AccountId: 011433970860
ContactId: ceeee64e-db95-48fc-a581-d98deefd63ad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1618800 ms
Total Talk Time (AGENT): 428743 ms
Total Talk Time (CUSTOMER): 680654 ms
Interruptions: 8
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/ceeee64e-db95-48fc-a581-d98deefd63ad_20250609T13:06_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi [PII], um, I was uh trying to get online so I could, uh, look at some claims and, uh, I'm not able to get online so I don't know if you can help me, um, either getting online or getting helping me with claim information.
[AGENT][NEUTRAL] Yeah, absolutely. So is it a claim for yourself? Are you a part of a group you're trying to log in as a group?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Well, actually kind of both. I have, um, let's see, I have a couple issues to deal with. Um, my wife was going to physical therapy and you guys were covering the copays, uh, they're telling her now that they, that copays have been exhausted.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, the limit, you know, has been reached, um, but I need to verify all of this, um, there were like 20 something visits and I just need to find out, you know, what was going on.
[AGENT][NEUTRAL] OK, so, OK, let's look at, OK, so do you have your policy number?
[CUSTOMER][NEUTRAL] want to tally it all up.
[CUSTOMER][NEUTRAL] Uh, yes, I do. It is 00964681.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And then let me just verify your first, last name, date of birth, please.
[CUSTOMER][NEUTRAL] Uh yes, my name is [PII]. Uh, date of birth [PII].
[AGENT][NEUTRAL] Thank you. And then lastly, if I could verify the physical address.
[CUSTOMER][NEUTRAL] Uh, yeah, uh, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Great, thank you. OK, so have you guys ever logged on before online just to manage the account?
[CUSTOMER][NEUTRAL] Uh, I have, but it, it's, I have logged on, but it seems like you have a different website now.
[AGENT][NEUTRAL] We do so last week we actually updated the portal and everybody's having to create new logins for the site. Uh, the first thing that I see on here, uh, [PII] is you guys actually don't have an email on file going forward you, yeah, the.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, that, that's why I couldn't verify my email.
[AGENT][NEUTRAL] Right, the email um is actually gonna be your username going forward instead of whatever you had in the past so let me add an email for you. What's a good email?
[CUSTOMER][NEUTRAL] Sure, uh, it's uh [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And then would I go in and say create your OSC account?
[AGENT][NEUTRAL] Uh huh, yeah, so on that login page once I get this added you're gonna clicky create your OSC account and then on the next page it asks.
[AGENT][NEUTRAL] Um, click which role best describes you, and you're gonna put, um, just insured, mhm.
[CUSTOMER][NEUTRAL] I'm an insured.
[CUSTOMER][NEGATIVE] Insured, yep, OK, yeah, I tried to do this before and and it wasn't accepting it.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Yeah, let's see here.
[CUSTOMER][NEUTRAL] Alright, so let's see, last name, email, date of birth, and then I won't click next until you tell me to go ahead, so.
[AGENT][NEUTRAL] OK, yeah, let's see here.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Hm, give me just a second here, Ma. I don't know what's going on.
[CUSTOMER][POSITIVE] Yeah, no problem.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] All right, so you should be good to move forward. Ms should recognize the email, um, and then it should send you hopefully, um, a confirmation email that lets you move forward here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hold on, it says complete your account set up. I click continue.
[CUSTOMER][NEGATIVE] Now it's telling me as soon as I hit continue it says changes you made may not be saved and then leave or cancel.
[CUSTOMER][NEUTRAL] OK, that's interesting.
[CUSTOMER][NEUTRAL] What happens if I leave? Oh, it takes me to a new place. Verification is necessary, so put in my email.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] You have to create a password.
[AGENT][NEUTRAL] Well, first you need to um put in, yeah, put in your email and get verification code. You'll need to put that code in and click verify your email before you create the password.
[CUSTOMER][NEUTRAL] I'll first do the verification.
[CUSTOMER][POSITIVE] Got it. Alright, hang on, I'm doing that now.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Ah, there we go.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Code [PII].
[CUSTOMER][NEUTRAL] Verify.
[CUSTOMER][NEUTRAL] OK, now put in a password.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I think I have caps on on hang on a second.
[CUSTOMER][POSITIVE] and clear.
[CUSTOMER][NEGATIVE] Can't type this
[CUSTOMER][NEUTRAL] OK, I agree, I agree. OK, continue, go to dashboard.
[CUSTOMER][NEUTRAL] Uh, OK, it goes back to log in.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Yeah, it'll take you back to log in and then you'll have to put in the verification.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah, and I was asking for verification again, yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That's part of the new like interface. It's always gonna be asking you now for a verification code when you log in, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. Alright, that's fine. Get it.
[AGENT][NEUTRAL] Oh, yeah.
[CUSTOMER][NEGATIVE] So come on code, where are you?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEGATIVE] Taking forever to get the code.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] refresh.
[CUSTOMER][NEUTRAL] You gonna have to request a new code because this is not coming. send new code. Let's try that. send new code.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let's try again.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] In the meantime, I have a question because there was a claim that was paid uh to uh provider of service with South Miami Hospital, which is an, it's an urgent care.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And they had billed it incorrectly, uh, as a hospital visit instead of a urgent care.
[CUSTOMER][NEUTRAL] And uh I, I got a thing an explanation of benefits from you guys saying that you guys paid the $353 to the provider. Meanwhile I've already had it reprocessed with my primary insurance and the amount due was, uh, my portion was gonna be $0 so how does that work and you guys are gonna need to get that money back from the provider.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What is that?
[AGENT][NEUTRAL] If it's an overpaid, let's see.
[CUSTOMER][NEUTRAL] Yeah, yeah, it's um the date of service was [PII] if that helps.
[CUSTOMER][NEUTRAL] And I'm still waiting now. Where is that thing? Let me check my, my junk mail. Maybe it went in there, but the first code didn't go into junk, so let's see.
[CUSTOMER][NEUTRAL] 2.
[AGENT][NEUTRAL] If it's an overpayment, I would think that the provider would need to reimburse you, I think, but let me double check.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah I was gonna I was gonna call them next to say hey, you know.
[AGENT][NEUTRAL] Right, let's see.
[CUSTOMER][NEUTRAL] You guys, you guys now have extra money.
[CUSTOMER][POSITIVE] Alright, oh, I got the email with the code. Let's see, I got actually two emails with the code. Hopefully one of these will actually work. Let's try the second one.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Verify.
[CUSTOMER][NEUTRAL] Email address verified, you can now continue.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Welcome to the online service center.
[CUSTOMER][NEUTRAL] Next and done privacy so many ops.
[CUSTOMER][NEUTRAL] Claim status updates via text message. No, I don't really need that, uh.
[CUSTOMER][NEGATIVE] Do not show skip.
[CUSTOMER][NEUTRAL] OK, da da da da da.
[CUSTOMER][NEUTRAL] My policy.
[CUSTOMER][NEUTRAL] Queens. There we are.
[CUSTOMER][POSITIVE] Process claims perfect.
[CUSTOMER][NEUTRAL] OK, all claims
[AGENT][NEUTRAL] All right. I'm checking on if it was an overpayment. I think that, yeah, probably, let's see.
[AGENT][NEUTRAL] Can I contact them.
[CUSTOMER][NEUTRAL] Is there a way to um.
[CUSTOMER][NEUTRAL] To download like a whole list of the claims.
[CUSTOMER][NEUTRAL] I don't like this uh layout here it's just I mean I just see claims and you know I just see like like information for one claim the next claim, and so on, but it's not like in a list format it's a little hard to look at.
[AGENT][NEUTRAL] Let me pull up our new guide here and see if I can.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, give me just see here.
[CUSTOMER][NEUTRAL] Sure, change is difficult.
[AGENT][POSITIVE] Yeah, I gotta follow along too cause it's all new for us too over here. Um, I was gonna say that I do, I did see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] When I put in.
[AGENT][NEUTRAL] The policy number. So it looks like your outpatient benefit max for the year is 500.
[AGENT][NEUTRAL] Um, it does show, um, [PII] at 500, it looks like.
[AGENT][NEUTRAL] And then you at the 353 43 says total claims paid to count is 22 for her.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let me see where the.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] List of
[CUSTOMER][NEUTRAL] Yeah, now I thought that um when I was looking at in the past, I was trying to see the benefits. I thought it was uh there was coverage I think up to $1000 for, for physical therapy.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I thought that was what was the.
[CUSTOMER][NEUTRAL] See
[CUSTOMER][NEUTRAL] View details.
[CUSTOMER][NEUTRAL] Policy details.
[CUSTOMER][NEGATIVE] See this doesn't give me any information.
[CUSTOMER][NEUTRAL] Where is
[AGENT][NEUTRAL] The $1000 is your maximum for in hospital. It looks like.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Wasn't there a specific one, a benefit for physical therapy though, or it's like physical therapy, occupational therapy? I thought it was 1000.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] You had a physician outpatient treatment writer that was added and that was for treatment in an outpatient hospital physician or physician's office. Um, that had a limit though of up to 4 visits per covered person per year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, the only thing I see on the schedule of benefits on here for 1000 is the inhospital maximum.
[CUSTOMER][NEUTRAL] OK, no, I don't, I don't think that's, that's not what I'm thinking. Where did I, I know I saw that some.
[AGENT][NEUTRAL] And that one, yeah, that was one.
[CUSTOMER][NEUTRAL] But maybe I can't find it now on your new website, uh, let's see.
[AGENT][NEUTRAL] Alright, submit a claim. Just a second.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, see.
[CUSTOMER][NEGATIVE] I think I got kicked out here. What is this? Oh no return to OSC.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it says to view claims and claim status, it says click my policy from the navigation menu.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then click view policy details from the center of your dashboard.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEGATIVE] I see policy details in the middle. I mean I have my policy on the on the left side selected then I see, I see like the main page it just says my details and I just see covered individuals and policy details in the middle here but there's no no place to link click anything.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] And then there's a claims tab. I can go to claims.
[AGENT][NEUTRAL] Right. OK.
[CUSTOMER][NEUTRAL] Uh, but then I can just see process claims.
[CUSTOMER][NEUTRAL] But I cannot.
[CUSTOMER][NEUTRAL] Like, uh,
[CUSTOMER][NEUTRAL] I can't click into the claims.
[CUSTOMER][NEUTRAL] And it it just shows like a like in a box format like a big box with claim number and it has insured and relationship policy number date of uh date received date completed all that.
[CUSTOMER][NEUTRAL] Actually it has everything there except the provider doesn't actually show the provider that was paid on on that page and then I can't click into it.
[AGENT][NEUTRAL] So it may still be loading. There should be in the top right hand corner. Once it's done loading, there should be a download document option.
[CUSTOMER][NEUTRAL] Oh really? OK, yeah, it's still spinning. I see a little circle going around and round and round.
[AGENT][POSITIVE] Yeah, yeah. So give it, give it, give it some time.
[CUSTOMER][NEUTRAL] Um, and it
[CUSTOMER][NEUTRAL] OK, well, let's see how long that takes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And the.
[CUSTOMER][NEUTRAL] And then as far as looking up like my policy benefits like where would I.
[CUSTOMER][NEUTRAL] See all of that.
[CUSTOMER][NEUTRAL] Like, cause I, I know, I know I saw the physical therapy as an option.
[CUSTOMER][NEUTRAL] It was listed separately, not, you know, not as an outpatient, not as, uh, anything else it was, it just said physical therapy.
[CUSTOMER][NEGATIVE] And it would they would cover the $40 copays up to was it I think $1000 or something, but I'm, I'm, I'm not finding that anywhere.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Um, give me.
[CUSTOMER][NEUTRAL] OK, meanwhile the little spinny thing stopped and there's.
[CUSTOMER][NEUTRAL] There's nothing to click.
[CUSTOMER][NEUTRAL] There's nothing to see the EOBs.
[CUSTOMER][NEGATIVE] Uh, no, there's nothing, no way to do anything here.
[CUSTOMER][NEUTRAL] By the end of the week, for the settles for voting forecast.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Are you using um Chrome as your browser?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] so on.
[AGENT][NEUTRAL] So, I can email you your policy because I don't see that on this.
[CUSTOMER][NEUTRAL] I say a typical offer age.
[AGENT][POSITIVE] Version that's been launched there's not a way at this time it doesn't look like to view the actual certificate so I'm happy to send that to you that way you have it.
[CUSTOMER][POSITIVE] OK, sure, that'd be great thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And and are you able to send me maybe in a in a list format like all of the claims for for [PII]?
[CUSTOMER][NEUTRAL] For a particular provider or just, you know, generally like just a list.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] It'd be nice if it was in like a spreadsheet format so I could download it and.
[CUSTOMER][POSITIVE] Work with it
[CUSTOMER][NEUTRAL] course
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I don't know if I have a way to do that. Let's see.
[CUSTOMER][POSITIVE] Yeah, I like the the old portal I was able to see it more like in a in a kind of a listing format a little easier to look at.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And I don't remember if I could download it or not. I think actually I could download it back then.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] call us today we gonna we gonna.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Across the country.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] conversation.
[AGENT][NEUTRAL] What I can do is, yeah, go through and look for the claim numbers and then see if we can put a list together to send you so at least you have a claim numbers you could at least you know reference.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] For that particular procedure code.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I did go ahead and send you the email with the policy certificate, so you should have that in the next few moments. Um, give us like a half an hour, an hour for the claims, uh, to get that sent over to you with a list for the ones for [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, all right, um.
[CUSTOMER][NEUTRAL] Perfect, um, yeah, I guess and then, you know, tell your tell your IT people or whoever is in charge of the website that.
[CUSTOMER][NEGATIVE] There are issues because it'd be I, I mean you would think I could even click in and and get an EOB.
[CUSTOMER][NEGATIVE] I can't even do that. There's no option to download the the EOB or or anything.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK yeah I'll definitely report it like we're still we're still reporting any issues that users are having because it was just launched on Monday of last week so I'll definitely report that because there yeah it's still really new so and there should be an option there to download um I apologize it's not working as it should but I'll definitely report your policy.
[CUSTOMER][NEUTRAL] Uh, also, yeah.
[CUSTOMER][POSITIVE] Oh wow
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Number and that you're unable to download and view see if it's an issue specifically with you or maybe it's affecting everybody and we'll work to get it resolved as quickly as possible.
[CUSTOMER][NEUTRAL] OK, alright, and then as far as that other thing I was talking about I should call the uh provider itself right? and see if they can uh.
[AGENT][NEUTRAL] All right, [PII].
[AGENT][POSITIVE] Yeah, if you, yeah, if you believe that it's an overpayment to them, then they would be the ones that you would want to take that up with, absolutely.
[CUSTOMER][NEUTRAL] Are they gonna refund that? Yeah.
[CUSTOMER][POSITIVE] Yeah. OK, I will give them a call thank you so much.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][POSITIVE] You too take care.
[AGENT][NEUTRAL] Bye bye.