AccountId: 011433970860
ContactId: aa05fd42-f937-44ca-90dc-b451bc245af5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1006059 ms
Total Talk Time (AGENT): 371695 ms
Total Talk Time (CUSTOMER): 451846 ms
Interruptions: 6
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/aa05fd42-f937-44ca-90dc-b451bc245af5_20250617T14:37_UTC.wav
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[CUSTOMER][NEUTRAL] every single day.
[AGENT][NEUTRAL] Thank you for calling APL, this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yeah, I need to understand how to file a claim, um.
[CUSTOMER][NEUTRAL] So for instance, I have.
[CUSTOMER][NEUTRAL] Copays that I pay and I understand that with the APL I can have my copays uh reimbursed, um, or if I have uh items that let's say my uh insurance didn't pay for, um.
[CUSTOMER][NEUTRAL] Some of those items could be covered by APL, um, I need to know how to file claims like that.
[AGENT][NEUTRAL] OK, so, um, you can go to [PII]. Can you hear me?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] I can't hear you.
[CUSTOMER][POSITIVE] Yes, I can.
[AGENT][NEUTRAL] Can you hear me now? OK.
[AGENT][NEUTRAL] You can go, you can go to [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And on the top right corner you'll see something that says uh claims and forms. If you click that you can scroll to find the claim that you would like to um submit.
[AGENT][NEUTRAL] And then, uh, all of our information on where to send that claim, it includes our fax number and our uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Email I'm sorry, our fax number and our mailing address, it's all on those claims, so depending on what kind of claim, mhm.
[CUSTOMER][NEUTRAL] Yeah, but, uh, I, I, I, I.
[CUSTOMER][NEGATIVE] Yeah, my problem isn't that my problem is what you know I've sent invoices and you said no, that's not uh what we need. You need some kind of billing medical billing that I don't.
[CUSTOMER][NEGATIVE] I get so frustrated because.
[AGENT][NEUTRAL] Oh, like an itemized bill.
[CUSTOMER][NEGATIVE] I don't know what you call it, but every time I've sent something I've gotten rejected and it said you don't have the right kind of billing document. What what do you call the the proper billing document that I have to submit?
[AGENT][NEUTRAL] Uh, typically we need itemized bills that have some type of procedure codes, um, or if you're admitted into a hospital, we need the hospital admission uh paperwork as well showing that you were staying there. Uh, it typically has to be some type of itemized bill or itemized receipt showing what each thing was paid for.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But, but is there a title for the type of deal?
[AGENT][NEUTRAL] And how much was paid towards it?
[CUSTOMER][NEUTRAL] Uh, what, what's the title of that kind of bill?
[AGENT][NEGATIVE] Just itemized.
[AGENT][NEUTRAL] It's, it's just called an itemized bill.
[CUSTOMER][NEUTRAL] But they're not gonna, it's an itemized bill, but I've said that and
[CUSTOMER][NEGATIVE] You you you said you tell me it don't have the procedures on there. I so it come I don't.
[CUSTOMER][NEUTRAL] So what you said it has to be some procedures, huh? You said I have to have some procedure numbers.
[AGENT][NEUTRAL] OK, what's your policy number?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What's that?
[AGENT][NEUTRAL] Yes, that should be on the itemized bill from your doctor. You sometimes you'll need to ask for that specifically. Um, those procedure codes will sometimes tell what, what they're billing for and then um you said that you were needing
[AGENT][NEUTRAL] They asked you for what kind of codes?
[CUSTOMER][NEUTRAL] So I stayed in the hospital.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Procedure codes.
[AGENT][NEUTRAL] Yes, that should come from the hospital. That's considered an itemized bill, um, because it has the procedure codes, what was, what was billed, um, exactly, not just numbers. We need to see what was actually billed for.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that we can see if it's covered by the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm gonna try this again. Alright, we'll see what, how far can I go back?
[AGENT][NEUTRAL] Uh, we don't have timely filing limits. So as long as your policy was active during your dates of service, you can file it for those claims.
[CUSTOMER][NEUTRAL] And I just, I want to confirm my policy is active.
[AGENT][NEUTRAL] OK, what's your policy number?
[CUSTOMER][NEUTRAL] Cause I'm a retiree now, so.
[CUSTOMER][NEUTRAL] Uh, I've got a group number 20681.
[AGENT][NEUTRAL] Does it have a policy certificate number on it or anything um that may end that may start with a 01? OK, what's the plan number?
[CUSTOMER][NEUTRAL] It's a plan.
[CUSTOMER][NEUTRAL] Yeah, 01 here here we go, 01.
[CUSTOMER][NEUTRAL] 791-989 ML 7
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] And who am I speaking with?
[CUSTOMER][NEUTRAL] A [PII]
[AGENT][NEUTRAL] And your date of birth?
[CUSTOMER][NEUTRAL] Excuse me?
[AGENT][NEUTRAL] Your date of birth?
[CUSTOMER][NEUTRAL] You said date of birth? [PII].
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] All right. Thank you.
[AGENT][NEUTRAL] And what's the address, what's the address that we have on file for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, I am showing that your policy is currently active.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][POSITIVE] Alrighty.
[AGENT][NEUTRAL] Yeah, it looks like, um, so when you're, if you're filing a claim on your behalf, you will need to send like the itemized bill that we talked about that has procedure codes on it, um, or it looks like one of them was denied because it needed a diagnosis code from labs. um, but also whenever you send in a claim on your behalf for this policy, since it's secondary gap, you will need to send your primary uh explanation of benefits.
[AGENT][NEUTRAL] Uh, with that claim showing that they, uh, paid partial or paid some of the bill, um, but anytime you go to the hospital and they, uh, charge your primary insurance first, your primary insurance will give you an explanation of benefits, um, and we will need a copy of that paper.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, no problem. Thank you.
[AGENT][POSITIVE] OK. You're welcome. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] That's it.
[AGENT][POSITIVE] Alright, well thank you so much for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] Hold on, hold on, hold on, man. So you, you see the ones that were rejected, right?
[AGENT][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] You, you see, so what was it that I needed to turn in for that?
[CUSTOMER][NEUTRAL] To to make those claims good?
[AGENT][NEUTRAL] Um, I just picked.
[AGENT][NEUTRAL] I just picked one, so let me get back on there.
[AGENT][NEUTRAL] Uh, it looks like for your lab works and everything that you did, we need, uh, the, the itemized bill that you would get from your physician, uh, that has the diagnosis codes on it.
[CUSTOMER][NEUTRAL] And then what about the ones where I was in the hospital in [PII]?
[AGENT][NEUTRAL] Let me go back.
[AGENT][NEUTRAL] Oh, you said in [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You don't see that?
[AGENT][NEUTRAL] Uh, give me just a moment.
[CUSTOMER][NEUTRAL] some of these friends are taking advantage of that so they plan to.
[CUSTOMER][NEUTRAL] So those are the potential storing areas what is
[AGENT][NEUTRAL] OK, here it is.
[AGENT][NEUTRAL] It looks like it was that diagnosis code that we needed for your labs.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Your explanation of benefits from your primary.
[CUSTOMER][NEUTRAL] Where do I get that from?
[AGENT][NEUTRAL] You'll get it from your physician.
[CUSTOMER][NEUTRAL] Where, where am I gonna get a diet?
[CUSTOMER][NEUTRAL] But I was in the hospital.
[AGENT][NEUTRAL] Right, so you, you can call them and ask them.
[CUSTOMER][NEGATIVE] I don't understand. I mean y'all make this so hard.
[CUSTOMER][NEUTRAL] It's like I have to be uh uh.
[CUSTOMER][NEUTRAL] A physician myself to figure out what I need to give you to get like so hard. I mean, where do I get this stuff from? I gotta go to my doctor's office to ask, ask him to give me a diagnosis code for when I was in the hospital.
[AGENT][NEUTRAL] Yes sir, um, because that's what they would send us if they send the claim on their behalf as well, but that's what we need to show, um.
[AGENT][NEUTRAL] What was paid.
[CUSTOMER][NEGATIVE] But that's not my primary that who cares for me in the hospital.
[CUSTOMER][NEUTRAL] That was some other physicians. I, I don't get it. I mean, I went to.
[AGENT][NEUTRAL] You'll need to get it from the hospital that you went to.
[CUSTOMER][NEUTRAL] The billing section.
[CUSTOMER][NEUTRAL] Diagnosis code. So who do I ask for that? The billing department?
[AGENT][NEUTRAL] Uh, you can ask them. They'll probably send it to you. Mhm.
[CUSTOMER][NEUTRAL] Cause I can't, I don't know who the doctors were.
[AGENT][NEUTRAL] Right, you can call the hospital and it it might be the billing department depending on the hospital, but call them and say that you need a copy of your receipts with you need a copy of your itemized receipts with diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And that should be all encompassing.
[CUSTOMER][NEUTRAL] Let me write this down.
[CUSTOMER][NEUTRAL] Hold on a minute, let me write this down.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 30 minutes
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Dye egg knots oh itemized bill.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Diagnosis code itemized bill and procedure codes, right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I will try to work on this.
[AGENT][NEUTRAL] OK, in the meantime, is there anything else I can help you with?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Um, yeah, since I got you on the phone.
[CUSTOMER][NEUTRAL] Uh, is your website, uh.
[CUSTOMER][NEUTRAL] See.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Oh, so it changed.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, because I tried logging on.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Let's see if it works now.
[AGENT][NEUTRAL] So for that, uh, so for your online portal account it's secured. [PII], uh, that part hasn't changed. We did get a new provider for that portal so you will need to for the first time.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Go in and create a new account, um, only fill out the information that's required, but once you create a new account all of the information from your old account should transfer over so you'll still be able to see all of the claims that you submitted in the past.
[AGENT][POSITIVE] And be able to upload these documents through there. You're welcome.
[CUSTOMER][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] Well, well, wait a minute, stay, stay on. Let's see if I can do this if I need help.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] It.
[AGENT][NEUTRAL] And the email that we have on file for you is a Gmail account you'll need to use that email.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] And when it asks for the member number, I don't have to put the letters at the end, do I?
[AGENT][NEUTRAL] Um, I would just put in what's required, so last name, email, and date of birth.
[CUSTOMER][NEUTRAL] Please
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Last name
[CUSTOMER][NEUTRAL] Was asking for more stuff. Oh, only the ones with the stars on it.
[AGENT][NEUTRAL] Yes, but, but it's not, it's not required, right, right, it's not, it, it's not required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Last name, email, and date of birth, alright, let's go with that.
[CUSTOMER][NEUTRAL] changes heartbreak in the.
[AGENT][NEUTRAL] And then it'll ask you to verify your email.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And you should get a verification code pretty quick if you don't see it, um, I would check your spam.
[CUSTOMER][NEGATIVE] vomiting.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Give you
[CUSTOMER][NEUTRAL] stuff.
[CUSTOMER][NEUTRAL] Last name, email, date of birth, next.
[CUSTOMER][NEUTRAL] Alright, error, no user was found.
[AGENT][NEUTRAL] All right, let me check.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] She she's sitting at.
[CUSTOMER][NEUTRAL] 0.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] OK, it should have worked. So if you go to, so you went to insured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You click last name [PII], you put your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And you put in
[CUSTOMER][NEUTRAL] And he said era.
[AGENT][NEUTRAL] And what was the email that you put in?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] We have the AA2. [PII].
[CUSTOMER][NEUTRAL] Oh, there's, that's, there's the problem. Let me use that one.
[AGENT][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] OK, let's see if it works now.
[CUSTOMER][NEUTRAL] Jackpot, OK, complete your account set up, continue. So once the email I use the AA2.
[AGENT][POSITIVE] OK, good.
[AGENT][NEUTRAL] Yes, and you'll verify that first. Mhm.
[CUSTOMER][NEUTRAL] The verification code.
[CUSTOMER][NEUTRAL] Then.
[CUSTOMER][NEUTRAL] really.
[CUSTOMER][NEUTRAL] people working.
[CUSTOMER][POSITIVE] And I'm waiting and I'm waiting, and it looks like I got something right.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Verify code. So that's where I put my new password in.
[CUSTOMER][NEUTRAL] Any password requirements?
[AGENT][NEUTRAL] Uh, no, you can just add any password you'd like.
[AGENT][NEUTRAL] Then it'll ask for first name last name and a display name is how you just how you wanna be identified in the system.
[CUSTOMER][NEUTRAL] looks like.
[CUSTOMER][NEUTRAL] The given name is that my last name?
[AGENT][NEUTRAL] Given name is first name, surname is last name.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEGATIVE] I think I messed something up.
[CUSTOMER][NEUTRAL] OK, we'll go with this.
[CUSTOMER][NEUTRAL] OK, exactly.
[CUSTOMER][NEUTRAL] people.
[CUSTOMER][POSITIVE] All right, I'm good, thank you.
[AGENT][POSITIVE] Did it work? All right, you're welcome. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's it.
[AGENT][POSITIVE] OK, well thank you so much for calling APL. I hope you have a great day bye.
[CUSTOMER][POSITIVE] Take care.
[CUSTOMER][NEUTRAL] You too. Bye.
[CUSTOMER][NEUTRAL] So