AccountId: 011433970860
ContactId: b11289de-a1fe-412b-baea-4ffe0eb159c8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 348609 ms
Total Talk Time (AGENT): 197498 ms
Total Talk Time (CUSTOMER): 146731 ms
Interruptions: 4
Overall Sentiment: AGENT=2.1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/b11289de-a1fe-412b-baea-4ffe0eb159c8_20250129T18:43_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, so I had a procedure uh done at a dermatologist's office, um, and they said that they don't put it through the secondary insurance. So I wanted to see if I could file the claim myself or how that would work.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yeah, absolutely. I can definitely help you with the information you need to file a claim. Do you mind if I get your name and a good policy number?
[CUSTOMER][NEUTRAL] Sure. Uh my name is [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. And what's that policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] Is that the group number?
[AGENT][NEUTRAL] It might say certificate or member ID.
[CUSTOMER][NEUTRAL] Is that what you want? Or payer ID? I have payer ID I have group number.
[AGENT][NEUTRAL] It wouldn't be either of those two. Is there a 3rd number on there?
[CUSTOMER][NEUTRAL] There's in hospital benefits cert number or outpatient benefits cert number?
[AGENT][POSITIVE] Either one of those will get me where I need to go.
[CUSTOMER][NEUTRAL] OK. D 2581442 ML 748, either one.
[AGENT][NEUTRAL] And can you repeat that for me again? I have the 2581.
[CUSTOMER][NEUTRAL] 0, you need a 0 1st. 02, yeah. Mhm.
[AGENT][NEUTRAL] 0, thank you.
[AGENT][POSITIVE] I'm so sorry. I'll stop talking. I'm ready to listen.
[CUSTOMER][NEUTRAL] OK, 02581442, [PII].
[AGENT][POSITIVE] Thank you so much. I knew I was missing a digit with a 0, but I wasn't quite sure what it was. I appreciate you.
[CUSTOMER][NEUTRAL] OK, OK, sure. Mhm.
[AGENT][NEUTRAL] Um, and Ms. [PII], would you be able to verify for me, please, your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you so much. And then just a couple more things if we could verify your mailing address on file, email and phone number.
[CUSTOMER][NEUTRAL] OK, uh, mailing address is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Email [PII].
[CUSTOMER][NEUTRAL] And what was the 3rd 1?
[AGENT][NEUTRAL] Um, so that email, it looks like it might be at a different email address, um.
[CUSTOMER][NEUTRAL] Is it [PII]?
[AGENT][POSITIVE] Yes, wonderful, thank you.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] And then just the phone number on file, my friend.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Perfect. Thank you so much for going through that verification process with me and
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So with this policy, there's a couple of things we would need to file a claim. You can submit them online through fax or um by mail. I highly recommend submitting them online though. Um, it's a lot quicker. Do you know if you've already set up our online portal?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm not sure, but I'm, I'm guessing yes, but I'm not sure I'd have to look.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] No worries, um, so what I can do is I can.
[CUSTOMER][NEUTRAL] Should I go on? I'm in front of my computer. Let me see.
[AGENT][NEUTRAL] Oh yeah, um, try going to [PII].
[CUSTOMER][POSITIVE] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] This site can't be reached hm, they won't let me go on at work.
[AGENT][POSITIVE] OK, no worries. I do see you've set one up though.
[CUSTOMER][NEUTRAL] it's [PII]. That's what it is?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Yeah, no they won't let me go on here.
[AGENT][NEUTRAL] OK, I do see you have set it up with us before in the past um it looks like you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Your username is [PII], um, so whenever you get available to give it a try, that's your username and it's set to go to your email that you just verified with me.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, what I can do for you is I can email you out a copy of that claim form. Um, our claim form is going to have all this information, but I'll say it anyway, but don't worry if you don't remember it. Um, in order to file a claim with us, um, we will need a copy of the itemized bill from your um provider, um, and it needs to have the diagnosis code and the procedure codes. I'm gonna send you a in the email, I'll include
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me see if it has it here.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It's a CMS 1500 form and typically that has everything we need on it and can make um the process of requesting the document a lot easier for you because you can ask for that particular form by name.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Along with that.
[CUSTOMER][NEUTRAL] Yeah, this doesn't have any codes yeah OK.
[AGENT][NEUTRAL] Um, you'll want that CMS 1500, and then you're going to need the copy of your explanation of benefits from your primary insurance, um, because we do follow your primary insurance based on how they pay, and then you'll take those two things and you'll send them to us. You can either upload them to the online portal or you can mail them and then that's all we need, and then we'll just process the claim from there.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, that's what I'll do, yeah, uh-huh.
[CUSTOMER][POSITIVE] OK all right great thank you.
[AGENT][POSITIVE] Yes, my pleasure, and
[CUSTOMER][POSITIVE] So you'll send you're gonna email me that information uh in any case? OK, perfect.
[AGENT][POSITIVE] Absolutely, yes, and you should get it within the next few minutes.
[CUSTOMER][POSITIVE] OK, great. Thank you for your help. I appreciate it.
[AGENT][POSITIVE] Hey, my pleasure, Ms. [PII]. If you have any questions along the way, just reach out to us. We'll be happy to take care of you, OK?
[CUSTOMER][POSITIVE] OK terrific thanks so much.
[AGENT][POSITIVE] My pleasure, thank you.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye.