AccountId: 011433970860
ContactId: b18b40ac-1184-45a2-a85d-ea56e1324a17
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 783950 ms
Total Talk Time (AGENT): 264259 ms
Total Talk Time (CUSTOMER): 300115 ms
Interruptions: 3
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/b18b40ac-1184-45a2-a85d-ea56e1324a17_20250602T19:29_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I was calling because um I have a claim. I submitted a claim and I was, I said I'm gonna check to see if they're missing something, but I wasn't able to log in.
[AGENT][POSITIVE] OK, well, I can help you with your.
[CUSTOMER][NEUTRAL] Because uh your website changed.
[AGENT][POSITIVE] I can help you with your claim. Um, yes, we do have a new website and IT is aware of the login issue, so I can um check on the claim status for you and I definitely do apologize for that.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Um, [PII], may I have a good contact number in case we're disconnected and your policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, here in at work, it's um [PII] because my cell phone doesn't work here at in school.
[CUSTOMER][NEUTRAL] So since I'm uh I'll be here until [PII].
[AGENT][NEUTRAL] OK, is that area code [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, and may I have your policy number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] The policy number of the claim?
[CUSTOMER][NEUTRAL] Or
[AGENT][NEUTRAL] Yes, this
[CUSTOMER][NEUTRAL] Because it's 22, 6:36 uh.
[AGENT][NEUTRAL] OK, that might
[CUSTOMER][NEUTRAL] It's because I didn't make a printout right.
[CUSTOMER][NEUTRAL] That's the group number I think of the district of the [PII] district.
[AGENT][NEUTRAL] Yes, um, hold on one moment, let me look under there for your policy. What's your last name, [PII]?
[CUSTOMER][NEUTRAL] [PII] that is.
[CUSTOMER][NEUTRAL] It's because I didn't make a print out of the of the claim number and I can't log in.
[AGENT][NEUTRAL] OK, hold on one second. I believe I just.
[CUSTOMER][NEUTRAL] And I received a letter that
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] I believe I just located your policy. Can you verify your date of birth?
[CUSTOMER][NEUTRAL] Yes, it's uh [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So let me take a look at this claim. Hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] It's because I think I did it wrong. I submitted everything in one single thing.
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold so I can take a look into the claim?
[CUSTOMER][POSITIVE] Yes, yes, I don't mind.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, wait a second, [PII]
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So yes, it looks like there was an error. I would say to resubmit the claim, but this time I just submit the pathology report and any billing you might have and then the claim form.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The pathology.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And the pathology and what else did you tell me?
[AGENT][NEUTRAL] Um, the pathology report, the itemized bill, and then the cancer claim form.
[CUSTOMER][NEUTRAL] Bills
[CUSTOMER][NEGATIVE] Item built in the cancer from.
[CUSTOMER][NEUTRAL] It's because I submitted everything and and then when I said I sent it I saw that it said that it has to be like separate.
[AGENT][NEUTRAL] Oh, yes.
[CUSTOMER][NEUTRAL] Like, uh, like it, the first one, like, for example, the first, uh, diagnosis of the cancer and I submit that and then do the one for the surgery.
[AGENT][NEUTRAL] Right, I will do the one for the diagnosis by itself. Um, that first occurrence benefit comes straight to you, and then which, whatever you have, um, you know, whatever you're wanting to submit after that, I would just, you can group it by the date of service or by what's being done.
[CUSTOMER][NEUTRAL] OK, yes, because I said I I submitted everything and when I send it I said maybe it was different and but I was waiting for in case you guys would call me.
[CUSTOMER][NEUTRAL] And then I said if I don't hear anything I'll give him a call but I received a letter that it said that you guys were gonna contact me in case you needed uh something else.
[AGENT][NEUTRAL] Like additional information?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yes, that the uh that you guys received the policy, the claim of the policy and it's in review.
[AGENT][NEUTRAL] Right, that's what we sent out.
[CUSTOMER][NEUTRAL] Any case, uh.
[AGENT][NEUTRAL] When we first received the claim?
[CUSTOMER][NEUTRAL] It was on May, yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And yes, and now on [PII], we also mailed out just like a uh um an explanation of benefits, but I'm sure you haven't received that yet, but it's coming back that it's an error, so I would just resubmit the documents.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, so then I fax it because since I can't log in?
[AGENT][NEUTRAL] Yes, you can fax it or you can mail it or um because there's no timely filing limit or anything. So if you wanted to wait until the online service center issues are resolved, you could, um we would process the claim.
[AGENT][NEUTRAL] Because the policy was active on the data service.
[CUSTOMER][NEUTRAL] Oh, OK. Um, and then I said maybe they don't, they're not gonna pay because it's not breast cancer or it was thyroid cancer.
[CUSTOMER][NEUTRAL] So then I said well I'll just wait.
[AGENT][NEUTRAL] Yes, um, I would, I would, well, the explanation of benefits is definitely on the way to you, but I, it's up to you. If you want to go ahead and mail it, you can, you can fax it or you can wait for the online service in there.
[CUSTOMER][NEUTRAL] OK, OK, so then I just do it separately, right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK ma'am, so then do I need because uh something when I, I'm trying to log in it says to dial 4 so they can help me so there's an issue on then on the logging in right?
[AGENT][NEUTRAL] Right, that's what, yes, so, um, IT is aware of the login issue and they're working on it. Um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it should be right now we're saying 24 to 48.
[CUSTOMER][NEUTRAL] It's because I, I call.
[CUSTOMER][NEGATIVE] Uh-huh. I called human resources here at work and they said, well, give them a call and let us know that way I can advise whoever calls me and tells me because I told her it's because I, I can't log in, I'm keying in the group number and it doesn't let me.
[CUSTOMER][NEUTRAL] But I said let me call them. I've been calling since the morning.
[AGENT][NEUTRAL] Well, now you shouldn't, now you shouldn't, hold on one second. So you shouldn't have to use the group number though, you're signing in as an individual. So were you using group or individual?
[CUSTOMER][NEUTRAL] I was signing in as a group of the school.
[AGENT][NEUTRAL] OK, so that might be the
[CUSTOMER][NEUTRAL] And then I tried the individual and it didn't let me on individual either.
[CUSTOMER][NEGATIVE] It says that it doesn't recognize my email.
[AGENT][NEUTRAL] OK, so I'll go.
[CUSTOMER][NEUTRAL] Because I go and create your.
[CUSTOMER][NEUTRAL] Create and then I went into the insured and when I go into the insured it's asking for my name it's asking for the policy group.
[AGENT][NEUTRAL] Right, if you go under group, um, it's going to ask for the group number. um just make sure that you're using, you're an individual, but if you've already tried that, I'll go ahead and send this over to IT so that they can look into it for your group.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, no, uh, when I go individual it asks my last name, my social and it doesn't, it does let me in, I think, but it then it takes me to another page to log in and when I key in my.
[CUSTOMER][NEGATIVE] So my uh email and the password, it doesn't let me log in.
[AGENT][NEUTRAL] OK, so I would just hold off for right now because of all the issues that's going on since we launched on Friday and let IT give you a call when it comes to the online service center with an update. But in the meantime, if you wanted to fax or mail, you could.
[CUSTOMER][NEUTRAL] Let me, let me try.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Oh, let me, yeah, let me ask you something. You said the first, uh, for the pathology, they send the check to me and then the others, they, it's to pay the hospital or?
[AGENT][NEUTRAL] Um, yes, the first occurrence benefit goes to you, um, that's a lump sum benefit, and then you can pay the bills or however you see fit, and then the, um, if we get the claim and there's something still owed to the provider, we can pay to them too, depending on the, you know, your coverage and the services.
[CUSTOMER][NEUTRAL] Oh, what did you mean?
[CUSTOMER][NEUTRAL] During, uh-huh.
[AGENT][NEUTRAL] So it can be both.
[CUSTOMER][NEUTRAL] Oh, OK, it's because I do still owe in MD [PII], but I have I established uh payments.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I'm paying monthly 295. I think I still owe like 2, 3000 I think.
[AGENT][NEUTRAL] So you should, the easiest thing to do would be to give them your policy number here for this policy and let them know that you have an additional cancer policy so that they can bill and you don't have to.
[CUSTOMER][NEUTRAL] Oh, OK, yeah, because I already have it there established since I didn't do the claim until right now.
[CUSTOMER][NEUTRAL] So I made arrangements.
[AGENT][NEUTRAL] I mean, I understand you made arrangements, but you can, you can still, if your insurance can pay towards it, I mean, it's up to you if you rather make the payments or have it billed to insurance.
[CUSTOMER][POSITIVE] OK thank you ma'am.
[CUSTOMER][NEUTRAL] Mhm. OK, OK, well, I'll see what it says on the information and I'll fax the information to you guys.
[AGENT][POSITIVE] All right. You're welcome. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] No thank you very much. It was only that that I wasn't able to log in and I said I wonder if they're still missing something or maybe I did something wrong.
[AGENT][NEUTRAL] No, not you, it wasn't you.
[CUSTOMER][POSITIVE] OK thank you ma'am.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] Uh huh thank you ma'am bye bye.
[AGENT][NEUTRAL] Bye bye.