRAL] OK, I have a question, um.
[CUSTOMER][NEUTRAL] About the uh coverage or or future coverage. Um, I have a, I have a procedure that I have to do this Friday, um, and they told me what the, the out of pocket or whatever, uh, is, and I asked them if they accepted the gap insurance. They said they do, but that I have to.
[CUSTOMER][NEUTRAL] Um, fill it out or request it or.
[CUSTOMER][NEUTRAL] On my own, I guess.
[CUSTOMER][NEUTRAL] Um, I don't understand how that works, but, um.
[CUSTOMER][NEUTRAL] Can you explain to me how that works?
[AGENT][NEUTRAL] You would have to, um, so basically they're saying they're not gonna file your benefits, you, you need to file it yourself. OK. Um, that's no problem. Um.
[AGENT][NEUTRAL] So you would just need to get the um who's your major medical company?
[CUSTOMER][NEUTRAL] Signal.
[AGENT][NEUTRAL] So OK, so you would just need to contact Cigna and let them know that you need the explanation of benefits for the data service that you wanna file for, then you'll contact the provider and let them know um that you need the diagnosis information from that visit and then you can just file it directly with us.
[AGENT][NEUTRAL] Um, now there's 3 ways to file a claim. You can if you're registered with the online service center you can upload the information there or you can fax it or just mail it by paper through the postal.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] I'm sorry, but I'm gonna ask you to repeat the, the first part. I got the second part, and I believe I'm registered with, with the online thing, um.
[CUSTOMER][NEUTRAL] But can you, can you repeat the, the first part about the provider or whatnot that you said?
[CUSTOMER][NEUTRAL] And I'm gonna write it down, so bear with me, OK?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, so, uh, can you repeat it, please?
[AGENT][NEUTRAL] So you would contact Cigna, you probably already have the explanation of benefits. It's that um they send it either in the mail or by email they notify you every time they get a claim and they process it and then it says this is not a bill and then they let you know we got a claim for this data service and how they processed it, whether or not they've applied anything to your deductible and then what your patient responsibility is so that's what you need, the explanation of benefits.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And is that something, right. And is that something that they do before the procedure or after?
[AGENT][NEUTRAL] From Cigna.
[AGENT][NEUTRAL] Oh no, that's after Cigna gets the claim and processes the claim.
[CUSTOMER][NEUTRAL] Uh, OK, OK, OK, OK, that's what I figured. I just wanted to make sure because I don't wanna call them and they'll be like, what are you talking about? OK, alright, so understood, get the explanation of benefits from Signa. Then once I do that, then you said I have to upload it to your site.
[AGENT][NEUTRAL] And then get the diagnosis from the provider.
[CUSTOMER][NEUTRAL] OK. When you say provider, you mean like my doctor or?
[AGENT][NEUTRAL] The people who are saying they're not gonna file the claim.
[CUSTOMER][NEUTRAL] Oh, and that's the hospital.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so, uh, the next step is, uh, uh, then get.
[CUSTOMER][NEUTRAL] Diagnosis from provider.
[CUSTOMER][NEUTRAL] Right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK then that's what I upload?
[AGENT][NEUTRAL] Yes, those two pieces of information.
[CUSTOMER][NEUTRAL] Or I, oh, OK, and that's the next step, right? Once I have those two.
[CUSTOMER][NEUTRAL] Then I uploaded to your site those two pieces of information correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] So in the excuse me, in the explanation of benefits.
[CUSTOMER][NEUTRAL] Um, that's what it'll show what was my out of pocket.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Responsibility or no?
[AGENT][NEUTRAL] Yeah, the explanation of benefits, yes, that's how we're gonna determine how much we're gonna pay, so yes.
[CUSTOMER][NEUTRAL] Oh, so you don't pay the whole thing?
[AGENT][NEUTRAL] I'm confused. What do you mean we don't pay the whole thing?
[CUSTOMER][NEUTRAL] Well, you just said that's when that's with the explanation of benefits that's what you decide what you're gonna pay.
[AGENT][NEUTRAL] Right, the explanation of benefits tells us how much your patient responsibility is that we need to pay.
[CUSTOMER][NEUTRAL] Oh, OK, OK, OK, sorry, I misunderstood you or, or, yeah, OK, OK, I, I guess I got confused with with what you said. OK, no worries.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then I upload.
[AGENT][NEUTRAL] Yeah, that's it just those two pieces of information.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, uh, and then um.
[CUSTOMER][NEUTRAL] I guess the website is that secured.
[CUSTOMER][NEUTRAL] And public.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. Well, I think that's, you answer my questions.
[AGENT][NEUTRAL] OK, was there anything else I can assist with today?
[CUSTOMER][NEUTRAL] Nope.
[CUSTOMER][NEGATIVE] No thank you that's it.
[AGENT][POSITIVE] OK, well thank you for calling APL you have a good day.
[CUSTOMER][POSITIVE] All right you too bye bye.
[AGENT][NEUTRAL] Mhm. Bye bye.