AccountId: 011433970860
ContactId: a8419f7d-7ec0-4a72-9507-3bcf97a687d7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2238510 ms
Total Talk Time (AGENT): 895231 ms
Total Talk Time (CUSTOMER): 1088277 ms
Interruptions: 8
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/a8419f7d-7ec0-4a72-9507-3bcf97a687d7_20250121T17:59_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I am trying to uh file a claim, uh yeah, file a claim online and we seem to have misplaced all of our information so can we start over with a password and all that good stuff?
[AGENT][NEUTRAL] OK, Ms. [PII], so you're trying to log in to the online service center so that you can upload claims information but you don't have any of your information to do that with?
[CUSTOMER][POSITIVE] Exactly
[CUSTOMER][NEUTRAL] Right, everything that I have is wrong, so I have a big X across it.
[AGENT][NEUTRAL] Uh, OK. OK. Well, sure. Yes, ma'am. I can help you with that. And what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And do you know your policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] I do now let me tell you this the policy is in my husband's name, but I'm the one that takes care of stuff, but I call him in here if you need to if that's not if that's a.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes. We, we will have to um do that, but you and I can do what we can do before you drag him in.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure. Oh right, policy number.
[AGENT][NEUTRAL] So, you can go ahead and give me the policy number.
[CUSTOMER][NEUTRAL] Uh-huh 00996647.
[AGENT][NEUTRAL] All right, thank you. So one moment, please, for me to get your information pulled up.
[CUSTOMER][NEUTRAL] It's under [PII].
[AGENT][POSITIVE] Thank
[AGENT][NEUTRAL] OK, Ms. [PII], I will have to verify several things with you first for security so we can go ahead and do that before um you get Mr. [PII] in, OK? So if you could verify his date of birth and then your date of birth.
[CUSTOMER][NEUTRAL] OK, his date of birth is [PII].
[AGENT][POSITIVE] Thank you. Mhm.
[CUSTOMER][NEUTRAL] And my date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And also your home mailing address, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. The uh phone number that we would have on file for Mr. [PII]?
[CUSTOMER][NEUTRAL] Mr. [PII] is [PII].
[AGENT][NEUTRAL] Thank you. And then his, I'm assuming, yes, his email.
[CUSTOMER][NEUTRAL] His email is [PII].
[AGENT][NEUTRAL] OK, thank you. So now, if um if you could get him in just because I do need to get his authorization.
[AGENT][POSITIVE] To help you with the portal. Mhm. Thank you.
[CUSTOMER][NEUTRAL] Sure, just a sec.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] There, oh, this is uh our APL insurance that I'm trying to get some stuff straightened out and she just needs because it's in your name. OK, here he is. Hello.
[AGENT][NEUTRAL] Hi, Mr. [PII]. This is [PII] with APO. How are you today?
[CUSTOMER][POSITIVE] Great, what can I do for you?
[AGENT][NEUTRAL] Well, Ms. [PII] was needing assistance in setting up and using the portal, and because the policy is in your name, we can only do that with you unless you give me verbal consent for this one phone call only to assist her with that.
[CUSTOMER][NEUTRAL] OK, well, you have my consent to help.
[AGENT][POSITIVE] OK, perfect. Well, thank you so very much, Mr. [PII]. I appreciate you getting on the line and I hope you have a nice afternoon.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, back to me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. So, were you trying to set up the profile?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Well, here's, here's one thing, can you pull up I've got two, I have 2 claims that I submitted last year. I had gotten way behind doing claims and so I sent several and they were wonderful. They, you know, came back, but 2 of them came back, um, and I don't know why. So do you have access to those before I try to go because normally I just, I do a paper copy and send them in.
[AGENT][NEGATIVE] Cause I
[CUSTOMER][NEGATIVE] But I thought, well this is dumb. I can do it online and then I realized I couldn't because we don't have the right password that we set up before obviously.
[AGENT][NEUTRAL] OK. So actually, so, OK, and again, any information provided will be a verification of benefits and not a guarantee of payment. So, do you want
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so on the claims, are they for you?
[CUSTOMER][NEUTRAL] Yeah, I just need to know
[CUSTOMER][NEUTRAL] Uh, let me see, yes, they are for me and then there was one for him that was questionable, but anyway, if you can pull up, I'm looking for, um, you want me to give you the date of when, um.
[CUSTOMER][NEUTRAL] Uh, it was submitted I guess or the, or, or the date of service for.
[AGENT][NEUTRAL] service, yes, ma'am, for you, I need the data service.
[CUSTOMER][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] OK, so it's [PII] date of service with [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it was for a mammogram.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Which normally they pay the, you know, for the mammogram.
[AGENT][NEUTRAL] OK, so let's OK.
[CUSTOMER][NEGATIVE] But they did not.
[CUSTOMER][NEUTRAL] And the weird thing is, on the little piece of paper that they send, it says check date, like [PII], like you would think that there was a check that was issued, but then on the actual piece of paper, it says benefits paid zero.
[AGENT][NEUTRAL] So according to the, OK, so according to the remark that's on that claim for that data service.
[CUSTOMER][NEUTRAL] And there was no
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and it actually looks like we received it twice, but the remark on here states we have received your wellness claim form. However, the claim form is not completed in its entirety. Please complete the statement of the insured sections H through E and return to our office for benefit consideration.
[CUSTOMER][NEUTRAL] You get
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] All right, so section A, um, section what? A through E?
[AGENT][NEUTRAL] It's, yes, ma'am, that's what it's showing.
[CUSTOMER][NEUTRAL] Sure, OK, just a sec.
[AGENT][NEUTRAL] As the remark.
[CUSTOMER][POSITIVE] Right, yeah, and I've got all that and on mine it's I must have called it sometime.
[CUSTOMER][NEUTRAL] And then you know I got busy or something it said missing the provider name which was really weird. OK, now this is one question I have. These are for mammograms, so my doctor like that I go to, you know, uh, for a well woman checkup every year, you know, she'll say, OK, and you're due for gram, and then I just go to one of our local, um, Chris's places that you could get into and all. So do I put the name of my provider because she's the one that says, hey, you go do a mammogram? OK, so not necessarily the.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, because she would have.
[AGENT][NEUTRAL] Right. She would be the one that's actually ordering it for you to have it.
[CUSTOMER][NEUTRAL] Yeah, go
[CUSTOMER][NEUTRAL] OK, I'll try that one again, um, so knowing that I put her stuff on there. OK, so that's the only thing, and I did, I submitted it twice. I have called, um, after the second time.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it said your your provider name I'm like, well, it looks like it's on here but I guess not. OK, that answers that question so I'll, I'll try that again right now there was one and you this may have been um.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] The deed, um.
[CUSTOMER][NEUTRAL] It was uh for [PII], um, yeah, he was the claimant and the insured and it the date on it was [PII] and it was his diagnostic testing it was a PSA.
[CUSTOMER][NEUTRAL] But it paid for one of them but not the other one that two different years on the same claim form or with.
[CUSTOMER][NEUTRAL] Do you see a payment of that?
[CUSTOMER][NEUTRAL] Around [PII] for [PII] for a PSA.
[AGENT][NEUTRAL] And you said it was
[AGENT][NEUTRAL] Mhm. I did. We received that more than once. Mhm. It looks like.
[CUSTOMER][NEUTRAL] And there was a picnic
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The first claim that was received.
[CUSTOMER][NEUTRAL] But
[AGENT][NEGATIVE] was paid, but the second one was, you know, denied.
[CUSTOMER][POSITIVE] OK, so the, so the 271222 was submitted and was OK, perfect. Yay, good for that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am, that one does, I don't, yes, ma'am. I don't see that we haven't paid us for him. Uh give me one sec. Yes, as of now, we don't have anything for him that we were, you know, needing any additional information on that's been submitted at this time. Mhm.
[CUSTOMER][NEUTRAL] Right, right, so he's up.
[CUSTOMER][NEUTRAL] He's up. OK, perfect. Alright, now let's go back to this other problem that I'm having because I'd really love to be able to do everything online, but I can't. So obviously we're in the system. Go ahead. How do I cancel out whatever we put in and start over again with a different password and what have you.
[AGENT][NEUTRAL] OK, so,
[AGENT][NEUTRAL] OK, OK, because it hasn't assigned a username or anything. It looks like it's just kind of in limbo out there um all right so let's try to do this. So go to the first, the very first screen.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you will select new user.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, that's where I am.
[AGENT][NEUTRAL] OK, then it's gonna ask you what role best describes you, and you will select the first that says I'm an individual.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Got it. OK, next.
[AGENT][NEUTRAL] Next, mhm.
[AGENT][NEUTRAL] Now, on that 3rd screen, Ms. [PII], all of that information pertains to Mr. [PII]. So that's his date of birth, his social, his email.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][POSITIVE] Alright, got it, um, I'll pay it.
[AGENT][NEUTRAL] So if you wanna go ahead and, yeah, go ahead and fill in that screen and then
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] When you're finished with that, click next and we'll see what happens from there.
[CUSTOMER][NEUTRAL] All right, got it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see here. All right, why are we not moving? What's going on?
[AGENT][NEUTRAL] And are you on a computer or on tablets? OK, because you, OK, and the reason I'm asking that is because you do have to upload documents from a computer. It does not currently support mobile functionality.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I'm on the
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh OK so I would have to upload.
[AGENT][NEUTRAL] And I
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I did have a user guide for the portal. Has anyone emailed you all that before?
[CUSTOMER][NEUTRAL] No, I was just gonna
[CUSTOMER][NEUTRAL] I don't think so, but you know what, if it solves all of this, it would be easier for me just to fill out the form and put it in the mail probably than to do all of that.
[AGENT][POSITIVE] Oh no, it's it's, well, no, it's really easy. The user guide just in addition to giving you the steps of setting it up, it tells you kind of how to navigate through it, but submitting a wellness claim in the portal is extremely easy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you don't, I mean, and you get an instant confirmation that we've received it. And Mr. [PII] can also, or, you know, you, since you have access to the portal now, or will, um, you can add in direct deposit information so that if we're able to pay benefits, it can be electronically deposited instead of us having to mail a paper check, which, you know, can be lengthy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh wow.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And just receiving it, you know, just the way of the world these days. But this user guide just gives you a lot of that information. So I mean, I'll be happy to email that to Mr. [PII]'s email that we verified so that you all will at least just have that. But give me just, so while you're trying to walk, yeah, while you're walking through those steps, is, are you still working on that one screen?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, that's great, do that just.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm on the screen now that says to create your account that's where it gets tricky.
[AGENT][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] I'm like, obviously we're in there somewhere and so it's not put in like his social and all of his information. I'm wondering if it's getting crossed up. So how do I erase whatever was there and get the new username password.
[AGENT][NEUTRAL] We can if there's, but it doesn't look like, so when you're getting to where it's asking you, OK, so when you enter all of that information in those 5 boxes and click next you're getting an error message.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, OK. When I go, OK, I was on um.
[CUSTOMER][NEUTRAL] I'm on log in now.
[CUSTOMER][NEUTRAL] So if.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] That I thought that we had that I have written down here.
[AGENT][NEUTRAL] I don't
[AGENT][NEUTRAL] Yeah, uh,
[CUSTOMER][NEUTRAL] It's, it's
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] But let me see
[AGENT][NEUTRAL] So what we'll need, OK.
[CUSTOMER][NEUTRAL] Let me try
[CUSTOMER][NEUTRAL] Alright, I've got that user name. OK, and the password that we had written down, let me try that again.
[AGENT][NEUTRAL] I
[CUSTOMER][POSITIVE] And I think it fits all of the criteria for um.
[CUSTOMER][NEUTRAL] Let's see that
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see, so I'll push submit and it says invalid user name or password.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] OK, so let me ask you this because I need to, we need in order for me to troubleshoot it, we're gonna have to, so like when I told you to click new user you did that and then I'm an individual and you did that and then the next screen, did you refill in all that information?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Here, let me see if I
[AGENT][NEUTRAL] In those 5 boxes.
[CUSTOMER][NEUTRAL] Yeah, just a second, let me do this again.
[AGENT][NEUTRAL] Because it's not look, it doesn't look like
[AGENT][NEUTRAL] There's a profile set up.
[CUSTOMER][NEUTRAL] That is the second date of birth.
[AGENT][NEUTRAL] On my end.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, OK, next.
[CUSTOMER][NEUTRAL] Alright, now I'm at.
[CUSTOMER][NEUTRAL] So create your account. OK, now see that's when you're asking for the user name and password. So do I go?
[AGENT][NEUTRAL] Right, but you don't have, so you're gonna have to set a username. It can be anything.
[CUSTOMER][NEUTRAL] OK, so I can change OK so.
[AGENT][NEUTRAL] Uh, yeah.
[CUSTOMER][NEUTRAL] Let's try. OK, um, and I think let's.
[AGENT][NEUTRAL] Because right now the system doesn't say a username.
[CUSTOMER][NEUTRAL] OK, so, um, on the username does it have to follow all the criteria at the bottom or is that just for the password? OK, so user.
[AGENT][NEUTRAL] No, the username can be anything. It's no minimum criteria, yeah, but there's nothing special about it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, now gonna go to the password and we're gonna try something and this is usually it.
[AGENT][NEUTRAL] Now, the password does have to meet all of that criteria.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's there.
[CUSTOMER][POSITIVE] Alright, it looks like that we have all of that. Let's try it again.
[CUSTOMER][NEUTRAL] Email
[CUSTOMER][NEUTRAL] Alright, I'm gonna send this to [PII]. Alright, and confirm [PII], right.
[CUSTOMER][NEUTRAL] OK, text message phone same number.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Next.
[CUSTOMER][NEUTRAL] See when I go up there, OK, so obviously I'm missing something on password and usually it'll show because we push next and it goes back up there and highlights that so.
[AGENT][NEUTRAL] OK, so password is a minimum of 8 total characters. You do have to use upper case, lower case.
[CUSTOMER][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You have to use numbers and then at least one special character.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, OK, so we're try this one more time.
[AGENT][NEUTRAL] I know that one of the special characters that will not let you use is the hashtag mark. That's one of them.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Oh, that's interesting because yeah all right so uh uh uh.
[AGENT][NEUTRAL] Too many, too many hashtags in our world. So for security, we don't use those.
[CUSTOMER][NEUTRAL] Uh-huh
[CUSTOMER][NEUTRAL] Oh right, let me see. OK, let me try that one second, and you know this was one of those that doesn't allow you to see it, you know, when you push a little eyeball and you're like, well, I hope I put it in there right so just.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Uh
[AGENT][POSITIVE] Yeah, you're fine. Take your time. I've got as much time as you need.
[CUSTOMER][NEUTRAL] Um, but it's what it is, that's what it.
[CUSTOMER][NEUTRAL] Alright, we'll try but that looks good. Now I'm gonna have to remember what I just did. Just a second. It's the hashtag exactly what it was, OK, um.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah. Yeah, that's for security, we don't allow that.
[CUSTOMER][NEUTRAL] Yeah, just a second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, now let's see what happens.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Nothing pushing submitting.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Nothing is happening, but at least I don't have a little box that says.
[AGENT][NEUTRAL] It hasn't given you any ugly messages yet.
[CUSTOMER][NEUTRAL] What is
[CUSTOMER][NEGATIVE] No pink boxes like do it again.
[CUSTOMER][POSITIVE] Oh my goodness, here we go. Your account has been successfully created. Hooray, right before.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, give me one minute. I write this down so I'll know what I just did. Oh my goodness.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's great. OK. All right, now log in. Well, let's, OK, so you know what, you can walk me through it. What invalid username or password? What? How can that be?
[AGENT][NEUTRAL] Oh, you must have typed one little thing. Yeah, it's it.
[CUSTOMER][NEUTRAL] Oh, and like I said, you can't see it. Oh my goodness. Oh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I'll try this again.
[AGENT][NEUTRAL] And just for knowledge in the future if you ever get locked out of it, you know, after so many attempts you can call us and well he would have to authorize us to um speak to you but.
[AGENT][NEUTRAL] We can provide the username, we just can't see the password, so you would have to do the if you forget it, you know.
[AGENT][NEUTRAL] Create a new password.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so I need uh I need.
[CUSTOMER][NEUTRAL] Just 8 total
[AGENT][NEUTRAL] And I did
[AGENT][POSITIVE] Oops, I'm sorry.
[CUSTOMER][NEUTRAL] Yeah 882
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] That's OK. We have a lag in our call and I, and it sounds like we're talking over each other, but I know that's not what it is because I can hear the break in the connection. Yes, a minimum of 8 total characters in length.
[CUSTOMER][NEUTRAL] 8, I just need 8.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uppercase lowercase, numbers.
[AGENT][POSITIVE] And a special one special character.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I'm gonna.
[CUSTOMER][NEUTRAL] OK, let's try this again.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Submitting
[CUSTOMER][POSITIVE] Yay, finally, OK, hello [PII], you can, alright, hold on, let me do this.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] It's the password.
[CUSTOMER][NEUTRAL] Oh my [PII]. OK. um, yeah, OK. All right, here we are. We are on the coverage.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Now,
[AGENT][NEUTRAL] And I did email that user guide to Mr. [PII]'s email, so he should already have that. I, and the email Ms. [PII] is from [PII].
[CUSTOMER][NEUTRAL] All right, so
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it does have a PO and online service center in the subject line.
[CUSTOMER][NEUTRAL] OK, good. Alright, now I'm looking at the screen that has claims processed in the last 24 months.
[CUSTOMER][NEUTRAL] So the two that were not that were processed but not paid.
[CUSTOMER][NEUTRAL] And I, we think we determined that was the same one that I sent in because I sent it in twice. Well, but obviously I left, but obviously I left off the same thing twice, which is weird. Can we look.
[AGENT][POSITIVE] Mhm, that is correct. Mhm.
[CUSTOMER][NEUTRAL] OK it was for [PII] and it was 78.
[CUSTOMER][NEUTRAL] Wait, why would they both have this? Oh, never mind. OK, 9:20 and 1011. All right, so here's the.
[CUSTOMER][NEUTRAL] And 2.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] That doesn't make sense. Um.
[CUSTOMER][NEUTRAL] I wish it would show that on there. Can I click on there and it'll show me?
[CUSTOMER][NEUTRAL] What I submitted [PII] date received date of service [PII]. OK, yeah, yeah, yeah, yeah.
[CUSTOMER][NEUTRAL] That's the name of brand, OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Alright, well, I'm sure that's OK. Need to file a wellness claim. Can I try that right now up there at the file a well wellness claim? OK, let's try it. You, you sure you have all the time in the world to walk this stupid woman through.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You are not stupid, and yes, ma'am, I do because that's the way that you should help someb[PII] and that way you'll see how much easier this is in, you know, filing a claim versus having to print off and mail all that information and
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] You know, and wait for your paper check.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] If we're able to pay benefits, so that's.
[CUSTOMER][NEUTRAL] Right, OK, so here we
[CUSTOMER][NEUTRAL] Uh, I'm filing a claim for [PII] and I'm gonna all right. What date was service?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You mark, yeah. I'll just follow.
[CUSTOMER][NEUTRAL] And uh [PII].
[AGENT][NEUTRAL] Step
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK. [PII].
[CUSTOMER][NEUTRAL] OK, now tell us the name of the facility. The services. OK, that's where, OK, or the physician that provided the service. OK, it was like I told you a while ago, so I'm gonna put my dog that ordered the mammogram or.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yeah, but you're correct, yes ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, probably where I'm messed up because I was like, well, that's not where, and I went to a different place than I usually do, so E N E Y, give me the name.
[AGENT][NEUTRAL] Yeah, cause I'm looking at the actual claim that was submitted and there's not the, the physician's name and physician's contact number.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Or blank.
[CUSTOMER][NEGATIVE] Weird.
[AGENT][NEUTRAL] I see where you, I mean, that you filled in everything else.
[CUSTOMER][NEUTRAL] Alright, so I'll
[CUSTOMER][NEUTRAL] OK, so it says tell us the name of the facility of the service or the physician that ordered. OK, so I need to like CA dash C. OK, so that's now there.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK now what contact number for this provider? OK.
[CUSTOMER][NEUTRAL] Of course I didn't write that down. I wrote everything else down the address, but not that. Let me see if I can find it real quick. OK, hold on.
[CUSTOMER][NEUTRAL] Um, [PII], let's see.
[CUSTOMER][NEUTRAL] That's [PII] about um
[CUSTOMER][NEUTRAL] TMF um.
[CUSTOMER][NEUTRAL] Like pal
[CUSTOMER][NEUTRAL] OK, and where's the phone number here?
[CUSTOMER][NEUTRAL] You know what's weird? They like you pull it up like it gives you the address but the phone number is, there we go, there we go, got it.
[CUSTOMER][NEUTRAL] Because they just have a little phone icon like, OK, I'm gonna call you but I don't. OK, sorry, thank you. I hope this is providing you great payment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] No, I just wanna make sure that you're able to submit your claim, Ms. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] 903606-756 perfect my furniture.
[CUSTOMER][NEUTRAL] Alright, now select the wellness exam screening or test that was performed. OK.
[CUSTOMER][NEUTRAL] Now migra.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. Now answer the question, but continue.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Mhm. And you can add that in there. Mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, that, OK, do I go to just continue and it's.
[CUSTOMER][NEUTRAL] Yeah, OK, alright, so please read the issue credit when you're ready to send me a quick um personal about OK, alright, got that.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Now.
[CUSTOMER][NEUTRAL] I know, yes, OK.
[CUSTOMER][NEUTRAL] Using your mouse. OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Wait
[CUSTOMER][NEGATIVE] I'm signing and it's terrible.
[AGENT][POSITIVE] Oh, that's the interesting part. Oh, yeah. I know.
[CUSTOMER][NEUTRAL] Yeah,
[AGENT][NEUTRAL] Everywhere I go somewhere that I have to sign my name like that, I'm like, who would ever know if that's really me or not?
[CUSTOMER][NEUTRAL] There.
[CUSTOMER][NEUTRAL] That's, that's the future.
[AGENT][NEGATIVE] Cause it sure doesn't look like my signature.
[CUSTOMER][NEUTRAL] OK, now I can't say.
[CUSTOMER][NEUTRAL] Alright, now, wait, I think I'm gonna miss a step on filing a direct deposit.
[CUSTOMER][NEUTRAL] Can I go back because it didn't ask me for any information, OK.
[CUSTOMER][NEUTRAL] Uh, just click file my claim, OK.
[CUSTOMER][NEUTRAL] Oh my plane.
[CUSTOMER][NEUTRAL] Submitting data please wait moments please.
[CUSTOMER][NEGATIVE] That doesn't look like a very fast heartbeat.
[CUSTOMER][NEUTRAL] I don't know where you are today?
[AGENT][POSITIVE] Ma'am, I'm so sorry, Ms. [PII]. Say that again.
[CUSTOMER][NEUTRAL] Oh, that's all right. I just was asking you if you had uh snow where you were where.
[AGENT][NEUTRAL] We do not, I do not have snow, but it is very cold for us. I'm not accustomed to this heat I'm used to, but this level of cold, you know, it's nice occasionally, we thought we might have gotten some
[CUSTOMER][NEUTRAL] Yeah. It's oh, it's.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Snow, um, in my area, I'm in [PII]. I'm in the central part and um right now it's like 28, but it feels like it's 20. So if you ask me how cold it is outside, I'm gonna tell you it's 20.
[CUSTOMER][NEUTRAL] See what?
[AGENT][NEUTRAL] Because that's how it feels.
[CUSTOMER][NEUTRAL] Yeah, Central [PII], is that what you said?
[AGENT][NEUTRAL] I am, uh-huh. Yes, ma'am.
[CUSTOMER][NEUTRAL] We're, yeah, we're in, um, no, well, [PII] by [PII] and every it was the strangest thing it showed that polar vortex going through the panel of [PII] is sweeping way down. So our friends where we used to live, oh they've got like 2 or 3 inches. They're like, oh, they're sending me all these pictures. I was like, uh, I have sunshine and cold temperatures, but no snow.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Way down.
[AGENT][NEUTRAL] Right? It is, yes, here in [PII] it's completely opposite. Central, northern [PII], which usually gets it, didn't get any. Central was under, you know,
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Uh, a possibility, but that decreased over the last several days. And then South [PII], which, you know, never gets snow or anything. They're the ones who got all of this, so it's so strange, but lots of strange things going on.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Oh my gosh.
[CUSTOMER][NEUTRAL] Yeah, yeah, uh, you know, right along the coast. So anyway, OK, I'm down to file a wellness claim, all little things successful entry, your claim is basic. So if you signed up to receive claim status, OK, download a copy of your completed claim form here. Do I have to do anything other than, you know, I never, I never got the information of, I mean, it asked me about direct deposit, but I never.
[AGENT][NEUTRAL] And did you say, yes. Oh.
[CUSTOMER][NEUTRAL] No, I haven't done anything. Can I go to the direct deposit on the little green bar?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The, uh, OK, you can't, I can't see everything exactly the way that you can see it. I can't get that, you know, deep into the portal, not signed in like in a profile. So does, do you see somewhere where it says about direct deposit information?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For.
[CUSTOMER][NEUTRAL] Yeah, across, across the top, the title of this page is file a wellness claim and and then bring timeline of everything like I was a claimant service details, direct deposit confirmation and temporary.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Try to click on that and see what happens. We'll learn something together because after, because where you signed on the page that you signed that's where you should have been able to um.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Put your information in.
[CUSTOMER][NEUTRAL] Yeah, do that.
[AGENT][NEUTRAL] Your direct deposit information.
[CUSTOMER][NEUTRAL] And I saw
[CUSTOMER][NEUTRAL] Uh-huh, I saw that and I, no, it won't let me go back. It's showing that I've gone through all 5 steps and it said successful entry, and I have a confirmation number. So, um, it's been successfully submitted, um, kind of or text me you'll receive a notification, you know what, that's OK for now.
[AGENT][NEUTRAL] And I do see.
[CUSTOMER][NEUTRAL] I'll just wait. I'll just wait till next time when I submit and then I'll know to look at that, um, and I'll.
[AGENT][NEUTRAL] But I can say that we did receive your claim. I mean, I can see that in line under your profile.
[CUSTOMER][POSITIVE] Perfect. OK, well that sounds good. OK, so we determined.
[CUSTOMER][NEUTRAL] That other than just this one which I submitted twice and didn't provide the right stuff so everything um any other outstanding claims that were not paid that you see there right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, let's see. So you, you've resubmitted for the [PII], is that the one that you uploaded?
[CUSTOMER][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so let me look to make sure.
[AGENT][NEUTRAL] Now I can see it looks like there was a data service submitted for [PII].
[CUSTOMER][NEUTRAL] Yes, that's the one I was looking at for my husband. Um, no, no, no, that's me.
[AGENT][NEUTRAL] OK, now, now this, now this is for you. Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And that one never was paid?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, ma'am. That one, the remark is a little different. Give me just a second.
[CUSTOMER][NEUTRAL] Office visit versus memo.
[AGENT][NEUTRAL] And the remark for that one for the [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, it states the information received does not indicate that a screening test to detect internal cancer took place. Therefore, no benefits are payable. Please refer to the benefits section of your diagnostic testing benefit writer for a list of screening tests that are generally medically recognized to detect internal cancer.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Good. And I think if I'm not mistaken, our particular plan is just like a PSA for my husband and a mammogram for me. Um, I think those are the two things that I guess I could look back and see if there was something else, but.
[AGENT][NEUTRAL] And 2, I don't know if you're aware and just for your knowledge, in your portal, there's also a copy of your policy, an electronic version of your policy that you can look at as well, um.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it has a, you know, it's a full copy of your policy, but, and make sure that that is doable to you. Let me just.
[CUSTOMER][NEUTRAL] OK, that's fine. OK, well this
[AGENT][NEUTRAL] Built and it is um.
[AGENT][NEUTRAL] I think there's several tests, but
[CUSTOMER][NEUTRAL] Do you think
[AGENT][NEUTRAL] It's still loading that information. It's a total of 53 pages so whenever you.
[CUSTOMER][NEUTRAL] There's other things
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Whenever you are looking at it, there's like if you click on your policy number, you should see a little PDF icon and if you click there, that should, and then it should start saying downloading.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's your policy certificate.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. All right. Um,
[AGENT][NEUTRAL] So, on your screening benefits, there's like 15 different.
[AGENT][NEUTRAL] Test
[AGENT][NEUTRAL] That would qualify under this benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] I, I'll be happy to read them or you can just look at that information.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah, I'll look at that later because usually it's just um I think it just pays for one diagnostic test a year and so usually both of us each, you know, I get my mammogram and he has a PSA test done also.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Mhm. And those two are on this list for sure.
[CUSTOMER][NEUTRAL] Good, OK, so now let me ask you one more thing, what do we determine?
[CUSTOMER][NEUTRAL] About the date of [PII] and that would have been for [PII].
[CUSTOMER][NEGATIVE] [PII] on my little thing it shows they did not pay for his PSA.
[AGENT][NEUTRAL] Let me put that back to his information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]. Yes, that was paid. The second time, you know, we received it for the same cause that was when we received it twice.
[CUSTOMER][NEUTRAL] Right, that's what it was. OK. 72 I see it. I see it. Oh, I know what it was. There were two things on the same.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, no, 12, OK, yeah, never mind. OK, we are good. I said, but help me out like I said, the whole silly thing all along was just the hashtag which I usually use for um.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know, things on my uh passwords and stuff and I'm like, what is going on here? So.
[AGENT][NEGATIVE] Yeah, for security, yeah, for security purposes, that's, that's a no no for us.
[CUSTOMER][NEUTRAL] Now I
[CUSTOMER][POSITIVE] Oh my goodness, OK, well, listen, you have been amazing. I hope you have a wonderful rest of your day. I hope all these calls are not crazy as this one, so.
[AGENT][NEUTRAL] Oh, well.
[AGENT][POSITIVE] Uh, this was not crazy at all, Ms. [PII]. It was my pleasure in helping you today. So, is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, I am good thank you so very much and you have a wonderful.
[AGENT][POSITIVE] Well, you are certainly good.
[AGENT][POSITIVE] I hope you have a wonderful afternoon and the rest of your week and try to stay warm as well.
[CUSTOMER][POSITIVE] I will thank you bye bye.
[AGENT][POSITIVE] OK, you're welcome. Bye-bye.