AccountId: 011433970860
ContactId: a84a2fbd-68ae-4984-94a6-50b1bdcd00ce
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 497200 ms
Total Talk Time (AGENT): 190509 ms
Total Talk Time (CUSTOMER): 206685 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/a84a2fbd-68ae-4984-94a6-50b1bdcd00ce_20250611T15:03_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APM. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi. Um, so I have a claim number and I got a, I got a letter that
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Explanation of benefits received does not list the amounts applied to the deductible.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, um, please submit a more detailed explanation of benefits.
[CUSTOMER][NEUTRAL] So, um, I just wanted to know um how, how to go about that.
[AGENT][NEUTRAL] How to submit the details?
[CUSTOMER][NEUTRAL] But what, what
[CUSTOMER][NEUTRAL] Yeah, because, OK, this, this is what happened. I
[CUSTOMER][POSITIVE] I, um, this is for physical therapy, and I told them to submit the claim directly to you, so I don't have to pay them.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so I guess they.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] Yeah. So I guess they, they didn't do it correctly, maybe.
[AGENT][NEUTRAL] You said you submitted, you wanted them to submit the claim to us directly, so they, so I'm just repeating so I make sure I understand.
[CUSTOMER][NEUTRAL] No, I
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] So you said that you sent, go ahead, I was just trying to understood go ahead.
[CUSTOMER][NEUTRAL] Yeah, so
[CUSTOMER][NEUTRAL] Yeah, I, I told them, they billed me.
[CUSTOMER][NEUTRAL] And so I told them to send the claim, I mean, yes, to send the to send it directly to you so that they'll, you can pay them directly so it doesn't have to go through me.
[CUSTOMER][NEUTRAL] But then I received a letter that.
[CUSTOMER][NEUTRAL] Maybe they didn't submit everything, so.
[CUSTOMER][NEUTRAL] That's why I'm calling.
[AGENT][NEUTRAL] OK, so you wanted them to submit the claim to us so that you, the asking this question is so I know how to proceed further. So because you mentioned that you sent it, you had them send it to us so that you wouldn't have to make them a payment, ma'am, are you saying at the time of service or just once the bill came out because that's two different processes. That's why I'm asking.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] When the bill, when my responsibility, when my responsibility came.
[CUSTOMER][NEUTRAL] So the primary insurance already paid them.
[CUSTOMER][NEUTRAL] And so the what was left was my responsibility and so I told them to bill you so that you will pay for that.
[AGENT][NEUTRAL] I got it. And may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Um [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. May I have your policy number?
[CUSTOMER][NEUTRAL] 01931074
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And I just need you to verify your date of birth and the mailing address on file.
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment, I'm just waiting for the claims to populate here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] All right, it's coming up now I'm um we're just down so it's, it's taking its time. I apologize.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] OK, so you're just receiving a copy of that explanation of benefits because you're the insured, but this was also sent to the provider. So they're going to send us a copy of the completed explanation of benefits. So basically what we received shows zeros for the co-pay.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] And co-insurance, so we don't know what to pay, so we're just asking them to send us the completed one with prices there.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so, so I don't have to do anything.
[AGENT][NEUTRAL] No, ma'am, um, they'll send it, they'll send it to us. I mean, if you have it, you can submit it and it can still be processed, but they'll send it to us, um, because they received it too.
[CUSTOMER][NEUTRAL] OK. Well, I, I don't know. I mean, I just wanna get it taken care of, so I have a copy of the bill. I have an EOB from my, from United, you know, I mean, that's why I'm calling it's like, do I need to do something? Is there, yeah, uh, uh, but, but the thing is.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] So this is your preference.
[CUSTOMER][NEGATIVE] I mean I can I can upload these files, but when I went to um log in you have a whole new system and so my log in doesn't work.
[CUSTOMER][NEUTRAL] And um,
[CUSTOMER][NEUTRAL] Our coverage ended in April.
[CUSTOMER][NEUTRAL] So, I don't think I can.
[CUSTOMER][NEUTRAL] Sign up for a new one again, so I don't know how to upload anyway.
[AGENT][NEUTRAL] OK, um, so this would just be your preference if you wanted to upload the document, you do have that option, but the provider will send it over. So it's
[AGENT][NEUTRAL] It's really no way to advise you. It's just however you wanna handle it. If you want to upload it, you can. Um, we did change to a new system, so you'll just have to create everyone has to create an OSC account and um because our new system ask for an email address versus versus the username or password so um you should still be able to create an account.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Would I be able to, even though
[CUSTOMER][NEUTRAL] Would I be able to, even though I
[CUSTOMER][NEUTRAL] Don't have coverage currently?
[AGENT][NEUTRAL] Yes, I was getting ready to answer that question. Yes, ma'am, you should still be able to um create the account even though you don't have um active service with us, you did at the time of service.
[CUSTOMER][NEUTRAL] OK, but um, where do I find the member ID?
[AGENT][NEUTRAL] So it says the social security or
[CUSTOMER][NEUTRAL] Because it's asking for a member ID.
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] I'm it's, it's asking for a member ID.
[AGENT][NEUTRAL] Or social security number you'll put your social security number in that field.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEGATIVE] Yeah, because, because we don't have coverage anymore I feel like I don't want to create a new account just because it won't, we won't need it.
[AGENT][NEUTRAL] All right. Was there anything else I could?
[AGENT][NEUTRAL] OK, well, that's up to you, but the provider has also received this documentation, so they'll be sending the explanation of benefits as well.
[CUSTOMER][POSITIVE] OK, great. Thank you.
[AGENT][POSITIVE] You're welcome. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] No, but just to clarify, so they got the same.
[CUSTOMER][NEUTRAL] Um, message and so it.
[CUSTOMER][NEUTRAL] They should also be responsible for sending that over, right?
[CUSTOMER][NEUTRAL] Whatever documents.
[AGENT][NEUTRAL] Right, they submitted this claim, so we sent the explanation of benefits back to them, but because you are the insured, you received the copy as well.
[CUSTOMER][POSITIVE] OK, great.
[AGENT][NEUTRAL] All right. Was there anything else I
[CUSTOMER][NEUTRAL] So I can just, I'll just wait. I'll just wait for them. I'll just wait for them to.
[CUSTOMER][NEUTRAL] Uh I'll just wait whether or not whatever they send back is fine or not.
[AGENT][NEUTRAL] Right, so once they send in the requested documents, we'll just go ahead and continue processing and give the um correct decision or the new decision.
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. Well, thanks for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] That's it.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Bye bye.