AccountId: 011433970860
ContactId: ad5281a0-2a4f-4fff-8b6a-d5b92e7e0076
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 851140 ms
Total Talk Time (AGENT): 536806 ms
Total Talk Time (CUSTOMER): 309533 ms
Interruptions: 5
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/ad5281a0-2a4f-4fff-8b6a-d5b92e7e0076_20250211T18:38_UTC.wav
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[AGENT][POSITIVE] Thanks for contacting APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes, I have a question about filing a claim. Um, I was looking to the form, uh, filling my claimants stuff out.
[CUSTOMER][NEUTRAL] Um, I don't need an employer statement because this isn't for disability or waiver of premiums. I'm looking at the attendant physician statement.
[CUSTOMER][NEUTRAL] Is it
[CUSTOMER][NEUTRAL] Necessary to have that filled out by a physician, or can I just include all of the, uh, physician, uh, instructions and treatments and the bill?
[AGENT][NEUTRAL] Well, look, we need to actually look at your policy because uh the forms are sort of multi, multi-purpose, so what we need to do is look at your, uh, your policy to see which one it is. Uh, I need to see it. So if you don't mean, if you don't mind please giving me your policy number, we'll get that verified. I can tell you exactly what sort of information you need.
[CUSTOMER][NEUTRAL] Sure. Uh, it is 025.
[CUSTOMER][NEUTRAL] 40992
[AGENT][NEUTRAL] Thank you. And if I could verify uh a name, date of birth, and a phone number, please, sir.
[CUSTOMER][NEUTRAL] Uh [PII] [PII].
[CUSTOMER][NEUTRAL] My phone number is [PII].
[AGENT][NEUTRAL] Great, thank you. Uh, it's just that we have some disability, uh, forms, claims, we have, uh, um, all sorts of different, uh, uh, policies. So what you have is a secondary or gap insurance, which is meant to complement your, your major medical. OK. So with a policy such as this, um, what we, what we need is there, there is a HIPAA form that is allowing us to look at your records. There is that first page of the claim form.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] That uh list your name, your address, uh, we verify that each time you send in a claim. And it also, you would put on there, uh, the, the date of treatment. Now, there are multiple dates, that's fine, you can do that too. But the attending physician's, uh, information, we don't need that so much, it's what we need.
[AGENT][NEUTRAL] Um, there are a couple of things that we need. Uh, one of them is the, uh, explanation of benefits from your major medical for each data service. So, for example, uh, [PII], let's just say that you went to the ER on the, on the [PII].
[AGENT][NEUTRAL] Um, and then you went to the urgent care on, on the [PII]. Um, and then you, and then you had, uh, uh, physical therapy on the [PII]. I would need three explanation of benefits. You can all do it, you can do it all in the same. You can turn it in all at once with this one, claim form, but I'm gonna need the explanation of benefits for each one of those, the, the, uh, uh, ER, the urgent care and the s and the physical therapy. of each one.
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] Right. Well, I mean, pretty much I have multiple, but really one is all I need that's gonna for this particular claim because it was, I was in the hospital and had kidney stone taken out. So immediately, right. So immediately, I mean, uh, just from that one visit, I, I mean, this last month has been ridiculous since the kidney stone thing. But really, the kidney stone thing is the only thing gonna be covered.
[AGENT][NEUTRAL] 00, I.
[CUSTOMER][NEUTRAL] Uh, one with the EOBs, uh, cause just from those two nights in the hospital and that one procedure, I've already hit my deductible and my out of pocket. So,
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Oh, OK. Wow, um.
[CUSTOMER][POSITIVE] And, and I've developed, and I've developed pneumonia since then and the and the pneumonia has left blood clots or something has left blood clots. So, I've been recently in the hospital this past weekend for blood clots when I went to go get a follow-up on my pneumonia. So, [PII], this has been a great month.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] I see
[AGENT][NEGATIVE] It sounds like you've had, you, you've done anything that's gonna happen from this point on, it should be good, you know, you, you've got it all over with in the first part of the year. Um, that is, that is terrible. Mm.
[CUSTOMER][NEUTRAL] Yeah, so this, this policy in particular should cover my deductibles $2500 so which, which I hit on my first procedure out.
[AGENT][NEUTRAL] Right, so what, what.
[AGENT][NEUTRAL] Oh, bless your heart. So, what, um, so yes, so yes. So what, uh what we need is your explanation of benefits for each one of those events, the hospital, the, uh, for anything that you had. And then the other thing that we need is the diagnosis code for those procedures. Now, obviously, it's, it's very difficult for people to, who aren't in, in medicine, whatever insurance to go look up the diagnosis code, we don't expect that. So, on, on your documentation, you can put, let's just say you, you have your EOB in front of you.
[AGENT][NEUTRAL] Just put, um, these procedures are for kidney stones. These procedures are for pneumonia. And I would, you know, if you had multiple things, put down multiple stuff. You know, this is, this is for uh kidney stones, this is for pneumonia, this is for uh the blood clots. Um, and, and let us know each one of those, um, and, uh, then, uh, and you just have to write it down.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So in this case there's probably.
[CUSTOMER][NEUTRAL] Right, and in this case there's probably no such thing as sending you too many documents and too many EOBs.
[AGENT][NEUTRAL] That's exactly right, yes, yeah, we, we've had, we've had, um, many, many, many now, now what I, I just need the ELBs that show your deductible co-payment or co-insurance. So sometimes people will send the EOB that, that shows, you know, their, their benefits from their, from their insurance. I don't need that. I just need the things that show the deductible, co-payment or co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that is what we're looking at. And because we don't want to keep going back and forth with you, um, and I'm sure you don't want us to, you just need to put down what, what the, what the event was. We don't expect you to look up the medical diagnosis, but just tell us. We'll look up the, the, the uh diagnosis code, but this, this is for my kidney stones. That's what that hospital visit was. This, yeah, so if you'll do that now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Do you have any problem, uh, so those are the documents that we need your, your, um, if you have any, uh, itemized bills, send those along as well, the EOBs, um, and you're right, not too many as many documents as you wanna send us, that's gonna be great. Now do you have any trouble getting logging in and, and sending them through?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I, I try to go online and, and, uh, set up my online user and, and there was a problem today, so I don't know what that's about but.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What, what is your, um, what is the, uh, uh, problem that you're coming up against? I mean, what, what does it say that, what are, what are we looking at?
[CUSTOMER][NEUTRAL] I, it, it just.
[CUSTOMER][NEUTRAL] Well, let me, let me go try it again.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] A user.
[CUSTOMER][NEUTRAL] I'm an individual.
[CUSTOMER][NEUTRAL] Went through like the 3 steps.
[AGENT][NEUTRAL] Yeah, you're
[CUSTOMER][NEGATIVE] And it just came up with an error.
[CUSTOMER][NEGATIVE] Uh, I don't think it's not necessarily that it couldn't find me. It just was an error.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, next.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Uh, oops, there seems to be a problem. No user was found with the information that was entered.
[AGENT][NEUTRAL] OK, let's start over again. Let's go to the very, let's go to the very very beginning, OK, so where, where it says log in.
[CUSTOMER][NEUTRAL] OK, new user, OK.
[AGENT][NEUTRAL] OK, yeah, you're the new user and you are an individual with a uh APL insurance.
[CUSTOMER][NEUTRAL] OK, next.
[AGENT][NEUTRAL] OK, so then we've got your name. Yeah, now I, unfortunately.
[CUSTOMER][NEUTRAL] Last name
[CUSTOMER][NEUTRAL] Oh, you know what?
[CUSTOMER][NEUTRAL] I may have typed my whole name.
[CUSTOMER][NEGATIVE] I can't follow instructions.
[AGENT][NEUTRAL] OK, well, that's all right. I, I, I've done that before too. Um, now, we do need the rest of that information, um, and then you will create a
[CUSTOMER][NEUTRAL] S
[AGENT][NEUTRAL] User name and passcode that we won't see.
[CUSTOMER][NEUTRAL] OK, no, I wouldn't it it says no no user was found with the information.
[AGENT][NEUTRAL] OK, so we've got your last name, your social security number, your uh residential zip code, your OK, OK, I think I know what you're, I think I, I may.
[CUSTOMER][NEUTRAL] Please try again.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] We're going to
[AGENT][NEUTRAL] Because usually when we have this little
[CUSTOMER][NEUTRAL] Oh, is it maybe my email? Maybe it has my school email since.
[AGENT][NEUTRAL] Yeah, yeah, yeah.
[AGENT][NEUTRAL] Uh, yes, sir. I wouldn't, I would, the one that you have on file. Let's see, that's usually the problem.
[CUSTOMER][NEUTRAL] Because I use my personal email.
[CUSTOMER][NEUTRAL] Let me try that.
[CUSTOMER][NEUTRAL] Let me try that.
[AGENT][NEUTRAL] It's the one ending in ORG.
[CUSTOMER][NEUTRAL] Yeah, that's my score.
[CUSTOMER][NEUTRAL] I use my Gmail account.
[CUSTOMER][NEUTRAL] That's 100% what it was. Now username, you can pick anything, huh?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, sir. Yeah, don't tell me, but yeah, just put this, I think they give you guidelines. I believe they give you guidelines.
[CUSTOMER][NEUTRAL] Oops.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Crap.
[AGENT][NEUTRAL] I know there's always something and then a passcode have to go through this multiple times.
[CUSTOMER][NEUTRAL] Well, and then my fingers aren't.
[CUSTOMER][NEGATIVE] Aren't doing what I want them to do. OK, now do I have to use my school email when it asks? Can I use my personal one?
[AGENT][NEUTRAL] Well, um,
[AGENT][NEUTRAL] Well, now that we've we've got your.
[CUSTOMER][NEUTRAL] Because it's creating the account.
[AGENT][NEUTRAL] Yes sir, if you, well, let me put it this way, if you want to um use your regular email, we need to stop now before you start anything, OK? Have you gotten to the point.
[CUSTOMER][NEUTRAL] OK, so I'll just use my school one.
[AGENT][NEUTRAL] Yeah, you'll have to use your school one if that's what, yeah.
[CUSTOMER][NEUTRAL] Uh, I, I don't wanna, I don't wanna complicate it.
[AGENT][NEUTRAL] And, and nobody else will see this, but you and then we'll see that the protected not excuse me, the non-protected information, that the protected information, the personal information will we won't see.
[CUSTOMER][NEUTRAL] Right. Oh.
[AGENT][NEUTRAL] And once you create a user ID and a passcode.
[AGENT][NEUTRAL] You will
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Is it not doing it? Or we having a, I heard of girls.
[CUSTOMER][NEGATIVE] No, I keep hitting caps lock instead of tab.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] Uh, I get frustrated when my hands don't do what I ask them to do.
[AGENT][NEUTRAL] Uh, I
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEGATIVE] I think I have that problem also.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] He just gets to the point, you know, that things aren't.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Nothing wants to do what you wanted to do, um, but at any rate, when you do get to, when you do get into the system, you'll notice on the right, on the left hand side it says, uh, there's a green button that says start a claim, and that allows you to start uh scanning stuff in and.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And I can do that. I see I I started filling out the, the uh PDF version so I can just do it online now. I don't have to do the other thing.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I would do that online, yes, and send in, and as I mentioned before, you just have to send in one claim form. Now, we do need the HIPAA form. You'll see that on there as well. But um we just need one claim form for these multiple events. You don't need to fill out one for each one. And um anything that you think is relevant to your insurance or to your uh your event, you know, your hospital, your medical history there, uh, go ahead and submit it to us. It's all confidential, um, and then you'll, you'll hit that, uh, that green button.
[CUSTOMER][NEUTRAL] Oh
[AGENT][POSITIVE] And then that will, that will scan it and we get it in real time. Now we're working on the claims that we received on the [PII], so it doesn't usually take us that long to get those done, usually 3 to 6 business days.
[AGENT][NEUTRAL] You'll also notice on there that you can track your, your claim, you know, like the you know the, you can track it, you can see when somebody's working on it and what the uh what the uh uh outcome is when, when you start getting a check. And I would also, Scott, you, you may see there is a direct deposit slip on there as well when you're seeing the forms. You may want to fill one of those out as well if you want, you know, otherwise it's a check.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Right, so it'll move faster on you, um.
[AGENT][POSITIVE] Yes, absolutely, yes, and you can also print out your cards. Hm.
[CUSTOMER][NEUTRAL] Did, did you, did
[CUSTOMER][NEUTRAL] Did, did you mention that you, there was already a claim for me?
[AGENT][NEUTRAL] No, sir, I did not. I said there are no claims for you.
[CUSTOMER][NEUTRAL] Oh, OK, I got you. OK, I thought, I thought I heard. I, I wasn't, I was busy typing, so I wasn't 100% engaged.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Oh sorry, no, there, there are no claims at this time, put it that way.
[CUSTOMER][POSITIVE] OK, so now I can start one online. I don't have to worry about the form that I've been working on.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Ouch, OK, fantastic this is.
[AGENT][POSITIVE] Yes, and you can actually save those things online and as I mentioned before you can track your claim to see how it progresses through the system and the ultimate, you know, being being resolved.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Awesome this is great.
[AGENT][NEUTRAL] Is there anything else at all that I can help with? Um, any other questions that you have? Are we good?
[CUSTOMER][NEUTRAL] No, I just gotta get.
[CUSTOMER][NEUTRAL] I just gotta go through all my statements and I actually I have more statements and bills and I, I, I don't even think I have an EOB from my insurance company yet.
[CUSTOMER][NEUTRAL] Um, oh, here's, uh, here's one, but it's not an EOB. It's basically saying, uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We know that you're in the hospital.
[AGENT][NEUTRAL] Yeah, I probably don't need that, um, but I would look for, and what you're looking for on your explanation, the benefits, you probably already know this, but I'm, I'm just gonna throw it out there anyway. It's, uh, they, they used to put these things in a grid, you know, uh, the, the, uh, charge, which your uh insurance allows, and then deductible, co-payment or co-insurance, and they'll have an amount on it. That's what we really need. So there's, um, uh, and if you, if you do have any itemized statements from the hospital or something like that, go ahead and send those through, but
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, the thing that just tells us that you're, that, you know, they know you're in the hospital, we don't really need that. Um, I don't need to, if you are receiving, and I hope that you aren't, but if you're receiving late notices, um, we don't need that either. The, the EOBs, the, the reason for the event.
[CUSTOMER][NEUTRAL] Now
[CUSTOMER][NEUTRAL] Not late yet.
[AGENT][NEUTRAL] Oh yeah, well, let's, we can, we can get it processed pretty quickly as, as, uh, once we get that sent in because as I said we get it in real time, um, so if you have any other questions, please let us know.
[AGENT][POSITIVE] Uh, and we will try and get this stuff done as quickly as possible.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] What what was your name again?
[AGENT][NEUTRAL] My name is [PII], um, and, uh,
[CUSTOMER][POSITIVE] You, you've been incredibly helpful.
[AGENT][POSITIVE] Well, thank you very much. If you do have any questions, just let us know. any of us will be able to help you, OK?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Alright thank you [PII].
[AGENT][POSITIVE] Mhm thanks for contacting APL have a good afternoon.