AccountId: 011433970860
ContactId: bcfa0ea2-6c76-4c25-bd7c-96fb0df814c2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 540469 ms
Total Talk Time (AGENT): 177556 ms
Total Talk Time (CUSTOMER): 211111 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/bcfa0ea2-6c76-4c25-bd7c-96fb0df814c2_20250620T15:52_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], uh, I am having some trouble with submission of documents, uh, for reimbursement under coverage, and I have no idea how I could possibly have got it wrong this time.
[CUSTOMER][NEUTRAL] Um, I would appreciate if you could just check and make sure either what else I need to do or whether or not I'm crazy because I can't seem to submit the correct documents.
[AGENT][NEUTRAL] OK, do you have your policy number?
[CUSTOMER][NEUTRAL] I do. Policy number is 02609747.
[AGENT][NEUTRAL] And can I get your first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and it's [PII].
[AGENT][NEUTRAL] OK, and then [PII], can you verify your address and email address?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the email address is either my work email, which is my first name [PII], or it's my personal email which is [PII].
[AGENT][NEUTRAL] OK, it looks like we've got your work email and then do you have a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yep it's [PII].
[AGENT][NEUTRAL] OK, thank you. Is this a claim for yourself?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Just pulled up.
[AGENT][NEUTRAL] I'm just reviewing what we've received so far. Let's see.
[AGENT][NEUTRAL] OK, so it looks like you're
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Submitted the same thing like 6 times.
[AGENT][NEUTRAL] Are you
[AGENT][NEUTRAL] Uh, yeah, it looks like you have primary insurance through United Healthcare. Is that correct?
[CUSTOMER][NEUTRAL] I just
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And I thought on the last one I provided my explanation of benefits, but I just got rejected again and it says please provide copies of your benefits for your primary insurance carrier, and I, and I don't, that's why I decided to call because I, that's, I'm pretty sure I did that.
[AGENT][NEUTRAL] Looks like
[AGENT][NEUTRAL] OK, let me see what I've got.
[AGENT][NEUTRAL] Um, we
[AGENT][NEUTRAL] We got a summary of your plan description.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I should, I gave you guys two different things I sent.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Medical member handbook which I thought was what
[CUSTOMER][NEGATIVE] You wanted it's 126 pages. I don't know what else I could send. Is that not right?
[AGENT][NEUTRAL] No, no, this is, um, we need the actual, so United Healthcare.
[CUSTOMER][NEUTRAL] The summary plan description.
[AGENT][NEUTRAL] Yeah, that just describes what your plan is. Um, we need from United Healthcare showing that they received this claim and how they processed it.
[AGENT][NEGATIVE] It's just it's usually just 1 or 2 pages.
[AGENT][NEUTRAL] Do you have a login with your United Healthcare?
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] Um, so if, if they process the claim, you should be able to log into your portal with them.
[CUSTOMER][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And then, um,
[AGENT][NEUTRAL] You know, download that.
[CUSTOMER][NEGATIVE] That means all of my other ones are probably about to get rejected too for my wife because I'm pretty sure I did not provide, well, maybe I did. I don't, I don't know what her doctor provided something different.
[AGENT][NEUTRAL] And then your doctor's office should also have a copy of the explanation of benefits from UnitedHealthcare.
[AGENT][NEUTRAL] And it just simply will state the charges, what was um paid um or went to your to your deductible from UnitedHealthcare. This gives a basic outline of how the claim was processed.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEGATIVE] But for some reason they haven't received it yet.
[CUSTOMER][NEUTRAL] Looking for.
[CUSTOMER][NEUTRAL] I'm looking for my.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm sorry, would you say that again? What am I supposed to be looking for?
[AGENT][NEUTRAL] It's an explanation of benefits.
[AGENT][NEUTRAL] It'll say EOB or explanation of benefits.
[AGENT][NEUTRAL] Now, if, if your healthcare provider for some reason hasn't submitted it yet to United Healthcare or hasn't gotten payment back yet, then it may not be in the system.
[CUSTOMER][NEUTRAL] No, they
[CUSTOMER][NEUTRAL] They did and like I've got a.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Oh there it is the explanation of benefits.
[AGENT][NEUTRAL] Yeah, that's it.
[AGENT][NEUTRAL] That's what we
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] So there's, there's um actually two pieces of information that we need. We need that explanation of benefits, and then we need like some type of itemization that you received from your doctor.
[AGENT][NEUTRAL] That shows, um, I think we may have that though. Did you submit an itemization for?
[CUSTOMER][NEUTRAL] Yeah, well you double check because I'm pretty sure I gave you that.
[AGENT][NEUTRAL] Yeah, let me make sure.
[CUSTOMER][NEGATIVE] I wish there was a way to like go back into the same claim, you know what I mean? Like I, I feel bad like I said, keep doing the new one every time and it gets kind of confusing as to what.
[CUSTOMER][NEUTRAL] I am
[CUSTOMER][NEUTRAL] Like, does that make sense? Like I'm.
[AGENT][NEUTRAL] Yeah, I, yes, I understand what you're saying, um.
[AGENT][NEUTRAL] Yeah, unfortunately, yeah, and I do, we do have the other part of the claim that we need. It's just that primary EOB that we need from United Healthcare, um, yeah, unfortunately you'll have to upload, um, and we'll we'll tie it.
[CUSTOMER][NEUTRAL] OK, so I'm just putting EOB for my I'm just gonna put the explanation of benefits for the dermatologist, and that should be it, right? I don't need to give you anything else again.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, I just submitted it. Here we go. I mean, it's gonna take a second, but I understand now what you guys are looking for and think I'm so happy I called because I was about to lose my my mind.
[AGENT][POSITIVE] I understand that's a lot of, lot of pages that were submitted, so yes, I totally understand. Sorry for the confusion and yeah.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] No, no, it's OK. I thought, yeah, I just, I wish I'd known that's what I needed. I would have done that in the beginning. I've had this paper.
[CUSTOMER][NEUTRAL] Go at least had access to it.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Well, now you know and you won't have you now you know what to do going forward.
[CUSTOMER][NEUTRAL] All right, well I have resubmitted it.
[CUSTOMER][NEUTRAL] Yeah and I'm probably gonna just wait for my other my wife's claims to get rejected so that I can turn around and resubmit hers because.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm guessing that's about to happen too.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, let me see on hers and yes I do by the way I, I do show it uploaded so.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Did you just upload some for her as well? No, it looks like we got these on 616, so I bet are those the same ones that you had submitted prior?
[CUSTOMER][NEUTRAL] Yeah, yeah, that's the, well, I, I thought I gave you guys the new I think for her she just needed the code so it might be OK because we uploaded.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Like what they paid and what was still outstanding, which is what I had to pay for what we had to pay out of pocket so you guys hopefully will see it on that one.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Hopefully that all works out. OK, thank you. I mean they're taking longer to process so I'm hoping that means you guys are gonna give me back some of my money, um.
[CUSTOMER][NEUTRAL] And uh that.
[AGENT][NEUTRAL] Yeah, it looks like, yeah.
[AGENT][NEUTRAL] They typically take about 7 working days or so.
[CUSTOMER][NEUTRAL] Does it look like the other ones are?
[CUSTOMER][NEUTRAL] OK, does it look like they're supposed to be approved or can you tell that at all?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] I can't tell um when they're in processing so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Understandable. OK, well I really appreciate it thank you so much for your time.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a great weekend.
[CUSTOMER][NEUTRAL] You too bye bye.