AccountId: 011433970860
ContactId: 9c43d1a9-50c5-4062-a614-86f0d8a13faa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 415679 ms
Total Talk Time (AGENT): 200651 ms
Total Talk Time (CUSTOMER): 192793 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/9c43d1a9-50c5-4062-a614-86f0d8a13faa_20250625T15:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, I have a question. I have, um, gap insurance and, um, my
[CUSTOMER][NEUTRAL] Uh, I paid my copay to my doctor, for myself. How do I get that reimbursed?
[CUSTOMER][NEUTRAL] Like what do I need to provide for you guys?
[AGENT][NEUTRAL] Um, yes, ma'am.
[AGENT][NEUTRAL] OK, yes, ma'am. I'll assist you with filing a claim. Um, first, could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Sure. My name is [PII] and the last name is [PII]. My phone number is [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now I need your policy number, please.
[CUSTOMER][NEUTRAL] My policy number is 02517445.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] And please verify your mailing address and your email address.
[CUSTOMER][NEUTRAL] Sure, my mailing address is [PII]. Um I have two emails, um but I'm gonna try the one I use most of the time it's [PII].
[AGENT][NEUTRAL] No, ma'am. I'm not showing that one. This looks like it may be your work email.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so that's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, ma'am. That's correct. But we can change it if you'd like for your other.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, we'll we'll leave it at that for now. We'll leave it at that, yeah, um, I don't have all the information I think you're gonna need, but I just need to know what I need to gather so I can call back and and do the claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, and is this for?
[CUSTOMER][NEUTRAL] Because I don't have the data services in front of me or anything, I.
[AGENT][NEUTRAL] OK. And so, is this for an office visit, um, doctor's office visit?
[CUSTOMER][NEUTRAL] Yes, doctor, doctor's office visit where they did a procedure.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK. Yes, ma'am, because I'm showing that under your policy, the co-pay for the office visit is not covered, but the charges that goes for the coinsurance and the deductible, that's covered up to $500 per day.
[CUSTOMER][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Yes, yeah, I, and, and so that's, that's what I would be asking for.
[AGENT][NEUTRAL] OK. And I'm actually showing that you do have a new policy number. And if you'd like, I can make a request to have a new card mailed to your home.
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] If you need a
[CUSTOMER][POSITIVE] Oh, that'd be perfect.
[AGENT][NEUTRAL] OK. And let me give you your new policy number and let me know when you're ready.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] Um, your new policy number is 026.
[AGENT][NEUTRAL] 41828.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah, that's your new policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, seeming like the, the data services were previous to today, um, and the issuance of the new policy number, do I use the old policy number when filing the claims or what I just call in and you guys would help me out with that?
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Well, the effective date for the new policy is [PII], so.
[AGENT][NEUTRAL] If the date of service was before then, you'll use the old, if it was afterwards, you'll use the new one.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, sounds great.
[AGENT][NEUTRAL] OK. And also the information that we'll need is the explanation of benefits from your primary insurance company.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For the date of service. And we'll also need your diagnosis code. You can get your diagnosis code from the provider's office. We'll just need some type of documentation from the provider's office with a diagnosis code on there. And you'll submit that along with the explanation of benefits from the insurance company. Now, you can file the claim online. You could fax us the information or you can send it through regular mail. Which way do you prefer?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I probably will, will, um, fax it to you guys.
[AGENT][NEUTRAL] OK. Let me give you our fax number.
[CUSTOMER][NEUTRAL] Um, or do not, OK, go ahead.
[AGENT][NEUTRAL] Um, our fax number is [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII] and please attention it to the claims department.
[CUSTOMER][NEUTRAL] Attention claims, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And if I do it online I just log in and do it it's right there, right?
[AGENT][NEUTRAL] Right. Have you set your policy up online yet?
[CUSTOMER][NEUTRAL] I don't remember to be honest with you, um.
[CUSTOMER][NEUTRAL] It's been a couple of months since I accessed anything, so, um, I don't remember if I did or not. That's, that's another thing that I have to verify.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, let me give you our website um because we did upgrade our website and everyone that have set up a policy would need to go in and recreate their policy online. So it sounds like you may have to recreate it anyway. Yeah, our website is secured, that's [PII]
[CUSTOMER][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] You'll go there to the homepage and you'll see a um bar. It may say create, recreate website or create your website and you click on that. You'll let the system know that you're the insured, answer the questions, and that way you'll set your policy up online and once you get in, you'll also see how to file a claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and so, um, when the system asked me for my policy number, I will put in the new one or put in the old one?
[AGENT][NEUTRAL] Put in the new one. Yes, ma'am. Put in the new one. It'll ask you, it'll be a uh area you can enter your policy number or your social. So first, I would try the social and if it doesn't um let you in with the social, do the policy number. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK. All right. Thank you so much. You've been very helpful. I appreciate your time.
[AGENT][POSITIVE] No problem. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, that's it. Thank you.
[AGENT][POSITIVE] Mhm. Thank you again [PII], for calling APO. You have a great day. Mm bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Mm, thank you.