AccountId: 011433970860
ContactId: b2b827b2-3740-42f7-893c-2363585b72fc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1313400 ms
Total Talk Time (AGENT): 460759 ms
Total Talk Time (CUSTOMER): 556344 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/b2b827b2-3740-42f7-893c-2363585b72fc_20250619T12:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEGATIVE] Um, hi, good morning, [PII]. My name is [PII], and I'm calling because I'm trying to look on my, I guess my claims website or something on your APL website to see what bills were paid and the dates of service because I have a workman's comp case and the hospital submitted the bills to my secondary and my primary instead of my workman's comp, and I can't see anything and it tells me that my email is not valid and that's making me really upset.
[AGENT][NEUTRAL] All right, let's take a look. What's your policy number? I'm sorry.
[CUSTOMER][NEGATIVE] Um, where do I find that at? because again I can't get on the website to see anything, so like I don't even know where to get that from.
[AGENT][NEUTRAL] OK, I'll just look you up by name so I can look you up by your name or social, whichever you would prefer to give me.
[CUSTOMER][POSITIVE] Um, I, I can give you either, which is ever is easier, so that way I can get it taken care of. Um my name is [PII] Last name is [PII]
[CUSTOMER][NEUTRAL] And my social is [PII].
[AGENT][POSITIVE] Alright, thank you, [PII]. Bear with me just one second while I take a look here.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Because, um, I had told them I said, you know, we, I have like a limit for like my out of network expenses or whatever it is like the $4000 or $5000 whatever it is, but um it's already been like I guess because the anything that was from [PII] and on was workman's comp and they should not have submitted it, but they did so the guy at JFK said to give him the bill so he could, I guess, refund it and build the workman's comp, but I can't find anything more the money log in.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, OK.
[AGENT][NEUTRAL] Um, I do need to verify, please, your date of birth.
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And then what address should we have on file for you?
[CUSTOMER][NEUTRAL] It should be [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so the email that's on your policy is [PII], is that the one you were using?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I was entering my regular email. I didn't know it was under my, my work email. Maybe that's why. Let me see if I can pull it up, um.
[AGENT][NEUTRAL] Yeah, so if you've never logged in before, I will tell you that you're gonna have to click that link that says create OSC account is that where you're at?
[CUSTOMER][NEUTRAL] That's strange
[CUSTOMER][NEUTRAL] I have logged in before, but I've not, I didn't know that it was that, so like I don't, I don't know what that means.
[AGENT][NEUTRAL] OK, so that is the email on file and I.
[CUSTOMER][NEUTRAL] Because that
[CUSTOMER][NEUTRAL] Do it on the you do it on the website, correct, because that's how I submitted my claim uh prior like in like you know the the previous years.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, OK, but about a week and a half ago we updated our online service center so everybody's having to create a new login and so you're gonna have to click create OSC account. If you don't wanna use that email we can update it but that's the email and that's the username going forward is the email address.
[CUSTOMER][NEUTRAL] Well, that would be.
[CUSTOMER][NEUTRAL] OK, so that
[CUSTOMER][NEUTRAL] OK, yeah, I'd rather use my email so how do I fix that?
[AGENT][NEUTRAL] OK, I'll update the email. What um email would you like on file?
[CUSTOMER][NEUTRAL] I would like [PII].
[AGENT][NEUTRAL] OK, I'm gonna repeat this back just to make sure I copied it down right. [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, give me just a second, let me update this.
[CUSTOMER][POSITIVE] Not a problem.
[AGENT][NEUTRAL] OK, so now on our log in page when you're going to sign in, click create your OSC account.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then it's gonna ask.
[CUSTOMER][NEUTRAL] And I'm, I'm the.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then after you click on that, it's gonna ask which role best describes you. You're gonna click insured and then click next.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Yes, I did that part.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I filled out the next part and it says complete your account set up, so I click continue.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's gonna send you an email verification code.
[CUSTOMER][NEUTRAL] All right, let me check
[CUSTOMER][NEGATIVE] Yeah, I thought because I didn't even get an email that the thing was updating so I wouldn't have known anything about that.
[AGENT][POSITIVE] Right, I'm sorry.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] The email is gonna come to my regular email or my work email?
[AGENT][NEUTRAL] No, it's gonna be your Gmail, so that's what you're gonna use, yeah, as your username and that's where all the verification codes will go because I put that one on there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's my card.
[CUSTOMER][NEUTRAL] I'll have to enter the code.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I have to verify my code, righ[PII]?
[AGENT][NEUTRAL] Right, so once you click continue and it sends you the verification code you have to put your when you put your email in, put the code and then click verify and then you're gonna create the password.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once you do all that, it should, it'll take you back to the home page and then like the account's complete and then you should be able to log in.
[CUSTOMER][NEUTRAL] OK, I'm gonna do that right now. I see it says your account has been created. Go to dashboard, so now I go back into log in.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So now um you've got your password and user name for the account um it's always gonna send this verification code it's a new added layer of security so um you will have to get a new code every time you log in though.
[CUSTOMER][NEUTRAL] That's OK. That's fine. Like I just, I got that email here so let me enter that and.
[CUSTOMER][NEUTRAL] OK, so it's in my dashboard now, where do I see like what claims were I guess paid for January because like obviously it would be for January so I wanna know if it was sent to like where it was sent.
[AGENT][NEUTRAL] So under when you're on the dashboard it looks like when you do you see something on the left that says my policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] Cause like I know that I didn't submit it and it had to have been sent like from the actual hospital themselves because you know they have your card on file but they shouldn't have sent it because I told them that the procedure that this is a workman's comp but I didn't have the number. I told them, you know, just I will give it to you but they just.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You know, they just want everything paid and I don't wanna, you know, God forbid I go to the hospital for anything after now my, my extra benefits are gone already. So JFK said that they would, um, I guess refund it back to you guys. I just have to show them, you know, whatever bill, and then they'll resubmit to the work that the comp. So I go to my policy.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] I know.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then to the right, yeah, and then to the right you there should be a tab that says claims that you can click on.
[CUSTOMER][NEUTRAL] I see all that there.
[CUSTOMER][NEUTRAL] I don't see any I see claims. OK, claims, OK, and then I can do uh.
[AGENT][NEUTRAL] This is all new for us too, [PII], so I'm trying to scroll through this guide and does that take you just to file a claim or can you actually see the claims? It may take it a minute to upload too.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] It says process claims. It doesn't tell me like claims that are like I I just I, I don't know if that's the only ones that I've submitted or ones that other people submitted.
[AGENT][NEUTRAL] No, that would be the mall.
[CUSTOMER][NEUTRAL] Like I know I get the
[CUSTOMER][NEUTRAL] Cause it says only 2500. Is my is my thing only 2500?
[AGENT][NEUTRAL] You're outpatient?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is that what you're asking? Let me see here, one second.
[CUSTOMER][NEUTRAL] Yeah, I, I, I thought it, I didn't know if it was more than that because I, I don't know if I have outpatient or inpatient. I think my thing was outpatient because it was the same day surgery.
[AGENT][NEUTRAL] Yeah, so your outpatient benefit max on your plan is 2500. Your inpatient is a separate amount which is 4000.
[CUSTOMER][NEUTRAL] OK, I didn't have anything inpatient thankfully, but um let me see, uh, it says early to service.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Yeah, on claims when you click on that it says from there you can see open pending and processed claims and then in the box to the right there should be like a download document option I believe.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK, but it doesn't show anything paid for this year, so how are my benefits maxed out for this year if nothing was paid?
[AGENT][NEUTRAL] I haven't, let me see what your benefits are showing me.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yeah, so I don't show that we've paid anything out this year on your member plan. I see that there was.
[CUSTOMER][NEUTRAL] Do I still have the
[AGENT][NEUTRAL] Yeah, you still have the full amount. I don't show anything's been used.
[CUSTOMER][NEUTRAL] It's so strange, cause like I, I don't know where it is. I, it says that I.
[CUSTOMER][NEUTRAL] Where is it open process.
[CUSTOMER][NEUTRAL] So the claim was sent [PII], this is data service [PII].
[CUSTOMER][NEGATIVE] Not paid. I don't know.
[AGENT][NEUTRAL] So that
[CUSTOMER][NEUTRAL] I I have to download the documents.
[AGENT][NEUTRAL] Let's see, so this claim, let me see, I see that let me.
[AGENT][NEUTRAL] Outpatient benefit year max, so that was for [PII].
[CUSTOMER][NEUTRAL] But the document shows that it was not for [PII]. If you look at the bill and the data service, it's after, the data service is [PII].
[CUSTOMER][NEUTRAL] JFK Medical Center outer expense. It shows [PII] and the [PII], so why would that not be um handled?
[CUSTOMER][NEGATIVE] That's what I'm not understanding.
[AGENT][NEUTRAL] So date of service [PII] when I look at it states the denial not a covered loss under plan.
[AGENT][NEUTRAL] And also on [PII].
[CUSTOMER][NEUTRAL] But I
[CUSTOMER][NEUTRAL] But it's a service that was done in the hospital. That was probably my, my anesthesia or whatever. So why would that not be covered if it's an outpatient thing?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Like the whole thing was from the bat.
[CUSTOMER][NEGATIVE] It won't even let me show the bill or anything like that. I know I updated everything like when I sent it in like online like I scanned the bill.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It wasn't [PII] at all.
[AGENT][NEUTRAL] Yeah, I don't, the date of service [PII] is one that's on here.
[CUSTOMER][NEUTRAL] And 18 is RM Gle 1 [PII], [PII] and [PII]. That's all for this year.
[AGENT][NEUTRAL] Yeah, the [PII] is just saying that the office visit is not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] And then the [PII] and that was an actual endoscopy, so why would that like there's no expense not be paid or taken care of.
[AGENT][NEUTRAL] I would have to pull your policy and see if there's any exclusion listed on there. You said it was for like an endoscopy?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It was an endoscopy, yeah, but I mean it was an inpatient uh procedure, but, you know, there was anesthesia, there was, you know, everything included with that. So that's why I'm not understanding why it wouldn't be taken care of.
[CUSTOMER][NEUTRAL] Because like my other one, if you look at my prior bill like from [PII], the same exact thing outpatient um expense, JFK Medical, it says the January, I mean um [PII] and [PII], it was the exact same thing. It was an endoscopy and they paid it it says outpatient expense processing SAC whatever that means.
[CUSTOMER][NEGATIVE] They, they took care of it, but this one they say no, it doesn't make sense.
[CUSTOMER][NEUTRAL] The same policy as last year.
[CUSTOMER][NEUTRAL] If you want that claim, I can give it to you because they refer to it.
[AGENT][NEUTRAL] What does that claim number end in?
[CUSTOMER][NEUTRAL] 3521249
[CUSTOMER][NEUTRAL] I wonder why it doesn't let me see the stuff that I sent. It's crazy.
[AGENT][NEUTRAL] OK, so what I can do on this, [PII] is, um, we can, we have two different kind of options. So on the dates of service for [PII], I can send this back over to an examiner and have them look at it and just see if it was processed incorrectly and then have them reach out to you um if you don't wanna wait for a call back I can call over and see if somebody's available now.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Um, but I see what you're saying as far as the other one, the facility processed as a paid on this one showing a denial.
[CUSTOMER][NEUTRAL] It it was literally.
[AGENT][NEUTRAL] Yeah, yeah, yeah, I, yeah.
[CUSTOMER][NEUTRAL] It was like it was
[CUSTOMER][NEGATIVE] Procedure I sent the bill. I don't know why it would have anything that's like a, a number that's not what I provided like I mean the dates of service because that's not pertinent to it because our room Jo is my bariatric, you know, regular like gastroenterologist and the other one was an emergency room, so that's not covered obviously, but maybe they all got sent together, but his JFK one should, should have been, you know, reimbursed or whatever.
[AGENT][NEUTRAL] Right, so yeah, I'll put that in the notes and then if you don't mind I'll just have them give you a call back um and if it was processing correctly then they'll just reprocess it for you.
[CUSTOMER][NEUTRAL] OK, yeah, cause that's why I thought it was kind of strange. I'm just like, I don't, I don't know why it would tell me cause it's, when I looked at it, I could have sworn that the document said um.
[CUSTOMER][NEUTRAL] Uh, something about our outpatient things satisfied. I'm just like, huh? What are you talking about?
[AGENT][NEUTRAL] No, yeah, that wasn't, and like I said, I don't know how a date, there was a December date in there from [PII], um, but anyhow, yeah, it wasn't referring to [PII] like you still have your full balance left, so, um, what is a good.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Maybe they were looking at something before. That's why because like that that shows stuff on there from [PII] which shouldn't be on there, so maybe that's why they say that.
[AGENT][NEUTRAL] Huh?
[AGENT][NEUTRAL] Yeah, like, but like I said, you have the full amount for the year so like I don't show anything that's been used, so what's a good call back number for you?
[CUSTOMER][NEUTRAL] It's um area code [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, just to confirm, you said [PII]?
[CUSTOMER][POSITIVE] That is accurate, yes.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, well I'm glad we got you logged in and everything like that that's all taken care of too and then I will give them this claim information and somebody will call you back on it, [PII], OK?
[CUSTOMER][POSITIVE] Thank you so much. I appreciate it.
[AGENT][POSITIVE] Yeah, you're very welcome. Anything else I can do for you?
[CUSTOMER][NEGATIVE] I just wanna know how come I can't see the stuff that I uploaded like that way I could just double check and make sure I did send like the, I mean I know it has the right data of service but like why can't I see it that way when I talk to the person I could tell them what I sent, you know what I mean?
[AGENT][NEUTRAL] Um, I believe, let's see. Let me see if there's a way to see.
[CUSTOMER][NEUTRAL] Because like when I go to download documents it only shows me like I guess like their determination email like it like you know like put their breakdown but it doesn't show me like you know my backup supporting documents or whatever so.
[AGENT][NEUTRAL] Yeah, let me see. OK, that's.
[CUSTOMER][NEUTRAL] I mean, I'm sure they have everything they obviously they'll be able to pull it and see what was submitted, so it's not a problem, but I just wanna be able to look at it to understand like if I sent something wrong or whatever it is.
[AGENT][POSITIVE] Right, no, yeah, we can definitely pull it and see like how many pages were sent and like we can uh re-review everything that was like uploaded and like and all of that for sure um.
[CUSTOMER][POSITIVE] I like that.
[CUSTOMER][NEUTRAL] Because I know it's the first time I sent it. I didn't like send I guess like that that cover page.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And then, so then I had to reset the second time. That's why I was like, I don't, I don't understand why you keep saying it's already met, but, but that's why I figured I would call.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Hey, do you know about how long it would take someone to call back? I mean, I, I'm not like in a rush like the second, but will it be today that they'll call back because I know to be on the lookout for it.
[AGENT][NEUTRAL] Um, it may be today. It shouldn't take any longer than 24 hours, um, for somebody to call you. So yeah, I, it's not gonna be days upon days.
[CUSTOMER][NEUTRAL] OK, that's fine. I just wanted to just that way I know where to be on the lookout if it's today or you know whatever because I, I, I am working, so I don't have my phone on the side and then not, you know, know that I'm calling.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, for sure, for sure, um, yeah, [PII], I mean, I am looking in our user guide it looks like it just gives you the option to download that explanation of benefits. I don't know that there's an option right now to re-review any submitted documents unfortunately.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And since this is a new online thing like so like when I go on here, it doesn't say um.
[CUSTOMER][NEUTRAL] Like, file a claim. So if I wanted to, oh, I see a thing worth to start your claim, never mind, I see it.
[AGENT][NEUTRAL] Yeah, the, the file claim is, yeah, it's still an option there.
[CUSTOMER][POSITIVE] Alright, very good. OK, cool.
[AGENT][POSITIVE] All right. Well, thank you for your patience today. I hope you have a good rest of your day, [PII].
[CUSTOMER][POSITIVE] Thank you so much. I appreciate all your help.
[AGENT][POSITIVE] You're welcome. Bye-bye.