AccountId: 011433970860
ContactId: c1484975-87cd-4f76-9bd3-4125b35fda09
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 424369 ms
Total Talk Time (AGENT): 114027 ms
Total Talk Time (CUSTOMER): 184089 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/c1484975-87cd-4f76-9bd3-4125b35fda09_20250226T17:29_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, I emailed um 3 medical claims uh to APL on the [PII]. Can you tell me what the status is?
[AGENT][NEUTRAL] OK, may I ask who's calling?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], do you have the policy number, please?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'm supposed to refer to one phone number. I mean one ID um.
[AGENT][NEUTRAL] May I start at 01 or 02?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] 01 02.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The 2nd.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 102.
[AGENT][NEUTRAL] What was your last name? Oh, go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] See, I had 3
[CUSTOMER][NEUTRAL] Yeah, do that. He, [PII]
[AGENT][NEUTRAL] OK, thank you. Give me one moment. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you ma'am, give me one moment.
[AGENT][NEUTRAL] [PII], your last name, correct?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Um, it is showing our system and what group are you with? Are your employer?
[CUSTOMER][NEUTRAL] Not employer, I have the multi plan so.
[CUSTOMER][NEUTRAL] It was a couple of plans I had.
[CUSTOMER][NEUTRAL] I'm, I'm really confused about it. I was told just to.
[CUSTOMER][NEUTRAL] I was told they were in network and it turns out they weren't so they told me to go ahead and um fax in a personal reimbursement claim to APL.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Because I'm trying to locate you in our system. What's the name of your employer?
[CUSTOMER][NEUTRAL] I'm not employed.
[AGENT][NEUTRAL] OK, um, um, do you have your group name or you just?
[CUSTOMER][NEUTRAL] It was, it was under PHCF let me see, just a second if I have any information. oh.
[CUSTOMER][POSITIVE] 00, this helps.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] This will help.
[CUSTOMER][NEUTRAL] It was.
[CUSTOMER][NEUTRAL] ID number 683.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 822759
[AGENT][NEUTRAL] Um, it's not one of our policy numbers. It sounds like it, um.
[AGENT][NEUTRAL] Could be with IMA, but um I apologize, Ms. [PII] and I don't show you in our system, um.
[AGENT][NEUTRAL] What's your social?
[CUSTOMER][NEUTRAL] OK, here's
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] This is what happened. I was, um, I had PHCS insurance at first enroll insurance, and they were through agents. It was kind of like fraud, but it basically was. And they said my doctors were in network and they weren't. So then I called first enroll, and they said the doctors will submit the claims and they will be denied. The only thing you can do other than that is to send them to APL, uh, complete a form.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEGATIVE] Get reimbursed
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Does that make sense?
[AGENT][NEUTRAL] Yeah, but I, the thing is I'm not showing you in our system and um.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] The number you gave is not a policy number of ours, that's why I was trying to.
[AGENT][NEUTRAL] Locate you.
[CUSTOMER][NEUTRAL] OK, what else do you need? Let me see a group number let me see what I have, um.
[CUSTOMER][NEUTRAL] I have
[CUSTOMER][NEUTRAL] Group number G.
[CUSTOMER][NEUTRAL] Uh, 12, does that sound right?
[AGENT][NEUTRAL] No, ma'am. Um,
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, how about, what is the um ID number start with?
[AGENT][NEUTRAL] Uh, either 01 or 02.
[AGENT][NEUTRAL] Do you have a copy of your card from APL?
[CUSTOMER][NEUTRAL] I didn't have APL.
[CUSTOMER][NEUTRAL] I don't have APL.
[AGENT][NEUTRAL] OK, well, this is APL.
[CUSTOMER][NEUTRAL] I called first and.
[CUSTOMER][NEUTRAL] I know, but first enrolled told me to send them to APL. The she even emailed me the um the form and.
[CUSTOMER][NEUTRAL] Let me see if I can
[CUSTOMER][NEUTRAL] APL.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Here it is from [PII], please attach an itemized statement for each visit you want to file on. And she sent me.
[CUSTOMER][NEUTRAL] The BWA with the APL form and I, I emailed them.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, because I'm not showing it in our system it's PHC.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Social security number? How about that?
[AGENT][NEUTRAL] Uh, we can, yes, ma'am. What's your social?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] No, ma'am. I'm so sorry. I don't show you in our system.
[CUSTOMER][NEUTRAL] OK, so I'm really confused. Why would [PII].
[CUSTOMER][NEUTRAL] Send me the form to file for reimbursement.
[AGENT][NEUTRAL] Uh, that I'm not sure. You might have to contact Ms. [PII] cause um I've looked on your name and your social, but I don't show you in our system, uh, system. I'm sorry.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Do you have a phone number for her?
[AGENT][NEUTRAL] Uh, no, ma'am. I don't know who she is. I apologize.
[CUSTOMER][POSITIVE] OK, I'll see what I can do thanks bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you for calling uh calling APL.