AccountId: 011433970860
ContactId: ad69bd4b-d503-4f36-bd04-299bb0fea753
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 362100 ms
Total Talk Time (AGENT): 107580 ms
Total Talk Time (CUSTOMER): 184691 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/ad69bd4b-d503-4f36-bd04-299bb0fea753_20250520T20:41_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, um, my name is [PII], and, uh, my mother, she's right here with me. Uh, she's, uh, she has a policy with you guys, and, um, so basically she paid, she went to the doctor, she paid her co-pay, and then she was told that she needed by her employer that she needed to submit the bills um through the portal so you guys would reimburse her for that co-pay.
[CUSTOMER][NEUTRAL] Uh, do you mind helping me upload the forms or upload the, the bills? Uh, I don't know what you guys need to help her get through with this.
[AGENT][NEUTRAL] Uh, what is the policy number?
[CUSTOMER][NEUTRAL] Policy number, OK.
[CUSTOMER][NEUTRAL] Policy number, I have 3 here. I don't know why. Oh, effective, uh, OK, the last one I think is 249-6925.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And Ms. [PII], verify your date of birth for me, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and um.
[AGENT][NEUTRAL] And your mom's name?
[CUSTOMER][NEUTRAL] [PII] this for [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, um, [PII].
[AGENT][NEUTRAL] OK, thank you. And has she set up on the online service center?
[CUSTOMER][NEUTRAL] Yes, um, I'm on the, I guess, website, um, I'm on the website and I, I see on the top of a table it says my coverage. It has um a lapse, a lapsed, and then an active policy number, and then I keep going down and it says my ID card, then I keep going down and it says my claims upload documents.
[CUSTOMER][NEGATIVE] Um, I tried uploading one of them, um, a couple of weeks ago, and now that I log back, like back then it showed there under my claims. Um, I, I mean, I uploaded the bill that she paid, and now that I go back to it, I don't see it here.
[CUSTOMER][NEUTRAL] Um, so that's why I'm calling to see if you get if you could help me, um, upload these um these bills that she's paid.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] When did you, uh, when did y'all last time upload the document?
[CUSTOMER][NEUTRAL] I would say the beginning of May, like the [PII] [PII].
[CUSTOMER][POSITIVE] [PII], like the end of April, I can't be actually wait. It was May, [PII] or [PII] that I uploaded it.
[AGENT][NEUTRAL] OK, cause I do show a claim was uploaded to for your mom on the [PII] and it was processed. Um.
[CUSTOMER][NEUTRAL] For how much?
[AGENT][NEUTRAL] Uh, it wasn't paid. Uh, the claim process is needing primary EOB.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so it wasn't, could you explain that? I'm sorry. I'm sorry for, for not knowing that much. Uh, what do you mean it wasn't?
[AGENT][NEUTRAL] No, you're fine.
[AGENT][NEUTRAL] Well, with this policy, it's a secondary supplemental policy only. So in order to complete the processing of the claim as secondary, that EOB or explanation of benefits of the major medical is needed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so do you, I'm sorry, yeah, so, I'm sorry. I don't, so what what exactly do you, so you guys aren't gonna pay us or do we need to submit more stuff or I don't.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] We need the primary explanation of the uh benefits for the data service you're falling for. So the explanation of benefits is what she would get from a major medical insurance, showing for that data service, how the claim was processed, meaning what was applied towards deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] OK, so once that's submitted, once I get that, I have to upload it?
[AGENT][NEUTRAL] Uh yes, ma'am. You will upload it as a new document and to upload claims, um.
[AGENT][NEUTRAL] On the site, it should have, need to file a claim right now and just follow the prompts and then you can upload that document.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then I would upload the bill again.
[AGENT][NEUTRAL] Uh, you don't necessarily have to upload the bill, just the primary EOB.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] OK, primary EOB I'm writing that down, sorry.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. Um, I'll, I'll get to work on that.
[AGENT][NEUTRAL] OK, yeah. And is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] OK thank you so much.
[CUSTOMER][NEUTRAL] Um, no, that'll be all. Thank you. I'll get that and then I'll upload another, um, another bill that she has.
[AGENT][POSITIVE] OK, uh, yes ma'am. Uh, you're welcome. Thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] How
[AGENT][POSITIVE] Have a great day.
[CUSTOMER][POSITIVE] Thank you. Bye.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] You too bye.