AccountId: 011433970860
ContactId: 9490413f-09da-4b57-ad4d-1e4c74c65845
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 362630 ms
Total Talk Time (AGENT): 208613 ms
Total Talk Time (CUSTOMER): 139401 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/9490413f-09da-4b57-ad4d-1e4c74c65845_20250514T22:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, I sent in a claim, but I'm confused because I don't understand if it's been accepted or if I need to send you something else because I originally sent it but it wasn't the right paper so I sent another paper.
[AGENT][NEUTRAL] OK, alright, well I can help you with claim status. Can I please get your name and your call back number?
[CUSTOMER][NEUTRAL] Yes, my name is [PII], and my phone number is [PII].
[AGENT][NEUTRAL] OK, and [PII], what is your policy number?
[CUSTOMER][NEUTRAL] I think this is it because I think they gave it to me last time I think it's uh 258-7791.
[AGENT][POSITIVE] OK, let me look that up real quick so I can get you some help.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII], I'll need for you to please verify your policy for me. Can you give me your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you ma'am and then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Wow, [PII]. Email should be [PII] and I forgot what I said.
[AGENT][NEUTRAL] And then the phone number that you gave me to call you back on is that your cell phone number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK perfect thank you so much for verifying your policy for me. All right, let me look, um, I do see that we had a claim submitted on [PII], and it does have a remark and I'll tell you what it says, um, let me look it up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] Please provide copies of your explanation of benefits from your primary insurance carrier.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] Oh my God, I don't even know what that means.
[AGENT][NEUTRAL] OK, so you'll call your.
[CUSTOMER][NEUTRAL] Because I went to UrgentMed.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] OK, so you should, you should have enough.
[AGENT][NEUTRAL] Their health insurance, um, besides the supplemental insurance, let me see what your group has so you'll know. Um, Blue Cross Blue Shield.
[CUSTOMER][NEUTRAL] Uh, we have um.
[AGENT][NEUTRAL] Oh, you have Aflac?
[CUSTOMER][NEUTRAL] Don't have
[AGENT][NEUTRAL] AvMed, OK, so you'll
[CUSTOMER][NEUTRAL] No, I met.
[AGENT][NEUTRAL] AvMed OK so you'll need to contact AvMed let them know that you need your explanation of benefits from that date of service that uh for the claim that you sent to in.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] They should be able to send it to you and then you can upload it into the online service center.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] I mean, I'm not trying to be rude, but this is the 2nd thing I had to hand in. This is gonna be like this every time I was told, oh, you just hand them your card. It's no big deal. Then I went to urgent care and they acted like they never saw that card in their life, and now I've sent in two different papers and it's not the right thing and I mean it's just a lot of work.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I understand, um, and most of the time the facility that you go to the doctor that you go to or the hospital that you go to, they file the claim for you and send us explanation of benefits in the itemized statement. But if you ever have to file yourself again, you'll always need three things your claim form, your itemized statement with the diagnosis codes and procedure codes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And your explanation of benefits from the primary insurance carrier, those three things always have to be set.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That way you'll know in the future.
[CUSTOMER][NEUTRAL] OK, so do you know what urgent cares are covered because I went to, I wanna call, I think it was called urgent me or something, and they acted like I had 3 heads when I told them about this card. So I'll go to a different urgent care next time if I need to.
[AGENT][POSITIVE] Bless your heart.
[AGENT][NEUTRAL] OK, let me look and see.
[AGENT][NEUTRAL] If you have
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Urgent care coverage on your policy.
[CUSTOMER][NEUTRAL] We have em now.
[CUSTOMER][NEUTRAL] No, I, I do, but it's $70 so I told this covered, but then they didn't know what I was talking about.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah, um.
[CUSTOMER][NEUTRAL] $75 I think.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the way this policy
[CUSTOMER][NEUTRAL] I don't know if I just went to the wrong urgent care.
[AGENT][NEUTRAL] Yeah, sometimes they give you push back and if they give you push back again a lot of uh uh unfortunately we're in a day where that happens but um.
[AGENT][NEUTRAL] Give them the same phone number that you called and they can call us and they can verify your benefits over the phone and we can give them all the claims information so that they can help you with your claim they can even file it electronically where they do it right from the computer like you're having to do, but it, there's uh a pro a payer ID number that should be on your card that they would have to use but any time you get pushed back.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Go ahead and give them our number and tell them that they can verify benefits and coverage and eligibility with us.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Directly.
[CUSTOMER][NEUTRAL] OK, that sounds good. OK, so tomorrow I'll call my insurance company, ask them for an explanation of benefits, and then just upload it again to your site?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Is that what I'm gonna do?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] OK, that sounds good. I'll try to do that. Thank you so much for all your help.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, you're so welcome, Ms. [PII]. And if you find you need more help, just pick up the phone and we'll help you some more then, OK?
[CUSTOMER][POSITIVE] Alright, and have a great day.
[CUSTOMER][POSITIVE] OK thank you have a great day.
[AGENT][POSITIVE] All right. You take care, Ms. [PII]. Bye-bye.