AccountId: 011433970860
ContactId: a9f80e5a-5cc5-457e-a885-cab2c558a9c5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 396279 ms
Total Talk Time (AGENT): 154586 ms
Total Talk Time (CUSTOMER): 190473 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/a9f80e5a-5cc5-457e-a885-cab2c558a9c5_20250113T16:30_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, I have a question please about filing a claim on the website.
[AGENT][NEUTRAL] OK, and your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And are you the policyholder, [PII], or are you calling on behalf of the provider's office?
[CUSTOMER][NEUTRAL] I am.
[AGENT][NEUTRAL] Provider's office, the policy holder, OK, what's your policy?
[CUSTOMER][NEUTRAL] The policy holder?
[CUSTOMER][NEGATIVE] No policyholder.
[AGENT][NEUTRAL] Got it. What's your uh policy number?
[CUSTOMER][NEUTRAL] Oh dear, let me look.
[CUSTOMER][NEUTRAL] Just a minute, let me find it.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I'm sorry, um, see if this certificate number is 00900996553.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And verify your date of birth, your mailing address, and your email address on file, please.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] All right, thank you for that information.
[AGENT][NEUTRAL] OK, and how can I help you today, [PII]?
[CUSTOMER][NEUTRAL] I'm online of the claim form and I'm trying to make a claim for a follow-up mammogram that I had to do and I don't, uh, is it under a wellness claim or is it a different form?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] It's the wellness claim form, but you'll have to print it, fill it out, and then upload it.
[AGENT][NEUTRAL] So
[CUSTOMER][NEGATIVE] Oh, I can't do it online.
[AGENT][NEUTRAL] I, I think we've been having a little issue with that, um, and are you on, are you on the [PII] side or are you on the online service center side?
[CUSTOMER][NEUTRAL] A in public.
[AGENT][NEUTRAL] OK, yeah, you'll have to print it.
[AGENT][NEUTRAL] Complete it and then upload it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, now I just submitted a different one for a regular mammogram and it went through. Should I redo that one?
[AGENT][NEUTRAL] And so let me look at that when I see it.
[AGENT][NEUTRAL] And you were able to complete that one without printing it?
[CUSTOMER][NEUTRAL] Uh-huh, uh-huh.
[CUSTOMER][NEUTRAL] And I guess my question was, and I'll still need this if I have to print it as well. Uh, it says select the wellness exam screening or test that was performed. I, I didn't want to just put mammogram again because it would look like a duplicate. How do I identify that it's a follow-up? I had to have a second one done, more detail.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So is it due to a medical concern?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so then it wouldn't be a wellness you would just complete.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, the regular cancer claim form.
[CUSTOMER][NEUTRAL] Uh, a regular cancer claim form. OK. Let me see where I find that.
[AGENT][NEUTRAL] Right, and so.
[AGENT][NEUTRAL] And then you would have to submit an itemized bill with that because it's just like a regular claim and not a wellness claim.
[CUSTOMER][NEUTRAL] OK, and so that's for the follow up. OK, let me, let me find out where that is, so I go to claim forms.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And go to cancer. It should be the 2nd or 3rd 1.
[CUSTOMER][NEUTRAL] OK, just a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh it's having me sign it again just a moment.
[AGENT][NEUTRAL] To the website?
[CUSTOMER][NEUTRAL] Well, when I clicked on claim forms it did.
[CUSTOMER][NEUTRAL] Oh, but it took me right to it, I guess, because, um,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I guess I was already logged in. OK, so I go to claim forms at the top. Well, it's doing it again when I click on claim forms at the top.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The upper right does it say claims and forms?
[CUSTOMER][NEUTRAL] It says claim? Oh no.
[CUSTOMER][NEUTRAL] Yes, when I click on that, then it takes me.
[CUSTOMER][NEUTRAL] To it says file claims online 24/7. Other ways to submit your claims, mail a paper form. Well, here it says download and complete the appropriate form, so let me try that.
[AGENT][NEUTRAL] Mhm. Yeah, that's where you should be.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, so I go to the regular cancer claim form.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And have they completed the ultrasound, I mean, the uh follow-up mammogram?
[CUSTOMER][NEUTRAL] Unfortunately, yes. Meaning I have to do some, I have to have a biopsy now. So, so I, I mail, fill this out, mail it in along with an itemized bill of the um the procedure, and then I, that's when I, OK. Do I need to send in any results or anything?
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Right, um, and so that will not be considered under the wellness benefit because they're doing additional testing and so they may request the biopsy when you send that in, so you may wanna wait.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you could attach the biopsy.
[AGENT][NEUTRAL] Results.
[CUSTOMER][NEUTRAL] After, I mean, if they need it, or I'm sorry, I misunderstood you. You're saying wait.
[AGENT][NEUTRAL] You know, once they, once.
[AGENT][NEUTRAL] Right, because you're, you're, you're submitting another claim for an X-ray, but you've not been diagnosed with any cancer yet. And hopefully, you won't. And so then it wouldn't, it wouldn't be covered. It's like a follow-up.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Which is due to a medical concern, so it's only covered we've already, you've already uploaded the wellness benefits, so we'll pay that one.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] But if this is a follow-up, then you, you'll need to wait until you get um until after the biopsy is done.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, so it's only the follow-up is only covered if it's cancer.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, I understand. OK, well, hopefully I hopefully I don't have to submit it. OK, well, thank you for your help. I, I appreciate it. And the other one you said that I did online, it went through so I don't need to do anything else on that. OK, thank you.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I know it. I know.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Yeah, I'm looking at it. Yeah, I see it in your file.
[CUSTOMER][POSITIVE] OK, thank you very much appreciate your help.
[AGENT][NEUTRAL] All righty. Anything else, [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, ma'am, that's all bye.
[AGENT][POSITIVE] Alright, thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Mhm.