AccountId: 011433970860
ContactId: bee6b4f4-2dbb-4a0f-a42e-9e69cfea4f80
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2372330 ms
Total Talk Time (AGENT): 999625 ms
Total Talk Time (CUSTOMER): 849528 ms
Interruptions: 11
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/bee6b4f4-2dbb-4a0f-a42e-9e69cfea4f80_20250605T13:08_UTC.wav
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[AGENT][NEUTRAL] Morning, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEGATIVE] Uh, yes, I'm having a problem logging into my account.
[AGENT][NEUTRAL] OK, you're the insured and you're trying to sign into your portal. Is that correct?
[CUSTOMER][POSITIVE] Correct. Yeah.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And Ms. [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you. And your policy number, please?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, I can't log into my account so I don't know it.
[AGENT][NEUTRAL] Hey, your full social?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] OK, Ms. [PII], thank you. Give me a moment please to locate your information and get that pulled up.
[AGENT][NEUTRAL] OK, Ms. [PII]. So first off, I will need to verify several things with you first for security. So if you could first please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you gave me, so that is the best number that we should have, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Thank you. And lastly your email address and I believe this appears to be your work email.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, thank you so yes ma'am, Ms. [PII], there was an update made to the portal over this past weekend, so you will have to set up your profile again. So when you get to the log in page just below where it says log in it says to create a new OSC account or create my OSC account.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Give me one second. I'm not actually looking at the verbiage. Bear with me.
[AGENT][NEUTRAL] It says create your OS account. Yes, ma'am. So you would just click there.
[CUSTOMER][NEUTRAL] It says create your account.
[AGENT][NEUTRAL] And go through the steps. Yes, ma'am. Uh-huh.
[CUSTOMER][POSITIVE] And I'm the insured, correct.
[AGENT][NEUTRAL] And then click next and then you actually I believe you're only going to have to fill in the 3 boxes currently that have the red asterisks.
[AGENT][NEUTRAL] So that would be your last name, that email address, and your date of birth.
[AGENT][NEUTRAL] And click next.
[AGENT][NEUTRAL] And this time, it is going to the that.
[AGENT][NEUTRAL] A security code and it will, it is something that you will have to do twice like a double two-factor authentication for security.
[AGENT][POSITIVE] And if it's OK for us just remain on the on the line so that you can make sure you know that you don't have any issues with it.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] You're doing OK today so far?
[CUSTOMER][NEUTRAL] I'm just a little bit under the weather.
[AGENT][NEGATIVE] Oh, I'm sorry. That's, that's never fun.
[CUSTOMER][NEUTRAL] I know, right?
[CUSTOMER][NEUTRAL] Just to verify this.
[AGENT][NEUTRAL] Yes, and, and that will be something you'll have to do.
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] Twice.
[AGENT][NEUTRAL] But it will prompt you.
[CUSTOMER][NEUTRAL] So do I select verify code or send new code cause I have the code.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, then you'll have to enter it. Yes, ma'am. If you have the code, you'll enter that code.
[CUSTOMER][NEUTRAL] Verify code?
[CUSTOMER][NEUTRAL] And then is it gonna send me another email?
[AGENT][NEUTRAL] I believe so. Again, this is all very new for us too, so we're just kind of.
[AGENT][NEUTRAL] Walking through the steps with you.
[AGENT][NEUTRAL] At the moment, Miss [PII].
[CUSTOMER][NEUTRAL] So it's a claim not verified.
[CUSTOMER][NEUTRAL] Email address
[CUSTOMER][NEUTRAL] And it's my option is change email.
[CUSTOMER][NEUTRAL] And if I hit continue.
[CUSTOMER][NEUTRAL] Oh wait, there it goes.
[CUSTOMER][POSITIVE] Very good.
[CUSTOMER][NEUTRAL] It just kicked me out.
[CUSTOMER][NEUTRAL] Making me log in again.
[AGENT][NEUTRAL] Mhm. And I believe it's going to ask you.
[AGENT][NEUTRAL] It may send you another code at that point.
[AGENT][NEUTRAL] To Ms. [PII].
[AGENT][NEUTRAL] Once you go back to the login screen.
[CUSTOMER][NEUTRAL] Yeah, it's
[CUSTOMER][NEUTRAL] Yeah, it didn't.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEGATIVE] Sure, this is pretty frustrating for you as well.
[AGENT][NEUTRAL] Um, it's, it's been a kind of a hectic week. Yes, ma'am, because everyone is having to do that. If you've previously, you know, of course, if someone has not ever set it up, it's not.
[AGENT][NEUTRAL] It's not so hectic on that part, but
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I'm logged in now um.
[CUSTOMER][NEUTRAL] Where do I go?
[CUSTOMER][NEUTRAL] Need
[CUSTOMER][NEUTRAL] OK, so now it looks all different than it did before, um, so now I wanna see.
[AGENT][NEUTRAL] It did, uh-huh, it does. So.
[CUSTOMER][NEUTRAL] I don't need to file a claim. I wanna look at my claims, so where do I go?
[AGENT][NEUTRAL] OK, so you should be, uh, you should see my, um,
[AGENT][NEUTRAL] OK, so under my policy out to the left of the screen, do you see like it says dashboard do you see where it says my policy?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. I claim.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you should just be able to click there, mhm.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] I see one claim is paid in 11 or $1,191.
[AGENT][NEUTRAL] Uh, which claim number are you looking at?
[CUSTOMER][NEUTRAL] 3609508
[AGENT][NEUTRAL] OK, yes, ma'am. OK, give me just one moment, and the information that I do provide for you on any clients information will be a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] So, on that claim, yes, ma'am, I can see that the benefit paid $1,191.59.
[CUSTOMER][NEUTRAL] OK, so when is that going to be processed?
[AGENT][NEUTRAL] OK. That went through our nightly, yes, ma'am. It went through our nightly processing on last night. So that check will be mailed today.
[CUSTOMER][NEUTRAL] Yeah it says process but.
[CUSTOMER][NEUTRAL] OK, but I had set it up as direct deposit.
[AGENT][NEUTRAL] OK, you will need to verify. I don't show that direct deposit information. Give me just a second. Well, actually, I, OK.
[AGENT][NEUTRAL] So I do see that um
[AGENT][NEUTRAL] Uh, let's see. Do you mind holding for just a moment so that I can check on that why it is showing as a check instead of direct deposit?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], it's [PII]. I have a question for you. How, well, first off, how are you today?
[CUSTOMER][POSITIVE] I'm doing great thanks how are you?
[AGENT][NEUTRAL] Uh, well, well, it's been a long week. Um,
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] I have an insured on the line who we processed a claim last night. She has direct deposit information in the system, but this is showing a check on the Amtrak and she's wanting to know why.
[AGENT][NEUTRAL] I wasn't gonna transfer her. I was just gonna try to see if somebody could tell me that.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Sure, I can see if I could try to help. um I'm not sure if that's on our end or customer service since it's already been released.
[AGENT][NEUTRAL] No.
[AGENT][NEGATIVE] It wouldn't be for a claim, customer service, it wouldn't be.
[CUSTOMER][NEUTRAL] Um, but I can
[AGENT][NEUTRAL] This is for claims.
[CUSTOMER][NEUTRAL] Oh, but you said I guess it was for the check though.
[AGENT][NEUTRAL] We issued her benefit.
[CUSTOMER][NEUTRAL] Right, they didn't they didn't enter in the direct deposit?
[AGENT][NEUTRAL] We, we issued it as direct deposit to her payment for her claim.
[AGENT][NEUTRAL] I mean, it should have been for a direct deposit, but it's showing that it was, the claim was paid with a check.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And there is direct deposit information. Uh-huh. It is 251-707-4 for [PII].
[CUSTOMER][NEUTRAL] OK, let's see what's the policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I do see that we have direct deposit information in Lion.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So that's what she's wanting to know, why would, why would a check have been issued?
[CUSTOMER][POSITIVE] So, I like on.
[CUSTOMER][NEUTRAL] So we don't like whenever we're processing we just enter into Lion we don't actually like the customer service they enter in the check information we don't actually select if it's a check or a direct deposit.
[CUSTOMER][NEUTRAL] So, for some reason,
[AGENT][NEUTRAL] So when a claim is processed, customer service.
[AGENT][NEGATIVE] I'm confused.
[CUSTOMER][NEUTRAL] Is the one that enters in the direct deposit.
[AGENT][NEUTRAL] Right, but we have.
[CUSTOMER][NEUTRAL] In in the lion system.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So like whenever we enter in like the like in lion like whenever we're entering the benefits we just hit enter so if there's direct deposit information in Lion, then it should be direct deposited but if there's for some reason not or maybe if it was entered incorrectly like the wrong account number then a check will be issued.
[CUSTOMER][NEUTRAL] So let me see if.
[CUSTOMER][NEGATIVE] The information was entered incorrectly, but customer service is the one that enters in the direct deposit we we don't actually.
[AGENT][NEUTRAL] And there's not a note.
[AGENT][NEUTRAL] Yeah, and there's not a note anything about direct deposit. There's nothing in there about a direct, who added anything about a direct deposit.
[CUSTOMER][NEUTRAL] 00 let me see if they have like the um authorization form and then I can see if the numbers match.
[AGENT][NEUTRAL] That.
[CUSTOMER][NEUTRAL] Because that's the only reason why I would think that it wouldn't have gone through is if the account information was incorrect.
[AGENT][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] Because then it would just, you know, bypass it and just issue a check. um, so let me see.
[CUSTOMER][NEUTRAL] But yeah, like the actual like if it's a check or direct deposit.
[CUSTOMER][NEUTRAL] Like on the claim side like we don't determine that like if they have the direct deposit information entered in through customer service then it will automatically issue a check or direct deposit.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Of course, I can't get line to even, I mean, not line but on base. My on base is just spinning.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It's just spinning.
[CUSTOMER][NEUTRAL] Yeah, so I see on [PII], I'm not sure whose name that is, that says bank info added.
[AGENT][NEUTRAL] What can you where are you seeing that?
[CUSTOMER][NEUTRAL] So, somebody.
[CUSTOMER][NEUTRAL] In the notes
[AGENT][NEUTRAL] Yeah, I can't, why can't I see that?
[CUSTOMER][NEUTRAL] Nos entered in on [PII].
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] I don't see any of that. May when?
[CUSTOMER][NEUTRAL] [PII], let me see if I can find who's at whose username that is. I don't think it's a claims person. Let's see.
[AGENT][NEUTRAL] That looks like that was an OSC. I think that probably is through the OSC.
[CUSTOMER][NEUTRAL] Oh OK. Oh, so maybe they entered it in themselves then their direct deposit?
[AGENT][NEUTRAL] I need, like, so let me let me because she can change that in the OSC but let me.
[AGENT][NEUTRAL] Let me get back on the line and verify with her because.
[AGENT][NEUTRAL] Yeah, that, I believe that signature thing is OSC.
[AGENT][NEUTRAL] And it's not
[CUSTOMER][NEUTRAL] Oh, so yeah, I would definitely check to make sure that it did that that she did it correctly on her end, but I do see that it's in the lion screen the check information, but maybe it was, I would just check the numbers, make sure that that she got those numbers correctly because if it doesn't match, then the system will just bypass it and issue a check.
[AGENT][NEUTRAL] Mhm. Sure.
[AGENT][NEUTRAL] OK, yeah, let me get back on there and do that with her because there's, I mean, nothing. I was looking for, you know, some type of correspondence or something in there that showed, you know, like where she had sent that information in, but it looks like I, I'm, I'm pretty sure, [PII] that that's indicates it was entered in the OSC. So let me, let me verify that with her. I appreciate you looking at it.
[CUSTOMER][POSITIVE] Oh sure, no problem. You're welcome.
[AGENT][POSITIVE] OK, thanks, girl. Have a good day. Hi, [PII], thank you, bye.
[CUSTOMER][POSITIVE] Mhm thanks you too bye bye.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] the
[AGENT][NEUTRAL] Ms. [PII], thank you very much for holding for me. OK, so you had entered your banking information into the online service center, it looks like, is that correct?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let's verify what was entered.
[AGENT][NEUTRAL] As far as your routing number and your account number please.
[CUSTOMER][NEUTRAL] All right, hold on.
[CUSTOMER][NEUTRAL] OK, the routing number is [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] And the account number is [PII].
[AGENT][NEUTRAL] OK, so that is correct. So what I was checking, they said that, you know, possibly if the information was not entered correctly that that could have been.
[AGENT][NEUTRAL] The, you know, if the account number was just even one digit off it would bypass that to issue a check. So I'm not sure if this is something with the new online service center or not.
[AGENT][NEUTRAL] Um, let me ask if anyone else has had this occur. Do you mind letting me check on that because anything that we're coming across like this, um, for example, Ms. [PII], we're, we're having to report to our IT department because they are diligently working on any.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Errors that there may be. So I wanna verify if anyone else has had this happen.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Do you have just a moment?
[CUSTOMER][NEUTRAL] Not really, but I will.
[AGENT][NEUTRAL] OK, someone I can put in a request for someone to call you back, but at this time, the benefit has been paid, but it is being sent to you in the form of a paper check.
[CUSTOMER][NEUTRAL] OK, and so now I can't see anything that I've uploaded as far as my claims.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So I don't know, I don't know how to review any of that.
[AGENT][NEUTRAL] Yes, ma'am. Now, the documents you could not review before once they were uploaded, you could not see those.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I could.
[CUSTOMER][NEUTRAL] So, so now basically I'm starting over because two of the other claims were denied.
[AGENT][NEUTRAL] OK, so there is another claim that's scheduled to go through processing tonight, the one that was denied ending in 44.
[CUSTOMER][NEUTRAL] Wait, hold on.
[CUSTOMER][NEUTRAL] Uh, my post, um, ending in 44. Why was that denied?
[AGENT][NEUTRAL] Yes, ma'am. I was going to explain that to you.
[AGENT][NEUTRAL] So there were two dates of service, [PII] and [PII] for the [PII], that one just states that that your insured, your primary insurance provided full benefits, so there were no benefits payable for that. For the [PII], it says covered outpatient services are hospital emergency room treatment, outpatient surgery in a hospital, or an outpatient surgery center.
[AGENT][NEUTRAL] Diagnostic testing in a hospital or in an MRI facility. Charges incurred in an independent lab are not covered.
[CUSTOMER][NEUTRAL] OK, and so what was that for?
[AGENT][NEUTRAL] That was for data service [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Um, so what about because there's another claim that's not even listed here, so I don't, I, I mean I'm, I'm really frustrated because I, I can't see what I've submitted anymore.
[CUSTOMER][NEUTRAL] So is there another, is there, because there's one more, um, that I did a stress test in the hospital, a stress test and the echogram.
[AGENT][NEUTRAL] And what day was that on, Ms. [PII]?
[CUSTOMER][NEUTRAL] I, I don't have it in front of me. I can't see it anymore, so I, I would have to go back through all my files to find it.
[AGENT][NEUTRAL] OK, I can see that there is a claim that is scheduled to go through processing tonight.
[AGENT][NEUTRAL] For you
[AGENT][NEUTRAL] And that is going.
[CUSTOMER][NEUTRAL] And what is that for?
[AGENT][NEUTRAL] It's loading your information.
[CUSTOMER][NEUTRAL] Cause that was in a hospital.
[AGENT][NEUTRAL] This is also for multiple dates of service and there will be a $500 benefit.
[AGENT][NEGATIVE] To be paid for this.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So why can I not see that on my account?
[AGENT][NEUTRAL] Because it hasn't gone through processing fully, it will go through our overnight processing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it's just not processed yet.
[AGENT][NEUTRAL] Fully. No, ma'am. Not where you can see that portion of it. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do I have any others pending?
[AGENT][NEUTRAL] Uh, no, ma'am. Again, this one that we'll go through processing tonight, there were several dates of, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I say several. one.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] 44 dates of service, 4 to 5 dates of service, and I'll be happy to go over these um remarks with you. Now you will be able to also see your explanation of benefits tomorrow with the remarks on there, but I'll be happy to go over those if you would like.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] Do you know if they're approved or not approved?
[AGENT][NEUTRAL] Some are that there was a $500 benefit paid. Correct, and there are several that are denied. Yes, ma'am.
[CUSTOMER][NEUTRAL] Cause I can't see it on my end.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's fine as long as I can see him tomorrow.
[AGENT][NEUTRAL] OK, and if you have any other questions?
[AGENT][NEUTRAL] Uh, you know, please call us back. I will ask and put in a request to have this looked at regarding your direct deposits.
[AGENT][NEUTRAL] Information to see why that did not go.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That way since that we verified and the information is accurate.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So is there anything else there that I could help you with at the moment?
[CUSTOMER][NEGATIVE] Or you, you can certainly tell your management that this this process now sucks and and so my, my question to you is when I do put in a claim because I'm about to put in another claim.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Am I gonna be able to see the documents that I've uploaded because I was able to um before.
[AGENT][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm I asking that question?
[AGENT][NEUTRAL] Because I did not I was not even aware, Ms. [PII], that once you uploaded them, I mean, you would have them saved on your computer in your file as to what you uploaded, but actually being able to log into the OSC and look at those documents, I was not aware that you could do that.
[CUSTOMER][NEUTRAL] She was the one.
[AGENT][NEUTRAL] You're the first person who's ever told me that they could do that, so that's why I'm checking.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And then um I can review.
[CUSTOMER][NEUTRAL] The explanation on everything except for 281, the ending in 281.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because that one happened. That one's.
[CUSTOMER][NEGATIVE] I don't, I don't have the option to download the.
[AGENT][NEUTRAL] Yeah, that one's not viewable to you yet because it hasn't gone through the other, yeah. It will go through our processing tonight.
[CUSTOMER][NEUTRAL] Oh it's in progress, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the other ones, um, if they're not viewable to you at this moment since that just went through processing last night, they should be viewable to you, I would say later this afternoon. If you can't click on them and see them now cause that takes, you know, that just takes a little time to get into the system for viewing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, I will let you know that, OK, so on, OK, so the 1191 59.
[AGENT][NEUTRAL] Ms. [PII], that actually is being paid to your provider. That was for a claim that was received from the provider.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So that's why a check is.
[CUSTOMER][NEGATIVE] I don't even have that.
[CUSTOMER][NEUTRAL] 1169.
[AGENT][NEUTRAL] No, ma'am. 119159.
[CUSTOMER][NEGATIVE] That's not even, I, I can't even see that one.
[AGENT][NEUTRAL] OK, because that one, that's the one that ends in 08.
[AGENT][NEUTRAL] That went through that's showing as a check.
[CUSTOMER][NEUTRAL] Oh, OK. And so why is that being paid to my providers?
[AGENT][NEUTRAL] That's because the
[AGENT][NEUTRAL] And the provider submitted that claim.
[CUSTOMER][NEUTRAL] OK, but I paid the claim. I paid that. that's an ambulance visit or ambulance, uh, I paid that out of my pocket. So you told me that the check was being submitted.
[AGENT][NEUTRAL] Well, it is, but I did not realize that you did not submit that claim that was submitted by the provider. So the benefit would be issued to them.
[AGENT][NEUTRAL] So that would be why it's not a direct deposit. Mhm. Whomever files the claim is typically, that is how the claim is processed.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Unless it is
[CUSTOMER][NEUTRAL] I'm the one who filed the claim to you all. I'm the one who paid out of pocket. I even sent my bank statement that I paid it directly.
[CUSTOMER][NEUTRAL] To Montgomery County Hospital District.
[AGENT][NEUTRAL] OK, let me, let me just.
[CUSTOMER][NEGATIVE] So how in the hell am I supposed to?
[AGENT][NEUTRAL] Ms. [PII], I'm just trying to look at the information and I'm, I'm just trying to explain to you what I see. So give me just a second to let me pull up that.
[CUSTOMER][NEUTRAL] I mean I sent all the information that they paid I don't know it was like.
[CUSTOMER][NEUTRAL] 100 bucks or something, but I can't see the documents in front of me anymore like I used to be able to on your site but I sent the documentation that how much the provider paid of it and then it shows that I paid it.
[AGENT][NEUTRAL] OK, so again, the claim that it it appears that this claim.
[AGENT][NEUTRAL] That was paid came from a, it was a it was faxed to us from the provider.
[CUSTOMER][NEGATIVE] Yes, because, because I, they wouldn't for whatever.
[CUSTOMER][NEGATIVE] um, I, I'm gonna call it HIPAA, but they could not send me.
[CUSTOMER][NEGATIVE] The detailed report and I don't know what that report is called all I had was just the invoice, the payment, but they could not send me um the time that I was in the ambulance all of the detail, which I think is ridiculous because I'm the patient.
[CUSTOMER][NEUTRAL] They said that they could only send it to you directly because that's what you needed were the procedure codes, etc. they wouldn't, they couldn't send it to me so the lady did fax it to you all.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] From Montgomery County Medical District, because the because they couldn't send it to me, she had to send it directly to you. So I don't know why that you had all of the backlog that I paid it.
[CUSTOMER][NEGATIVE] So how am I supposed to trace this down, call my insurance company, and so now the insurance company has to cut me a check.
[AGENT][NEUTRAL] Well, it would be the provider that we paid this to, not actually the insurance.
[CUSTOMER][NEUTRAL] Well, provider is the insurance, United.
[AGENT][NEUTRAL] OK, but we didn't pay the benefit to United. This benefit was paid. It appears to the.
[CUSTOMER][NEUTRAL] Who did you pay it to?
[AGENT][NEUTRAL] To the
[AGENT][NEUTRAL] It's MCHD EMS.
[CUSTOMER][NEUTRAL] Yeah, so they've already been paid.
[AGENT][NEUTRAL] Yes, ma'am, and they saw it.
[CUSTOMER][NEUTRAL] There's a, I, I included everything that the invoice was 0. I gave you my bank statement and so now I have to go back through MCHD and have them pay me?
[AGENT][NEUTRAL] It would be a refund or an overpayment from them.
[CUSTOMER][NEGATIVE] This is the worst company I've ever dealt with.
[CUSTOMER][NEUTRAL] I mean, because I provided.
[AGENT][NEUTRAL] And there is
[CUSTOMER][NEUTRAL] Multiple documents. There are probably 7 different documents that I sent to you and then I have no idea how many documents they sent to you, but they should have sent the payment as well.
[AGENT][NEUTRAL] Because on here is marked for assignment of benefits. So on the claim form that's how it was marked so that's why the benefits were paid to the provider who filed the claim.
[CUSTOMER][NEUTRAL] OK, so how is the 5 the other one set up that's being processed today?
[CUSTOMER][NEUTRAL] Is it going back to the provider or is it coming to me?
[AGENT][NEUTRAL] I believe that it's, let me see.
[AGENT][NEUTRAL] Um, no, ma'am, this one was filed by you and so the benefit would be to you, so it should be for a direct deposit because your information is actually, I mean, you're everything is correct on that.
[CUSTOMER][NEUTRAL] OK, so, but I'm the one who filed, um, the, the, the last one we were just talking about 508.
[AGENT][NEUTRAL] OK. Now, that one shows that we received it from the EMS.
[CUSTOMER][NEUTRAL] And, and all of my documents.
[AGENT][NEUTRAL] Again, it shows that we received a, a fax claim.
[CUSTOMER][NEUTRAL] No, no, that's, that's not a true statement because I could even when I go back and I triple check because they didn't have all the information when I went to go download documents, you could see everything I uploaded and I filled out the form for the claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I was the one who did that. So whatever process that you guys are going through, you didn't have the two combined. They just took the last information of the missing pieces and they just went off of that.
[CUSTOMER][NEGATIVE] And there was no way for me to combine them. It was just, you have one option to upload that I couldn't make any notes. I couldn't do anything to combine them.
[AGENT][NEUTRAL] And again, based on what I see Ms. [PII], the reason that this claim was paid to the MCHD EMS, it appears that we received that claim from them.
[AGENT][POSITIVE] And there was an assignment of benefits on the claim. Now, I will be happy to transfer you to someone who could better explain that.
[AGENT][POSITIVE] But I'm providing you to the best of my ability, the information that I can see.
[CUSTOMER][NEUTRAL] OK, so now how do I, I go to start a claim.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh. You're gonna be filing a new claim.
[CUSTOMER][NEUTRAL] Mhm. Well, I don't have the information yet, but.
[AGENT][NEUTRAL] Sure, yes. Uh-huh.
[CUSTOMER][NEUTRAL] I'm just walking through this.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And then do so I upload the file.
[CUSTOMER][NEGATIVE] But I have nowhere to make notes or anything.
[AGENT][NEUTRAL] And there were, yes, ma'am, but you couldn't make notes in the portal before.
[AGENT][NEUTRAL] Not in the online service center with APO.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So if I don't provide you everything,
[AGENT][NEUTRAL] Then
[CUSTOMER][NEGATIVE] I mean I have a better idea of what you need now before I upload it, you know, everything else, but before I didn't even know I mean I got what I got from as utilizing the example from the ambulance that's all they sent me so then I need it all and then to find out I can't even get that information which again I think is ridiculous because I'm the patient.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] I, and I don't know why they couldn't provide that. I mean, I don't know what the reasoning behind them not being able to, to provide you that information.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] Now, I can tell you to make it easier if, if in the future, the providers are not gonna file the claims for you, I always recommend that you present your APL card along with your primary insurance card.
[CUSTOMER][NEUTRAL] Well, so here's the other thing is that.
[AGENT][NEUTRAL] Because it makes it easier, you know, and
[CUSTOMER][NEGATIVE] Well, I, I understand, but I, so I've had my insurance for one year and I've never needed to use it other than just maybe a doctor's visit. So I have never once heard from APL. Nobody has ever mailed me anything. I did not even, I, and, and this is my fault, but I thought United was handling APL.
[AGENT][NEUTRAL] For you.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, yes, ma'am. No, they don't.
[CUSTOMER][NEGATIVE] Or my company, yeah, and so, but I've never once received anything from y'all, never.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I never even I've never even known the name of your company. Um, all I know that when I signed up through Best Buddies is that I had gap insurance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I've never had gap insurance before. I, I didn't even understand what that was, and I'm [PII] old. I mean, I understood what.
[CUSTOMER][NEGATIVE] What I was signing up for, but I anticipated that United was handling that or assumed rather. And if I didn't do my due diligence, I would still have paid all of this out of my pocket because you all have done nothing to send me anything. So how, how are you not?
[AGENT][NEUTRAL] Now, we mail ID.
[AGENT][NEUTRAL] Yes ma'am, we mailed ID cards last August to [PII].
[CUSTOMER][NEGATIVE] No, you did not.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] You may not have received them, but yes, ma'am. They were mailed on that date.
[CUSTOMER][NEGATIVE] No, I did not get that.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEGATIVE] Oh, I never received that.
[AGENT][NEUTRAL] OK, and then you also should have access to your portal which you now have since created your profile which does have your ID cards with your all of your information on it. There's your policy certificate is also in that portal for your review um.
[CUSTOMER][NEUTRAL] Never.
[AGENT][NEUTRAL] So I'm sorry, I don't, I can't explain why you didn't receive the cards that were mailed to you last year, but I do see your policy went into effect on [PII].
[AGENT][NEUTRAL] And the ID cards, we received your enrollment at the end of July, and they were mailed to you on [PII].
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEGATIVE] Uh no.
[CUSTOMER][NEUTRAL] And is an ID card like a plastic credit card type?
[AGENT][NEUTRAL] No, it isn't. It's a paper car[PII] Mhm.
[AGENT][NEUTRAL] It's not like a driver's license or that.
[CUSTOMER][NEUTRAL] OK, yeah, I've, I've never heard of this company ever before.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] When I go to my policy, I'm under my details, where is my card information? Is it just policy?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I mean there's no
[CUSTOMER][NEGATIVE] It because I did print it off previous um in the old version of your system but now it looks completely different so I just need the coverage, the effective date and the policy number is that I mean because there's no.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Like that.
[AGENT][NEUTRAL] Back under? Yes, we're under the dashboard out to the left where you said you saw my policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If you click there it says would you like to review the coverage details of your policy and there's an option and then there next to that it says do you need access to your ID card?
[CUSTOMER][NEUTRAL] So I go to my policy.
[AGENT][NEUTRAL] If you're wanting to look at your policy certificate, if you want to go to your ID card, you click on view your ID card.
[CUSTOMER][NEUTRAL] And then what?
[CUSTOMER][NEUTRAL] OK, I see that now.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And then your policy details would be under that new policy. So yes, ma'am. So is there anything else at the moment that I can help you with?
[CUSTOMER][POSITIVE] All right, thank you very much.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No ma'am.
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] OK, Ms. [PII]. Well, thank you for calling APL and I do hope that you have a very nice day.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Good one.
[AGENT][POSITIVE] Mhm. Thank you.