AccountId: 011433970860
ContactId: cdaf89d7-3252-4fd9-9ad9-73cb3abb1beb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 982849 ms
Total Talk Time (AGENT): 272296 ms
Total Talk Time (CUSTOMER): 567706 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/cdaf89d7-3252-4fd9-9ad9-73cb3abb1beb_20250612T15:16_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APR. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, I'm, I'm trying to log into my account or for whatever reason I take is taking longer, longer than usual and when it, when it does is basically um.
[CUSTOMER][NEGATIVE] Um, um, it, it basically says that, uh, I don't have any access to my account.
[AGENT][NEUTRAL] OK. Yes, sir. We upgraded our system and what you would need to do is go in and uh reset up your policy. Um, when you go to our website, [PII], you should see a button that says uh create account.
[AGENT][NEUTRAL] Do you see that button where it's asking you to create a new account?
[CUSTOMER][NEUTRAL] Uh, look, it says create your, I mean, Oscar, Sam, and Charlie, is that what the one you're talking about?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Oh, OK. See, I was wondering, I was wondering because I, I, I, I, it didn't allow me to do it. So all I gotta do, I guess just follow the steps and then we take it from there.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Thank you so much. I do appreciate your time, ma'am. OK?
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Well, yes, I mean, I mean, I mean, I can get the information in terms from my uh my uh.
[CUSTOMER][NEUTRAL] My um my group number and all that and I have an existing claim.
[CUSTOMER][NEGATIVE] That, you know, the benefits are being denied because I have not, according to your company, I have not submitted the information. I send uh the, the information from the doctor I've seen for my pain, my cervical, as well as the MRI and I, I don't know what else can I submit.
[AGENT][NEUTRAL] OK. Yes, sir. I can assist you with claim status. Um, could I get your name and a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. Uh, my name is [PII]. Last name is [PII], [PII] The phone number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, could I get your policy number, please?
[CUSTOMER][NEUTRAL] Sure, uh, OK, well, uh, well I have a group number and then I have a in hospital benefits certification number is that what you need?
[AGENT][NEUTRAL] Yes, sir. I can look it up by that number.
[CUSTOMER][NEUTRAL] Cause that's
[CUSTOMER][NEUTRAL] OK. Sure, you have the whole thing or the last four digits?
[AGENT][NEUTRAL] Um, the whole thing.
[CUSTOMER][NEUTRAL] Oh, OK, so it's 02.
[CUSTOMER][NEUTRAL] 26
[CUSTOMER][NEUTRAL] 30
[CUSTOMER][NEUTRAL] 94
[CUSTOMER][NEUTRAL] M [PII]
[CUSTOMER][NEUTRAL] [PII] [PII] 7.
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, please verify your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] The date of birth is [PII], um, and my mailing address is [PII].
[AGENT][NEUTRAL] OK. And please verify your email address.
[CUSTOMER][NEUTRAL] I don't know which one I use. I have to wait, I have uh [PII].
[AGENT][NEUTRAL] OK. Yes, sir. That's the one we have on file.
[CUSTOMER][NEUTRAL] Is that the one that, oh, OK, great.
[AGENT][NEUTRAL] OK. And what's the date of service on the claim you're calling about?
[CUSTOMER][NEUTRAL] Well, this is for several ones the the the the um
[CUSTOMER][NEUTRAL] The name of the doctor is uh Doctor [PII].
[AGENT][NEUTRAL] OK. Well, what's one of the dates of services? I will need the date of service to look up the claim to see why it's denying.
[CUSTOMER][NEUTRAL] Uh, sure, give me one sec I be on my.
[CUSTOMER][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] So, um, I believe I found it. Yes, I have several ones, um, I have, uh, one that is basically, hold on for a minute please, if you don't mind.
[CUSTOMER][NEUTRAL] Yeah, they they did it.
[CUSTOMER][NEUTRAL] 825, 2023.
[CUSTOMER][NEUTRAL] That's just one of them.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][POSITIVE] OK, I'm showing that that claim paid it actually paid out to you. You filed the claim and we paid you.
[CUSTOMER][NEGATIVE] No, pay me. I mean, I don't see any money. You mean you pay the doctor, right?
[AGENT][NEUTRAL] Yeah, it was back in
[AGENT][NEUTRAL] No, we, this claim was a claim that you filed and it was paid out to you for date of service [PII].
[CUSTOMER][NEGATIVE] Well, I haven't received any money.
[AGENT][NEUTRAL] Yeah, this was years ago. Um, let's see, I can get the date for you.
[CUSTOMER][NEUTRAL] No, I understand.
[CUSTOMER][NEUTRAL] Right, right, but I have, I haven't, and you can certainly check if it was a check that was mailed, obviously you can certainly confirm that the check hasn't been cashed because um I haven't received anything from you.
[AGENT][NEUTRAL] OK, one moment. I'll look it up for you. Let's see.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK. Yes, sir. I'm showing that it was issued on [PII] and it was mailed to address [PII], and it was cashed on [PII].
[CUSTOMER][NEUTRAL] And what is the amount?
[AGENT][NEUTRAL] The amount was $452.77.
[CUSTOMER][NEUTRAL] OK, $452 and 700, I'm sorry, what?
[AGENT][NEUTRAL] 77 cents.
[CUSTOMER][NEUTRAL] 77. OK, so, um.
[AGENT][NEUTRAL] And it was for dates of er it was for several dates of services. It was for.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I'm sorry, go ahead, please.
[AGENT][NEUTRAL] It was for 8:25 23 and.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Um, 92923.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] 92923. 0, OK.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Uh-huh. So those are the basically the, the two, I guess the claims that were paid off 452 and 77, right?
[AGENT][POSITIVE] Yes, sir. That's correct.
[CUSTOMER][NEUTRAL] Yeah, so, OK, so has there been any of a payment to the, for this claim or not? Can you check that for me?
[AGENT][NEUTRAL] Um, I would need the date of service.
[CUSTOMER][NEUTRAL] OK. So the, the next school, I'm sorry.
[AGENT][NEGATIVE] So far.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So the next one was [PII].
[AGENT][NEUTRAL] OK, I'm not showing that claim on file, so we would need that claim and it can still be submitted. There's no timely filing limit.
[CUSTOMER][NEUTRAL] OK. So, OK, so.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] Because I have already submitted this, um, so I, I can certainly don't have an issue resubmitting the, the, uh, the invoices that I have. It's actually 3 pages. So, um, do you think that is the best way to do it, or do you mind if we can, uh, basically go over to see whether or not any other claims have been paid or refused payment.
[AGENT][NEUTRAL] Um, yes, I can look up other claims for you and yes, um, you would need to submit the claim for [PII].
[CUSTOMER][NEUTRAL] [PII], or [PII]. OK. So the next one was, uh, almost a year later, which is [PII].
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] OK. Yes, I'm showing that we did receive that claim and it's denying because we need the EOB from your primary insurance company. And we also need your diagnosis code from the provider's office. So this claim can be
[CUSTOMER][NEUTRAL] OK, hold on, hold on.
[CUSTOMER][POSITIVE] Yes, yes, yes, ma'am. I apologize for interrupting and let me just write this down so I, I can, OK, so.
[CUSTOMER][NEUTRAL] You mentioned something about the uh the um what do you call the um medical, the, the, the uh
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The primary medical insurance.
[AGENT][NEUTRAL] Yes, sir. The explanation of benefits from your primary insurance company for this service.
[CUSTOMER][NEUTRAL] Explanation of benefits, OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And what else did you say that you need? Mm?
[AGENT][NEUTRAL] We need your diagnosis code. It's the code for the illness, the reason why you're seeing the doctor, and you can get that from the, the doctor's office. We just need documentation with the diagnosis code on there. And it could be the statement or it could be a letter from the doctor, something um from the doctor's office with the diagnosis code.
[CUSTOMER][NEUTRAL] OK, you, you would think that people that do this for a business, they will know what paperwork they need to me, right? Amazing.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] So, so could we go on to
[CUSTOMER][NEUTRAL] Uh, uh, the next one, if you don't mind.
[AGENT][NEUTRAL] Sure. What's the date of service?
[CUSTOMER][NEUTRAL] I have one that, yes, and then I'm sorry, I didn't catch your name.
[AGENT][NEUTRAL] It's [PII], um, it's spelled [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][POSITIVE] Very, no, you've been very helpful. I appreciate you. I just wanted to make sure that that uh use your name. So [PII], the next one is, is the last day is [PII].
[AGENT][NEUTRAL] OK, I'm not showing that claim on file. So you can submit the EOB from the primary insurance and documentation with the diagnosis code.
[CUSTOMER][NEUTRAL] OK, so that would be for that as well, OK, so, so the next one is then.
[CUSTOMER][NEUTRAL] [PII], no, I'm sorry.
[CUSTOMER][NEUTRAL] We already, we already did 10 1001, 2024, right?
[AGENT][NEUTRAL] Let's see. I have to check again.
[CUSTOMER][NEUTRAL] [PII], yeah.
[AGENT][NEUTRAL] Yeah, for this one, we'll need again the EOB and the diagnosis code.
[CUSTOMER][POSITIVE] OK, perfect. So, so, so the next one then would be uh.
[CUSTOMER][NEUTRAL] Jesus, um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm not showing that claim, so that would need to be submitted.
[CUSTOMER][NEUTRAL] OK, so the ones that basically is, obviously I will have to submit them as as as um along with the explanation of benefits and the the diagnostic call from the doctor, right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] See, it took me a couple of months to get the right person, but I'm getting there, man. I really appreciate your time. Um, and then we have one that is, is basically dated [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yes, this needs to be resubmitted and we'll need the EOB and diagnosis code.
[CUSTOMER][NEUTRAL] OK, so basically, uh, to just to summarize, uh.
[CUSTOMER][NEUTRAL] Um, let me, OK, so I think I put it right here in the bill. OK, so, so, basically, there was a check that was sent to me, uh, for service dated [PII], as well as, uh, and, uh, I guess [PII] for the amount of $452.77.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And to be honest with you, I, I, I, I, I, I certainly don't remember receiving it certain I'm just
[CUSTOMER][NEUTRAL] As soon as I hang up, um, I, I'm gonna go and check my bank statement, but I, I, I just, you know, I, I wouldn't go. I wouldn't, I wouldn't tell you I didn't get it because I, I don't remember, to be honest with you. But let me ask you, in, in case, you know, I didn't cash the check. In other words, if I can go and, and go to my bank statement and there's no check for that amount, what would be the process involving in terms of saying, you know, that I personally did not cash the check.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, let me give you the check number and um you would need to verify it with your bank because we're showing that you cashed it.
[CUSTOMER][NEUTRAL] OK. The check number, if you don't mind me.
[AGENT][NEUTRAL] Yes, the check number is 184.
[AGENT][NEUTRAL] 2733.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it was cash um.
[CUSTOMER][NEUTRAL] And that's the number.
[AGENT][NEUTRAL] It was cashed on [PII], and again it was for $452.77 and you would have to get with your bank to investigate that.
[CUSTOMER][NEUTRAL] Sure, right, [PII] you said?
[AGENT][NEUTRAL] Yes, sir. [PII].
[CUSTOMER][POSITIVE] OK, and the amount is $452.77. I, I, I really, really, really greatly appreciate you have actually made my day because at least now I, I know what's going on and what is the next steps I need to basically make. Is there a number, uh, do you guys send some kind of survey, uh, so that I can basically say what that, that, you know, what.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] What wonderful job you have done, because I gotta tell you, the last couple of times that I called, I just, I, I wasn't able to go anywhere, to be honest with you.
[CUSTOMER][NEUTRAL] Um, so,
[AGENT][NEUTRAL] Um, well, what I can do is give you my supervisor's phone number and you can call and leave her a message.
[CUSTOMER][NEUTRAL] Oh, that's nice. OK, so it's EV. We had this conversation on uh [PII]. Could I have the number please?
[AGENT][NEUTRAL] Um, yes, her number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You got that, you, you went too fast for me. 601936.
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][POSITIVE] OK, so let me just make sure that we're on the same page [PII] and uh I really appreciate your help because at least I know what to do and like I said before, I wouldn't be here telling you, oh, I didn't cash the check because I have so much stuff going on like I don't really recall. So if I didn't, then I would know to get in touch with the bank and see what happened with that check, but I certainly do appreciate your help. I hope we have a wonderful day.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] OK. I thank you too so much, [PII] and is there anything else I can assist you with?
[CUSTOMER][POSITIVE] You'll be more than helpful. I, I really appreciate it.
[AGENT][POSITIVE] OK, no problem. Well, I thank you again for calling ATL and you have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] The same to you, ma'am. Bye-bye.