AccountId: 011433970860
ContactId: b409db17-9293-463b-b741-4ab01c9979e9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 487059 ms
Total Talk Time (AGENT): 187170 ms
Total Talk Time (CUSTOMER): 148255 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/b409db17-9293-463b-b741-4ab01c9979e9_20250620T18:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, my name is [PII]. I have, uh, an account with you guys. Um, I just had a knee replaced, full knee replacement done last Monday, and I was wondering what claims can I put in.
[AGENT][NEUTRAL] Um, yes, sir. I can assist you with your benefits. Um, first, could I get your name again and a good callback number?
[CUSTOMER][NEUTRAL] It's [PII] and the phone number is [PII].
[AGENT][NEUTRAL] OK. Thank you. Now I need your policy number, please.
[CUSTOMER][NEUTRAL] I don't have a card, so I don't really know my policy number.
[AGENT][NEUTRAL] OK, I can look it up by your social.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Want me to stay with the nurse.
[AGENT][NEUTRAL] OK, thank you. Now, please verify um your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] OK, thank you. Now, please verify your email address.
[CUSTOMER][NEUTRAL] I think I put [PII].
[AGENT][NEUTRAL] I know there's a different one.
[CUSTOMER][NEUTRAL] Or [PII] then [PII].
[AGENT][NEUTRAL] Um, there's no [PII], it's just [PII]. Do we need to update that?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] There's no [PII] on it, yeah, it's, it's [PII]. Sorry.
[AGENT][NEUTRAL] OK, one moment. [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] OK, yes, I've updated your email address.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] No problem. And the surgery, was it, were you admitted or was it an outpatient surgery?
[CUSTOMER][NEUTRAL] It was outpatient. I, I, I was there at [PII], July, I mean [PII] and I was let go by like I think [PII] or [PII]
[AGENT][NEUTRAL] OK. Yes, I'm showing for outpatient benefits, we cover up to $2500 per calendar year and that's for the co-pay, the co-insurance, and the deductible after your primary insurance processes the claim. Um, what normally happens is that you would, um, let your providers.
[AGENT][NEUTRAL] know that you have insurance with us and they will call us to verify your benefits and submit the claims themselves. Um, we can go that route. I can give you all of your information, your policy number, and just give them this phone number to call to verify your benefits, or I could assist you with filing the claim yourself.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, probably assist me would be easier.
[AGENT][NEUTRAL] OK. Well, what you would need to do is um
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Well, which way do you prefer? Would you like to mail us the documentation, fax it, or file the claim online?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] Oh sorry, um.
[CUSTOMER][NEUTRAL] I'll file a claim online I guess would be the fastest.
[AGENT][NEUTRAL] OK. Well, our website is, let me know when you're ready.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, the website is secure. Yeah, OK. It's [PII], that's [PII]
[CUSTOMER][NEUTRAL] Ready?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, sir. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And it should take you to our home page and you should see an option to create your account or.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To set up your policy online.
[CUSTOMER][NEUTRAL] And so,
[CUSTOMER][NEUTRAL] Create your OSC account.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Put insured.
[AGENT][NEUTRAL] Yes, you're the insured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And when it asks for your policy number, your social, you can enter your social.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] There's no user was found with that information that was entered.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Did you leave any information out or?
[CUSTOMER][NEUTRAL] No, I put my, I put my last name, Social Security, residential zip code, my email and birth date, and it says.
[CUSTOMER][NEUTRAL] No user was found with that information. Please try again if this is error persists. Contact customer service that's 256-860-6 option 4.
[AGENT][NEUTRAL] OK. Well, um, where it asks for the social, let me give you your policy number. Try entering this.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, your policy number is 214.
[AGENT][NEUTRAL] 83. Mhm.
[CUSTOMER][NEUTRAL] 114.
[CUSTOMER][NEUTRAL] 21483
[AGENT][NEUTRAL] 88
[CUSTOMER][NEUTRAL] 214-838-8
[AGENT][NEUTRAL] Yes, sir, that's your policy number.
[CUSTOMER][NEUTRAL] Let me write that down.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] number
[CUSTOMER][NEUTRAL] For AM public.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Oh my [PII].
[CUSTOMER][NEUTRAL] Check here.
[CUSTOMER][NEUTRAL] That's try that.
[CUSTOMER][NEUTRAL] Mm, no, no user was found.
[AGENT][POSITIVE] Wow.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's going on with the website.
[CUSTOMER][NEUTRAL] Uh, and my nurse just, and my therapist just got here. Um, I gotta, I'm gonna have to call you back. What can I do? Um,
[AGENT][NEUTRAL] Yeah. Well, what we'll need, um, you've already had the surgery.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Yeah, last Monday.
[AGENT][NEUTRAL] OK. Well, we'll need documentation from your um
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Primary insurance company for the date of service, the explanation of benefits, and we will also need documentation from the provider with your diagnosis code on it. So you can fax that information to us or um upload it online once you set up your policy and I suggest that you uh try again because we haven't had any issues with the website. I've been helping people get set up online all day, so I'm not sure what's going on. I apologize.
[CUSTOMER][POSITIVE] All right, well, let me get my therapy done and then I'll call you back to see what I can do.
[AGENT][NEUTRAL] OK. Well, is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] No thank you have a good one.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL. Bye.
[CUSTOMER][POSITIVE] Thank you.