AccountId: 011433970860
ContactId: 9447fc95-81f6-4d6c-8c8c-9970b57101be
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 282600 ms
Total Talk Time (AGENT): 168651 ms
Total Talk Time (CUSTOMER): 90387 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/9447fc95-81f6-4d6c-8c8c-9970b57101be_20250219T13:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I, I, um, I need to submit, um, I got a bunch of invoices from my doctor that I paid out of pocket for.
[CUSTOMER][NEUTRAL] Let me send over to you guys.
[AGENT][NEUTRAL] OK. Yes, sir. First, could I get your name and a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] It's um [PII] Phone callback number is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Now, could I get your policy number, please?
[CUSTOMER][NEUTRAL] Yeah, it is.
[CUSTOMER][NEUTRAL] The payer ID number or the effective.
[AGENT][NEUTRAL] It'll be the outpatient certificate number.
[CUSTOMER][NEUTRAL] I remember.
[CUSTOMER][NEUTRAL] No, outpatient is 02435172 M.
[CUSTOMER][NEUTRAL] L 8.
[AGENT][NEUTRAL] Thank you, [PII]. Now, please verify your first and last name and your date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And please verify your mailing address and email address.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, [PII] email address is [PII].
[AGENT][NEUTRAL] OK, this looks like it may be a work email address you have on file.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Well, for your email address, it looks like it may be your work email address. Could you please verify that?
[CUSTOMER][NEUTRAL] Oh, might, might get national show. I, I might go on. I'll see what it is.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK. And also, in order to file a claim, you can mail us the documentation, you can fax it to us or you can file the claim online. Which way do you prefer?
[CUSTOMER][NEUTRAL] How I do it online.
[AGENT][NEUTRAL] OK, um, well, you would need to go to our website to register and let me give you our web address.
[AGENT][NEUTRAL] It is secured, that's [PII].
[AGENT][NEUTRAL] You should see a blue button. It may say register here or it may say new user. You'll click on that button.
[CUSTOMER][NEUTRAL] The user
[AGENT][NEUTRAL] Yes, sir, no user.
[CUSTOMER][NEUTRAL] Like I'm an individual with APL insurance policy.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Yes, sir, and fill out the information to set your policy up online and once you get signed on, you'll see a button that says upload documentation and you'll upload the documentation in order to file your claims that way. And once we receive your claims, um, please allow 7 to 10 business days for processing and you can always go online to check the status or give us a call.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you guys send me a check, how does that work?
[AGENT][NEUTRAL] Right, if the uh benefits are covered and you send us the correct documentation, do you know what documentation we need in order for you to file a claim?
[CUSTOMER][NEUTRAL] Uh, I got the, um, the receipt of payments for all these coming back stress tests.
[CUSTOMER][NEUTRAL] And everything else.
[AGENT][NEUTRAL] Well, we need the explanation of benefits also from your primary insurance company. Since we're your secondary insurance, we cover the portion that your primary insurance company doesn't pay up to a certain amount. So we need the EOB.
[CUSTOMER][NEUTRAL] Yeah, it tells it tells you what the out of pocket is and all this.
[AGENT][NEUTRAL] Um, yeah, but it has to come from the insurance company. It can't come from the doctor's office.
[CUSTOMER][NEUTRAL] So what I need to call my insurance company yet?
[AGENT][NEUTRAL] So we would need
[AGENT][NEUTRAL] Yes, sir. Um, and normally you can go online and print that information off. It's called an explanation of benefits and you can um get that from your primary insurance company. We'll need that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, that sounds what their benefits are, what they cover, what so you guys, OK.
[AGENT][NEUTRAL] You're right. And then also, we'll need your diagnosis code. The diagnosis code is the code for the illness or accident, the reason why you're seeing the doctor.
[CUSTOMER][NEUTRAL] Yeah, they got, they got the um code it says like code 93015 cardiovascular stress test.
[AGENT][NEUTRAL] OK, that's a procedure, right, that's a procedure code. We need the diagnosis code. And again, that's the code for the illness and you can write that on the documentation. You can get that information from your doctor and write it on there. Just let us know that this is the diagnosis code or maybe more than one. Write those on the explanation of benefits and then upload that documentation.
[CUSTOMER][NEUTRAL] Is that what you're looking?
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] That's it. I appreciate it.
[AGENT][POSITIVE] Mhm. Thank you again, [PII], for calling APL. You have a great day. Mm bye.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you