AccountId: 011433970860
ContactId: b02c60a7-34b1-4504-9dae-373229f75e0e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1429219 ms
Total Talk Time (AGENT): 569658 ms
Total Talk Time (CUSTOMER): 468863 ms
Interruptions: 6
Overall Sentiment: AGENT=0.8, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/b02c60a7-34b1-4504-9dae-373229f75e0e_20250603T16:45_UTC.wav
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[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], uh, good afternoon. My name is [PII]. I'm calling from Associated Financial Consultants, the broker, and I'm just calling to follow up on a claim.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, then you're calling to follow up on a claim you all submitted for remember.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes ma'am. I can try and help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is the policy number for the number?
[CUSTOMER][NEUTRAL] Um, 245-6692 member's name is [PII].
[AGENT][NEUTRAL] OK, give me just a moment to get that information pulled up and then yes, I will have to verify a few things with you for security and I'll save on any information provided would be a verification of benefits and not a guarantee of payments. So just a moment.
[CUSTOMER][POSITIVE] No problem.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so again, any information provided would be a verification of benefits and not a guarantee of payment. What is the patient's name again and their date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And then who is the agent of a record for this group?
[CUSTOMER][NEUTRAL] Uh, [PII] Mine.
[AGENT][NEUTRAL] Thank you. And then what is your email address, please, [PII]?
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mm, OK. And do you, how do you spell [PII]?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] There's 2 of us here, one's with an [PII]
[AGENT][NEUTRAL] OK, so how, how could the email be listed a little different? That's not the same email that I have on file.
[CUSTOMER][NEUTRAL] Oh, maybe you guys use the one that I don't even use it's uh [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and what is the date of service and the total bill amount please for Mr. [PII]?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm I don't even know if I have all that. Hold on one second.
[CUSTOMER][NEUTRAL] I know on [PII] they told us that the claim was being processed. Hold on, I'm going to like a ton of emails.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That we were told we would have a check within a week to 10 days copay primary $10 and specialist $80.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] It was for an MRI.
[CUSTOMER][NEUTRAL] OK, so I don't see anything there. Hold on.
[CUSTOMER][NEUTRAL] just please check OK let me open that.
[AGENT][POSITIVE] Take your time. OK.
[CUSTOMER][NEUTRAL] Um, OK, so.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Explanation of benefits was sent in January um.
[CUSTOMER][NEUTRAL] Outpatient benefits dated [PII].
[AGENT][NEUTRAL] That's the data service, OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The reference please.
[CUSTOMER][NEUTRAL] The above reference claim appeals appears to be a duplicate of a previously dismissed expense receipt of your claim is acknowledged. However, in order to provide further consideration is lost.
[AGENT][NEUTRAL] And what's the claim number on that?
[CUSTOMER][NEUTRAL] The EOB was sent in.
[CUSTOMER][NEUTRAL] Um, policy number, no reference number? I would assume.
[AGENT][NEUTRAL] I mean, I'm sorry, the, the claim number, the claim number. Mhm.
[CUSTOMER][NEUTRAL] Oh, here I'm sorry claim number 3587545.
[AGENT][NEUTRAL] OK, so I do see that that one was denied as a previous, a duplicate of previously submitted expenses. OK, so just a sec.
[AGENT][NEUTRAL] Let me pull up the original claim receipts, see what the denial was on that for you.
[AGENT][NEUTRAL] And do you have a total bill amount on the claim, [PII]?
[CUSTOMER][NEUTRAL] Mm, total bill charges 2090.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] This claim is actually for more than that.
[AGENT][NEUTRAL] Uh, give me just a second to look at a few things on here. Hold on one second.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, so for that data service, yes, that was to build them up. Now, the remark codes.
[AGENT][NEUTRAL] For the [PII] data service.
[AGENT][NEUTRAL] Um, it's a paragraph. I'll read it to you.
[AGENT][NEUTRAL] Receipt of your claim is acknowledged. However, in order to provide further consideration of this loss under this policy, we will need supporting documentation to evidence the accident or sickness. Supporting documentation may include, but is not limited to, itemized bills with the diagnosis codes.
[AGENT][NEUTRAL] Super bills, office notes, hospital admission and discharge summaries, and our diagnostic testing results. We're in need of the diagnosis.
[AGENT][NEUTRAL] That's one of the remarks for that data service. Let me see what the, it's the same day um it's the same remark for both codes.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] The EOB was sent in.
[AGENT][NEUTRAL] But that's not what we're needing the diagnosis codes. Either the itemized bill or Supervi. It it it doesn't indicate that we didn't receive that, but that wouldn't have that information on there.
[AGENT][NEUTRAL] The primary EOB doesn't have that. Sure.
[CUSTOMER][NEUTRAL] Hold on 1 2nd for me.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I'm on with APL.
[CUSTOMER][NEUTRAL] Did you guys send in for um [PII] the diagnostic codes or the itemized bill?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Do you know when that was sent in?
[CUSTOMER][NEUTRAL] So that was sent in she's checking the date uh and what you sent me I don't see.
[CUSTOMER][NEUTRAL] Like that attached or date.
[CUSTOMER][NEUTRAL] Hopefully I don't have to call you back.
[AGENT][NEGATIVE] I'm gonna look at the documents that we received that was denied as a duplicate.
[CUSTOMER][NEUTRAL] Yeah, because she says it was sent in and she had called the other [PII] had called on [PII] and was told the claim would be processed, but he's now he's questioning, you know, like where his payment has been over a month, blah blah blah.
[CUSTOMER][NEUTRAL] On that
[AGENT][NEUTRAL] Um, when he called him, we explained to him, yes, I do see that someone did talk to him on it and was explained that we needed the diagnosis codes.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] I can't say that.
[AGENT][NEUTRAL] We told him what was needed at that point.
[CUSTOMER][NEUTRAL] She said on [PII] is when we were told that we needed those diagnostic codes. Uh it was sent on [PII], and she has a confirmation you wanna forward it to me?
[AGENT][NEUTRAL] Well, we've
[AGENT][NEUTRAL] Yes, we did not.
[AGENT][NEUTRAL] Uh, it, uh, give me just a moment. I'm still trying to look.
[AGENT][NEGATIVE] Oh, the last thing that was received.
[CUSTOMER][POSITIVE] You're fine take your time.
[AGENT][NEUTRAL] That's just the claim detail.
[CUSTOMER][POSITIVE] You're good.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Have you got a 2025?
[AGENT][NEUTRAL] That's the United Healthcare. That's all that was sent. So that is a duplicate that doesn't have.
[AGENT][NEUTRAL] The diagnosis code on it. Let me see what date that was received.
[CUSTOMER][NEUTRAL] And then the other one is uh.
[AGENT][NEGATIVE] What was denied as a duplicate did not have that.
[AGENT][NEUTRAL] That was received on [PII] or [PII], I'm sorry, and processed on [PII].
[AGENT][NEUTRAL] It's only the explanation of benefits.
[CUSTOMER][NEUTRAL] So on
[AGENT][NEUTRAL] 48, we received an explanation, the primary explanation of benefits.
[CUSTOMER][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] Hold on, I'm going back um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, 48 was I see claim submitted and confirmation on [PII] it was sent in with ICD 10 code BV33Y0Z and and 42.89 for [PII] MRI.
[AGENT][NEUTRAL] And what, how was that sent since we can't, since we can't receive it via email, how did you all send that? Claims information can't be emailed. How did y'all submit that?
[CUSTOMER][NEUTRAL] That was sent in on the [PII].
[CUSTOMER][NEUTRAL] [PII], do you know how you sent that on the [PII]?
[CUSTOMER][NEUTRAL] Through the portal.
[AGENT][NEUTRAL] OK, that for whatever reason was not received on this end under his profile.
[CUSTOMER][NEUTRAL] Confirmation. So.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh [PII], it was 48. I put it in there on [PII] at [PII].
[AGENT][NEUTRAL] Uh-huh. [PII] is the what we, as I said, we did receive an upload on [PII].
[CUSTOMER][NEUTRAL] Well that upload has the codes.
[CUSTOMER][NEUTRAL] I'm looking at the upload also.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, there was what we received.
[CUSTOMER][NEUTRAL] I mean I could resend it to you but it was.
[AGENT][POSITIVE] Yeah, I'll be happy to pull that up again. Give me just a moment. So it shows.
[CUSTOMER][NEUTRAL] It's even like highlighted in the middle. It's highlighted yellow in the middle with the code.
[AGENT][POSITIVE] Oh, I'm sorry.
[AGENT][POSITIVE] Yeah, it's still working.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I don't know who submitted this, but it is, it says claim detail for [PII]. It's one page.
[AGENT][NEUTRAL] And
[CUSTOMER][NEGATIVE] No, this is 2 pages. I mean, I could resend it to him or to however you tell me to do it, but it's 2 pages in yellow right smack dead in the middle. It says ICD 10 code-dash BV33Y0ZA and 42.89. This is the codes for [PII] MRI.
[AGENT][NEUTRAL] And this, I don't know uh because again what was uploaded this one page was on 48 that was by the broker. I can see that, but that is, that is the only thing that's in here.
[AGENT][NEUTRAL] From the a broker upload.
[CUSTOMER][NEUTRAL] So how do you want me to resubmit this? How can we get this taken care of as quickly as possible as this gentleman's been waiting months.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Now you can if you would like to try and upload it again while we're on the phone, I should be able to see that to confirm that it's received to be in line for processing [PII].
[CUSTOMER][NEUTRAL] Let me see, hold on.
[AGENT][NEUTRAL] And what is the online service center confirmation number that you have?
[CUSTOMER][NEUTRAL] Let me.
[CUSTOMER][NEUTRAL] Um, give me one second, I'll go right back to that.
[AGENT][NEUTRAL] Sure, yeah.
[CUSTOMER][NEUTRAL] I'm just saving this to my computer so that I can upload it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] APL claims save.
[CUSTOMER][NEUTRAL] Um, confirmation number 0 00SC 96324.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And again, yes, I mean it's like it was only partially uploaded.
[AGENT][NEUTRAL] Because again, that is the page where it's one document.
[AGENT][NEUTRAL] I don't know what happened.
[CUSTOMER][NEUTRAL] OK, so if I'm under his name under APL portal, what do I do? What, how do I do this?
[CUSTOMER][NEUTRAL] Can I upload it through here?
[AGENT][NEUTRAL] Uh, you should be able to.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Just to file a new claim.
[CUSTOMER][NEUTRAL] Do I start a claim or go to claim, start, start your claim?
[AGENT][NEUTRAL] Mhm, you would, because you can't.
[AGENT][NEUTRAL] Yes, yes, because you cannot.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Tie documents already existing claim numbers but the system will know that that was a missing piece of information for this data service.
[CUSTOMER][NEUTRAL] Um, what you'll need policy information next step.
[CUSTOMER][NEUTRAL] So like group DS.
[CUSTOMER][NEUTRAL] Ruark.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Select claimant name this is [PII].
[CUSTOMER][POSITIVE] [PII] it's my first time using the new APL. I like it.
[AGENT][NEUTRAL] Yeah, well, it's, it's, it's new and I mean, there's, there have been, you know, some little hiccups with it just like with anything new, [PII], so we're trying to work through this. That's why I wanted you to see if you could upload that while we're on the phone still, you know, so I can.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] See if it's received.
[CUSTOMER][NEUTRAL] I'm submitting fingers crossed.
[AGENT][POSITIVE] Fingers crossed. Well, I'm glad that you were able to sign into the portal and, you know, at least some people are having trouble even signing in, you know. Yeah, everybody's having different types of pains.
[CUSTOMER][NEUTRAL] Yeah, before calling you, we did it.
[AGENT][POSITIVE] So we're just again trying to get through them the best we can.
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] That's all you can do get ironed out.
[AGENT][POSITIVE] IT is, yeah, and that's right. IT is working diligently on.
[AGENT][POSITIVE] Very end of it and so I think it's gonna be really great.
[AGENT][NEUTRAL] Once everything is ironed out, yeah.
[CUSTOMER][POSITIVE] It seems nice so far few minutes I've been using it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It still says submitting like I'm on the screen it just still says you know confirm details and it's showing submit with a little circle circulating.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what browser are you using? just out of curiosity, Vonn?
[CUSTOMER][NEUTRAL] Uh, Google Chrome.
[AGENT][NEUTRAL] Um, OK.
[AGENT][NEUTRAL] And there's just some questions that IT if for some reason it's, it won't upload for you that we have to get the information for.
[CUSTOMER][NEUTRAL] Mm, let me plug in my laptop before anything.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK, it says successfully submitted. I'm gonna download it and save it again.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For my records.
[AGENT][NEUTRAL] And then I'm gonna give it a second to see if I can see it.
[AGENT][NEUTRAL] And I can, I can see that there has been something just uploaded in the portal, so give me just a moment, and it's in line for reviews so I just want to look at the make sure that the documents, you know.
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][POSITIVE] No problem.
[AGENT][POSITIVE] pulled in properly this time.
[CUSTOMER][POSITIVE] Yeah, it's fine take your time.
[AGENT][POSITIVE] And thank you for your patience.
[AGENT][NEUTRAL] On this.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, why is it telling me that?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Alright, I don't know what.
[AGENT][NEUTRAL] OK, so give me just a second. I need to ask a question.
[CUSTOMER][POSITIVE] You're fine, no problem, take your time.
[CUSTOMER][NEUTRAL] You use anywhere Diaz Ruis or you have like a [PII] file.
[CUSTOMER][NEUTRAL] So I
[CUSTOMER][NEUTRAL] No, because she received it. She, she's waiting it's in like a line to be reviewed, but I just wanna say that I resubmitted it.
[AGENT][NEUTRAL] Yeah, I'm just making sure that we actually got the documents is what I'm trying to check on now.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] OK, so I'll just do that.
[CUSTOMER][NEUTRAL] She shows the confirmation but she doesn't show this form.
[CUSTOMER][NEUTRAL] Yeah, I know.
[AGENT][NEGATIVE] Jeez
[CUSTOMER][NEUTRAL] Well, hold on, don't tell him anything yet. Wait till I get off the phone.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, so I'm just
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It's such a gloomy day, right? Who wants to work?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] There's so many people here today. We're like a hybrid office and so many employees are here today.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][POSITIVE] Which is a good thing. I like seeing faces.
[CUSTOMER][NEUTRAL] Um, this
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Limited.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] 25.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Can we get you another.
[AGENT][POSITIVE] I'm just asking a few questions, [PII]. Thank you so much. So.
[AGENT][NEUTRAL] I can't see the documents yet, but they said it could take just a little bit for us to, for me to be able to see them, but I'm trying to see if, you know, since you all have already submitted this before.
[AGENT][NEUTRAL] Approximately how, how long would be before we could actually see the documents?
[AGENT][NEUTRAL] So I can verify how many that's what I'm trying to check. That's what I'm trying to check to find out for you.
[CUSTOMER][NEUTRAL] Oh, I have no idea.
[CUSTOMER][NEUTRAL] I mean.
[CUSTOMER][NEUTRAL] I have no idea because oh you OK I mean I could wait or you could call me back or email me got you I understand.
[AGENT][NEUTRAL] No, I'm trying to check on it. Actually, if you can, if you could just wait, [PII], it is just as soon as I hang up with you, I'll have, I'll have someone else, um.
[CUSTOMER][POSITIVE] Yeah, not a problem.
[AGENT][NEUTRAL] What
[CUSTOMER][POSITIVE] No, you're good take your time.
[CUSTOMER][NEUTRAL] I'm in no rush.
[AGENT][NEUTRAL] OK, so since they're working on some of the things in the OSC, it shows that we received it, but it possibly could take overnight before we can see the documents like before it gets fully processed where we can see them on the portal on the profile from my end.
[AGENT][NEUTRAL] Access that I have. So if you want to check back tomorrow just to verify that we can see the documents, if you also, you know, if you want.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you want to fax the information in, you can do that too. It's gonna take about that long to get on his profile as well. It's about a 24 hour to get it.
[AGENT][NEUTRAL] You know, received and processed.
[CUSTOMER][NEUTRAL] I mean, I'll just wait. Should I just call tomorrow?
[AGENT][NEUTRAL] Yeah, if you would just call around, um, you know, this time tomorrow, I would give it 24 hours.
[AGENT][NEUTRAL] Um, so that we can verify it.
[AGENT][NEUTRAL] Because I can see the upload, I just can't see the documents. You will just use my name, [PII], along with today's date.
[CUSTOMER][POSITIVE] No problem, is there any like reference number or anything?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] 060325 got it no problem [PII] so I'll do that. I'll call back tomorrow like around [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Well, is there anything else that I can help you with?
[CUSTOMER][POSITIVE] No, that's it. I appreciate it.
[AGENT][POSITIVE] Well, you're very welcome. And thank you for calling APL. I hope that you have a very nice afternoon, [PII].
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][NEUTRAL] Yes, ma'am. Bye-bye.