AccountId: 011433970860
ContactId: ad69f3af-eb75-41f0-8b50-709df802fd8c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 813280 ms
Total Talk Time (AGENT): 393121 ms
Total Talk Time (CUSTOMER): 294950 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/ad69f3af-eb75-41f0-8b50-709df802fd8c_20250527T22:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, ma'am. Um, so I want the doctor visit on uh [PII].
[CUSTOMER][NEUTRAL] Uh, when I went, I gave them the card information, um, they called to verify the insurance, but it was closed, I guess, because it was Saturday, so they said call us back on Monday to rebuild.
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So I did, I did call them back on Monday and I told him to rebill. They called me back a few minutes later and they told me that you guys don't work with networks and that therefore they cannot bill, bill you guys. So they sent me the bill and they told me that I needed to uh forward it to you guys to see how much you guys will be paying so I can pay the difference. So I'm calling to see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How that works cause I never had to deal with this before in my life.
[AGENT][NEUTRAL] Right, right. I understand. OK, I can help you um with your benefits and your billing. Can you please give me your name and your callback number?
[CUSTOMER][NEUTRAL] Yes, my, my name is [PII].
[CUSTOMER][NEUTRAL] And spelled [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My phone number is [PII].
[CUSTOMER][NEUTRAL] 490
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then what is your policy number, sir?
[CUSTOMER][POSITIVE] OK, I got it right here.
[CUSTOMER][NEUTRAL] Starts with a D as in delta.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 49700319
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so what I'm going to need to do, um, Mr. [PII] is transfer you on over to IMA 90 Degree Benefits. Let me give you that phone number in case the call is disconnected.
[AGENT][NEUTRAL] You let me know when you're ready.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. The
[CUSTOMER][NEUTRAL] I already called 90 degrees.
[CUSTOMER][NEUTRAL] I already called them.
[CUSTOMER][NEUTRAL] They say that they do only like the preventive medical benefits, but VIP um supposed to be taken care of by you guys, so that's why I'm calling you.
[AGENT][NEUTRAL] OK, um, can I get your social security number and that'll pull in your policy for me because that policy number you gave me is for 90 Degrees.
[CUSTOMER][NEUTRAL] Oh, I'm sorry. Well, I got the policy certificate number here as well. It's just that it's so confusing. That's the number that we're asking for, so maybe that's why. So the policy certificate number is 02.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK. Yes, sir.
[CUSTOMER][NEUTRAL] 62
[CUSTOMER][NEUTRAL] 3133
[AGENT][NEUTRAL] OK, let me pull that up real quick.
[AGENT][NEUTRAL] OK, Mr. [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, sir. And then can you verify your address, phone number, and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] My physical address is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Um, what else do you need?
[AGENT][NEUTRAL] Your email address?
[CUSTOMER][NEUTRAL] My email address is [PII].
[AGENT][NEUTRAL] Thank you and I see that um is your callback number that you gave me the same as your cell phone number, sir?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK. Thank you. I appreciate that very much.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK thank you I appreciate you verifying that so they told you to call us and see how much of the bill we would pay?
[CUSTOMER][NEUTRAL] They just told me to bill you guys just to basically forward you the, the bill.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, so you're gonna just file your.
[CUSTOMER][NEGATIVE] But I never did this in my life. I never had to deal with this, so.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, and they should have been able to do it for you but um that's not a problem. I can help you file your own claim. Are you signed up on the online service center?
[CUSTOMER][NEUTRAL] I'm so confused, ma'am. I don't know which one you're talking about. I did enroll in the uh benefits in the card, um.
[CUSTOMER][NEUTRAL] Hotline or whatever, you know, not online but uh website.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Um, and that's it. I don't know if you guys are the same or you guys are different ones, I don't know.
[AGENT][NEUTRAL] OK, alright, well, that's OK. I can help you, sir. We have an online service center where you can directly file your claim through. Let me give you that address. I'm looking at it now and you're not signed up for ours, so let me give you the address so that you can sign up for it.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You, it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then when you go into there for the first time you're gonna sign up as a new user.
[AGENT][NEUTRAL] And then your second option is gonna be you're an individual with an APL policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You will choose your username and your password that you want to use.
[AGENT][NEUTRAL] And then once you get in there, you're gonna go to claims and forms.
[AGENT][NEUTRAL] And when you get into claims and forms, you're gonna choose the claim form that says hospital indemnity.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You'll you'll pick that hospital indemnity claim form.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] At the top of the claim form, it gives you a cheat sheet that you can use um just at the very top of it tells you exactly what you need to spend in to submit your own claim.
[AGENT][NEUTRAL] Uh, you'll need the
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Fill out the claim form.
[AGENT][NEUTRAL] And you'll need an itemized bill with the diagnosis code and the procedure codes that comes from your provider.
[AGENT][NEUTRAL] And then your signature.
[AGENT][NEUTRAL] And then once you get all your
[CUSTOMER][NEUTRAL] OK, so on the forms.
[AGENT][NEUTRAL] Mhm, yes, sir.
[CUSTOMER][NEUTRAL] Uh, it's just that you're going a little too fast, ma'am. I've never done this before, so you said I go to a hospital indemnity and, and then I choose a form, right? Which form is that again?
[AGENT][POSITIVE] OK, I'm sorry.
[AGENT][NEUTRAL] When you get into the online service center you're gonna click on claims and forms.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Once you click on claims and forms, you will choose the hospital indemnity claim form.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You're gonna click on it and download it.
[CUSTOMER][NEUTRAL] I got it.
[CUSTOMER][NEUTRAL] Download, OK.
[AGENT][NEUTRAL] And then when you download it at the very top of the claim form.
[AGENT][NEUTRAL] It tells you exactly what you need to send in with your claim.
[AGENT][NEUTRAL] So you'll complete the claim form, you'll upload the bill information the itemized bill that they're going to give to you.
[AGENT][NEUTRAL] And you just, after you get all that, you're gonna submit your claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] When you when you
[CUSTOMER][NEUTRAL] All right, isn't it uh.
[AGENT][NEUTRAL] Yes sir. When you
[CUSTOMER][NEUTRAL] So you, they send me the, the bill with the codes and everything, you know, like I said, I'm not a doctor, I've never done this before. I don't know how codes work.
[AGENT][POSITIVE] Yes, they're gonna send you an.
[CUSTOMER][NEUTRAL] I do have the bill, uh, with the total with the codes and everything for each step that they did on me, uh, and the total on the bottom, and that's all I know. Um, is there any way I can just forward it and just, you know, they, they can see the codes and everything?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, it sounds like they've already given you. Does it say itemized statement at the top?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, that's what you need, yes, sir. So you're gonna download that.
[AGENT][NEUTRAL] On your computer or if you've but if it's been sent in an email you just save it on your computer and you then when you're in the online service center you're just gonna upload it from your computer along with the claim form.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then you will submit your claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you'll get a confirmation number.
[AGENT][NEUTRAL] That your claim has been received.
[CUSTOMER][NEGATIVE] Suits.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yes, you'll submit and then you'll get a confirmation number.
[CUSTOMER][NEUTRAL] confirmation number.
[AGENT][NEUTRAL] Once we receive your claim, it will take 7 to 10 business days to process it.
[CUSTOMER][NEUTRAL] I got you, OK.
[CUSTOMER][NEGATIVE] So, is there uh any other way like can I call the, the, it's in [PII], the Austin Regional Clinics. Um, can I just call them and tell me, can you rebuild for me cause I, I mean, honestly, I, it's, you know, I've never done this before and like I said, why am I doing all this when, when I'm supposed to have insurance coverage and everything? I never deal with this before.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Right, right, let me give you if you call them.
[AGENT][NEUTRAL] If you call them and give them this payer ID number, they should be able to file your claim for you. Let me give you that number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 608.
[AGENT][NEUTRAL] 01.
[CUSTOMER][NEUTRAL] 60801, that's the payer ID number.
[AGENT][NEUTRAL] Yes sir, and we also have a claims mailing address if they choose to mail it. Let me give you that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That that address is [PII].
[AGENT][NEUTRAL] 248.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII]?
[AGENT][NEUTRAL] Oklahoma.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then if they
[CUSTOMER][NEUTRAL] Uh, uh, can you give me the, the zip code again, please?
[AGENT][NEUTRAL] Yes, sir. [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, and.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] If, if they want to fax it in.
[CUSTOMER][NEUTRAL] Let me repeat, let me, let me repeat the address is, uh, let me repeat the [PII]. It's uh [PII] [PII], correct?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, yes, and the last four digits on the end of the zip code, they may need them is [PII].
[CUSTOMER][NEUTRAL] [PII] got it.
[AGENT][NEUTRAL] Yes sir, if they choose to fax it, we have a fax number that they can send in your claim for you also let me give you that number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] And they should be able to file your claim for you and if they have any questions or anything like that please have them call us and we'll talk to them we'll talk to them we'll verify your policy, your benefits, anything that they need for us to do so they can help you file the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sounds good. All right, thank you so much for your help.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're very, very welcome, Mr. [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] No, that'll be it. Thank you so much. Have a good day.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] You have a good day too and thank you for calling APL sir bye bye.
[CUSTOMER][NEUTRAL] Bye bye.