AccountId: 011433970860
ContactId: 994b9ac7-0a9f-4355-9942-877b4414cebc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 764000 ms
Total Talk Time (AGENT): 304222 ms
Total Talk Time (CUSTOMER): 331143 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/994b9ac7-0a9f-4355-9942-877b4414cebc_20250604T17:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name's [PII]. Um, I called the other day, but I need some help. Um, I tried creating an account online and I'm having a problem, and then I had a question about a couple, um, claims I need to file.
[AGENT][NEUTRAL] OK, I can help you with that. um, can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] 263-078-3
[AGENT][NEUTRAL] Give me just a moment to look that up.
[AGENT][NEUTRAL] And can I get your first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] 82665
[AGENT][NEUTRAL] And the address that we have on file?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and do you have the phone number that we have on file as well?
[CUSTOMER][NEUTRAL] Uh, either [PII] or [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It was the first one because it goes by the um.
[AGENT][NEUTRAL] The policy holder. Mhm, mhm.
[CUSTOMER][NEUTRAL] Holder [PII]? OK.
[CUSTOMER][NEUTRAL] OK, I'll know that for the future.
[AGENT][NEUTRAL] Yeah and that um when creating an account you'll need to use everything that we have on file um so I I don't know if that was something that was asked in your online profile when you were trying to to set it up um.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] No, I, no, so I'm on, I'm on your website [PII].
[CUSTOMER][NEUTRAL] And it says create your OSC account correct?
[AGENT][NEUTRAL] Yes, so you'll go to [PII].
[CUSTOMER][NEUTRAL] Oh, they didn't tell me that last time, so what do I go to?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] OK.
[CUSTOMER][NEUTRAL] OK, and then that's where I create the account?
[AGENT][NEUTRAL] And then you'll go to create your OSC, yes, and you'll need to use um what we have on file. Do you wanna um confirm the email that we have on file?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK, other than the information I just gave you, what else will they ask me?
[AGENT][NEUTRAL] Uh, it should ask for your email because you know you no longer log in with the username it'll be email.
[CUSTOMER][NEUTRAL] So it's under [PII], correct? Mhm.
[AGENT][NEUTRAL] Yes, so you will need to use that when logging in.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you'll click insured.
[CUSTOMER][NEUTRAL] Hold on let me see if I can just go there while I have you real quick.
[AGENT][NEUTRAL] Yeah, that's OK.
[CUSTOMER][NEUTRAL] Cause yeah, the, the other young lady didn't tell me to go to the secured, so I've been trying to do it just on the.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Let's see, hopefully, maybe we'll see this is different.
[CUSTOMER][NEUTRAL] OK, so it says create your OSC account so I click on that and then insured, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] No, I, I'm not an agent or broker, OK.
[CUSTOMER][NEUTRAL] Oops.
[CUSTOMER][NEUTRAL] OK next, OK, so this is what I did. So last name.
[CUSTOMER][NEUTRAL] It's under [PII] So it's asking for a member ID. So that's not the policy number. Is that the member ID on his insurance card or is that a different number?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Or his social security number.
[CUSTOMER][NEUTRAL] OK, so I can't use the number ID number on the card. I have to use the social security number.
[AGENT][NEUTRAL] Uh, you should be able to, um, if it's not a red if it doesn't have like an asterisk on it, it's not required, um, it's up to you if you want to include that information, but yes, it'll be under the policy holder.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what's your social? [PII].
[CUSTOMER][NEUTRAL] The insurance company trying to file the claim? do you wanna use it or no?
[CUSTOMER][NEUTRAL] OK, he doesn't wanna use his social on there. OK, so it doesn't have an asterisk I won't put that.
[AGENT][NEUTRAL] Yeah, that's OK.
[CUSTOMER][NEUTRAL] OK, email.
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, which is what I've done, and then I go next.
[CUSTOMER][NEUTRAL] And then it says complete your account set up, I hit continue.
[AGENT][NEUTRAL] So yeah, the next part will be verifying your email so you'll add your the email address that we discussed, yeah.
[CUSTOMER][NEUTRAL] Uh, I
[AGENT][NEUTRAL] Um, and check for a pop up.
[CUSTOMER][NEUTRAL] OK, it never gave me this part before.
[AGENT][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] Maybe because I wasn't in the secure one. Hold on, [PII].
[AGENT][NEUTRAL] And you'll click send verification code, and if you don't see a verification code, um,
[AGENT][NEUTRAL] Then I would check your spam as well. Now I will say due to the information that's in the system, you will need to verify that you'll need a verification code every time you log in um just to keep secured. um, so just keep that in mind. You'll no longer use a display or you'll no longer use a username, it'll go by email whenever you log in.
[CUSTOMER][NEUTRAL] How long does it normally take to get the verification code in the email?
[AGENT][NEUTRAL] Um, everyone I've helped on the phone, it's typically been less than a minute.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you can refresh uh your screen or or not your screen for secured but refresh your email um and check the spam.
[CUSTOMER][NEGATIVE] Yeah, that's what I'm doing now but nothing's coming through.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, and to verify the spelling, [PII], correct?
[CUSTOMER][NEUTRAL] Yes, [PII]hm.
[AGENT][NEUTRAL] OK. I just want to make sure that we didn't have it misspelled.
[CUSTOMER][NEUTRAL] I'm looking to see spam around to spam.
[CUSTOMER][NEUTRAL] You know sometimes it says the email is full when it's not so.
[CUSTOMER][NEUTRAL] Oh here it is OK.
[CUSTOMER][NEUTRAL] 0
[CUSTOMER][NEUTRAL] 78124.
[CUSTOMER][NEUTRAL] Verify code.
[CUSTOMER][NEUTRAL] OK, so now I just have to put in a password right? you said?
[AGENT][NEUTRAL] Right, you'll create a password.
[CUSTOMER][NEUTRAL] Uh, other options.
[AGENT][NEUTRAL] Um, I don't know if the display name is required. Uh, this is just to know which like who is accessing the account. So if you and um [PII] have the account set up and you want to have different um name display names on there, it's just to know who's who um I don't know if it's a requirement though.
[CUSTOMER][NEUTRAL] Yeah, I know.
[CUSTOMER][NEUTRAL] It doesn't have any, should I just continue without putting the display name or anything maybe?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah and then if anything else if you click the button it might just say that you need to include it and then you can just include a display name uh it's really for your own purposes uh because you won't use the username to log in anymore.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And we can see all claims or anything filed here, right? OK, so now go to dashboard.
[AGENT][POSITIVE] Yes, it'll be a little bit more user friendly once you get in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let's see if I can get in now. Oh, and it's always gonna send a verification code to his email.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Every time, OK, so let's see if I get that.
[CUSTOMER][NEUTRAL] OK, well that was faster. I got that [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] All right, looks like.
[CUSTOMER][NEUTRAL] OK. File a claim, file a claim system. OK, so then I can just go in here and start filing the claim. Yeah, I think so. So quick question, so for the one claim, um, he had to have shoulder surgery. And unfortunately, where the doctor did the surgery, they would not take the insurance, so we're filing the claim. So I know I need to use the hospital indemnity and everyday solutions claim form, correct?
[AGENT][NEUTRAL] Did it work?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, you'll use that form.
[CUSTOMER][NEUTRAL] And send in a copy of the itemized charges for that facility.
[AGENT][NEUTRAL] Yes, and make sure that they have procedure codes or units on them depending on the type of surgery, um, because we will look at those procedure codes. Um, some hospitals don't just give you that, you have to ask for it, um, especially since you're filing on your behalf. So just make sure that it has procedure codes. Yeah. Um, and yeah, you should be able to do all of it from the OSC account now that you've got it created.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] If
[AGENT][NEUTRAL] You can even check claim status, um, should you need to upload anything else into that claim, um, for whatever reason, you can also upload it more documents into your claim once you've submitted them.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, so I can either upload this or fax it to you, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Then I had called before to see and they said acupuncture because you also need to get some acupuncture due to the shoulder surgery, um, that he had coverage. Uh, do I use that same form? And does that have to be a separate claim?
[AGENT][NEUTRAL] Let me check. You should use the same form if it's under the hospital indemnity policy. Was it under a different date of service?
[CUSTOMER][NEUTRAL] Yeah, because the one thing I'm gonna send in is the same service because also the anesthesiologist, I have to submit on our own. Um, and then the acupuncture was on various dates as part of the treatment. So that's like a separate thing. But I didn't know if I use the same type of form or if there's a different type of form.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, same form, but um, you can file the acupuncture dates um together, but you'll want to send that in as a separate claim since it wasn't at the same time. Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] That's what I thought.
[CUSTOMER][NEUTRAL] OK, OK, and then, um, like anything that's been, you know, submitted from the hospital or any other doctors, will we be able to see that online to see what's being paid or not or how that's going or no, not only what we submit for a claim.
[AGENT][NEUTRAL] I believe it's only what you submit um.
[AGENT][NEUTRAL] Because we can't give information out, so if the doctor files the claim, um, we can give it to the doctor, um, but just the same with you, if you file a claim and the doctor is asking us unless we are specifically requesting medical records, we can't disclose it with anyone who didn't submit the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's fair enough. And then the last, the young lady that I talked to before was gonna email us a copy of the policy, um, but we never got that. Is that gonna be on his dashboard here or does that have to be sent to us separately?
[AGENT][NEUTRAL] Yes, it should be on the dashboard. It should be on the dashboard um it might be if you're logged in it should be on the left hand side, um, either my dashboard and then you can click, I believe it's a blue box with hands and a heart in the middle.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that should have your policy and uh claims and everything right there in the tab.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, all right, I'll look for that if I have any questions I'll call back. I appreciate your help thank you.
[AGENT][POSITIVE] Thank you for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Alright bye.