AccountId: 011433970860
ContactId: a294ac14-183a-40c7-a48b-3105671e40ee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1159209 ms
Total Talk Time (AGENT): 325902 ms
Total Talk Time (CUSTOMER): 411546 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/a294ac14-183a-40c7-a48b-3105671e40ee_20250509T13:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling AP. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning. Uh, my name is [PII], and I would like to submit the claim. Uh, I pay from my packet. Uh, how I can do that?
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with filing a claim. Um, first, I'll need to go callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] My phone number is [PII].
[CUSTOMER][NEUTRAL] 283
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Now, I need your policy number, please.
[CUSTOMER][NEUTRAL] OK. Um, I have a, here is the group number.
[AGENT][NEUTRAL] OK. Do you see where it says outpatient certificate number?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. What's that number?
[CUSTOMER][NEGATIVE] It's a 0.
[CUSTOMER][NEUTRAL] 016998
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][NEUTRAL] 0 ML 8.
[AGENT][NEUTRAL] OK. Please verify your first and last name and your date of birth.
[CUSTOMER][NEUTRAL] Uh my name, uh first uh [PII]
[CUSTOMER][NEUTRAL] Last name [PII].
[CUSTOMER][NEUTRAL] U
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Now, please verify your date of birth.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Now, please verify your mailing address and your email address.
[CUSTOMER][NEUTRAL] It's the [PII].
[AGENT][NEUTRAL] And please verify your email address. Mhm.
[CUSTOMER][NEUTRAL] An email
[CUSTOMER][NEUTRAL] Email is like my first name, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm showing that you don't have an email address on file. Would you like to add that email address?
[CUSTOMER][NEUTRAL] Yeah, you can add it if you.
[AGENT][NEUTRAL] OK, and again, that's [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK. OK. I've added that information and yes, ma'am, um, normally, the provider files the claim. What you can do is um give your provider our phone number and also um your policy number so they can call us to verify your benefits and to see how to file a claim. And if they file the claim, then we'll pay them directly. Or if you would like to file the claim yourself, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEGATIVE] Uh, I would like myself, because yesterday when I went, they said, um, they're gonna give me the everything, the old paperwork, and I need to do myself because they're not uh doing this.
[CUSTOMER][NEUTRAL] Why I'm calling you.
[AGENT][NEUTRAL] OK. If you
[CUSTOMER][NEUTRAL] I want to do myself.
[AGENT][NEUTRAL] OK. If you would like to file the claim yourself, you can mail us the information, you can fax us the information or you can file the claim online, which way do you prefer?
[CUSTOMER][NEUTRAL] Uh, online, can I attach everything, all the paperwork?
[AGENT][NEUTRAL] Yes, ma'am. You can file the claim online. What you would need to do is go to our website. Let me give you our website.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Let me know when you're ready.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK. Our website is secured. That's [PII]
[AGENT][NEUTRAL] Do
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And once you go there, you'll see a blue button or a blue tab that says new user.
[AGENT][NEUTRAL] You'll click on that button.
[CUSTOMER][NEUTRAL] Uh, give me one second. I'm gonna do the, the, at the same time. Is it possible?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] At least I can go to the website and make sure that I'm um.
[CUSTOMER][NEUTRAL] Same page as you are.
[AGENT][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] OK, is the, the, the, because here is on the Google it's showing me uh.
[CUSTOMER][NEUTRAL] APL secure and uh APL claim status. 00, should I go to the secured one?
[AGENT][NEUTRAL] Yes, go to [PII].
[CUSTOMER][NEUTRAL] Uh-huh. And here is, um, say the file claim online, right? Or I need to create the account and put as a user, uh, new user?
[AGENT][NEUTRAL] Yes, go to new user to create your account first.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK. Is it allowing you to create a new account?
[CUSTOMER][NEUTRAL] It's asking me the question which role best describe you? I'm individual with the APL or?
[CUSTOMER][NEUTRAL] Insurance policy or I should for employer in group because I'm um in uh insured uh from my work.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right, it sounds like you're the first one, select the first one, you're an individual.
[CUSTOMER][NEUTRAL] Uh, even though I, uh,
[CUSTOMER][NEUTRAL] Sign for the the um.
[CUSTOMER][NEUTRAL] Group offer the APL product to my employee.
[AGENT][NEUTRAL] That's correct. You're the individual. You're, you're setting up your individual policy.
[CUSTOMER][NEUTRAL] OK, um, then I need to.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] I just saying me no it found that any information what I should to do.
[AGENT][NEUTRAL] OK. Is it asking you for your policy number?
[CUSTOMER][NEUTRAL] Yeah, it's asking me for the group number.
[AGENT][NEUTRAL] OK, let me give you the group number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Your group number is 23143.
[CUSTOMER][NEUTRAL] Yeah, but it's not taking.
[CUSTOMER][NEUTRAL] Again, I'm sorry, because here is the question is asking when I'm both as a new user is asking, I'm individual with the APL insurance policy and second one, I, I'm group who offer APL products to my employee. So this is was offered through my employee. Should I click to the second one?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] No, ma'am. You need to click the first one because you're setting up a policy for yourself and not the group.
[AGENT][NEUTRAL] So click the first one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Is it letting you set up your policy?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] One second, please.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEGATIVE] I don't know why it doesn't take my uh the password.
[AGENT][NEGATIVE] It's not allowing you to set up the password.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So what's, what message is it giving you?
[CUSTOMER][NEUTRAL] It's giving me the red. It doesn't say.
[CUSTOMER][NEUTRAL] The symbols probably I need to put some different symbols. I'm sorry.
[CUSTOMER][NEUTRAL] Oh, now it's speaking. Thank you for waiting.
[AGENT][POSITIVE] 00, no problem.
[CUSTOMER][NEUTRAL] OK, my, uh, account, uh, created.
[AGENT][NEUTRAL] OK. And now that your account is created, you can log in and follow the instructions to upload the documentation to file the claim. And the information we need for you to file the claim is that we need the EOB from your primary insurance company.
[AGENT][NEUTRAL] For the date of service.
[CUSTOMER][NEUTRAL] Are you mean
[CUSTOMER][NEUTRAL] Um, because I went to the orthopedic.
[CUSTOMER][NEUTRAL] Uh, I, I, um.
[CUSTOMER][NEUTRAL] They did the X-ray and they did the, the, the shot, steroid shot.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] What I need to do.
[AGENT][NEUTRAL] Yes, what you would need to do is wait for them to file a claim with your primary insurance company. Who's your primary insurance?
[CUSTOMER][NEUTRAL] It's Blue Cross Blue Shield.
[AGENT][NEUTRAL] OK. Once they file the claim with Blue Cross and Blue Shield, you would need to get the explanation of benefits for the date of service for yesterday. We would need the explanation of benefits from Blue Cross and Blue Shield. And we will also need documentation from the doctor's office with your diagnosis code, um, explaining why you need the services that you received yesterday.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] You get that from your doctor's office. And once you get that information, you'll upload, you'll log into your um your policy and file the claim. You'll send us that information, the EOB and documentation with your diagnosis code from your doctor's office.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, um, yesterday when I went they already give me the all the uh cos they give me the receipt, uh, how much I paid all the copy of the receipt and all the um.
[CUSTOMER][NEUTRAL] The what's called the quote should I upload now?
[AGENT][NEUTRAL] No, ma'am. You don't.
[CUSTOMER][NEUTRAL] Since I already have the older.
[AGENT][NEUTRAL] Yeah, you will wait until you get the documentation from Blue Cross and Blue Shield because we can't pay the claim until we get that documentation. So you'll save the information that you have now and once you receive the explanation of benefits from Blue Cross Blue Shield, then you'll upload all the documentation together at the same time.
[CUSTOMER][POSITIVE] OK, got it. OK, thank you so much. I really appreciate it.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Um, here is one more question. Here is on my account which I created now. It said my coverage.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It said the group um.
[CUSTOMER][NEUTRAL] Policy number and uh it's different. It's like a 2, what is it? I'm a little bit confused. Here it say um
[AGENT][NEUTRAL] Yes, ma'am. You do, you do have a new policy number as of [PII]. I can give you your new policy number and I can also have a new card mailed to your house if you would like.
[CUSTOMER][NEUTRAL] Um, new card?
[AGENT][NEUTRAL] Yes, ma'am, with your new policy number on it.
[CUSTOMER][NEUTRAL] Yes, please, if it's possible, because this card is for couple of years already. And of course, we are every year uh updating all the information. So if it's possible, can you send it to me the new one?
[AGENT][NEUTRAL] Yes, ma'am. I can have a new card mailed to you.
[CUSTOMER][NEUTRAL] OK. And when I'm gonna, uh, the upload the claim, I just click to, here it is on the bottom and say my claim upload documents. I need to click there, right?
[AGENT][NEUTRAL] Yes, ma'am. That's where you'll click to upload the documentation once you receive it.
[CUSTOMER][POSITIVE] OK. OK. Thank you so much.
[AGENT][POSITIVE] OK, I thank you and Zilla for calling APL. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Uh, no, uh, ma'am, uh, uh, one more thing, uh, yesterday they did the X-ray for me and they did the, the shot, the steroid shot to my, uh, feet. Um, it's covered, right?
[AGENT][NEUTRAL] Um, we can't guar we can't guarantee payment over the phone, but it does sound like something that would be covered as long as it's related to an illness or an injury.
[CUSTOMER][NEUTRAL] With my policy.
[CUSTOMER][NEGATIVE] Yeah, it's a kind of injury I did. And so, uh, I twisted my ankle and it's so painful. So I went yesterday and they um said they're not accepting APL. I mean, they said, uh, you can send and do it yourself, but they're not processing anything. I was very shocked. How is it possible because any doctor was taking, but this office is not taking.
[AGENT][NEUTRAL] Well, yeah. Fortunately, if they don't take it, then you can file the claim yourself. And it does sound like something that we do cover. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much. I really, really appreciate for your help.
[AGENT][POSITIVE] OK, I thank you [PII] for calling APL. You have a great weekend and get to feeling better.
[AGENT][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Oh thank you. I really appreciate it. I'm sorry, one more question. If everything gonna be OK, you guys sending the like a check to myself or how it work the system?
[AGENT][NEUTRAL] Yes, ma'am. If the, if you file the claim and it's approved and the uh benefit is available, we'll send the payment to you since you filed the claim, it'll go to you.
[CUSTOMER][POSITIVE] OK, perfect, perfect.
[CUSTOMER][POSITIVE] Perfect thank you so much, really appreciate it. Have a good one.
[AGENT][NEUTRAL] You do the same. Thank you for calling APL. Mm bye.
[CUSTOMER][POSITIVE] Thank you. Bye.