AccountId: 011433970860
ContactId: d649be23-c57a-450a-9eae-91b693c0ce02
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 789039 ms
Total Talk Time (AGENT): 226450 ms
Total Talk Time (CUSTOMER): 268379 ms
Interruptions: 5
Overall Sentiment: AGENT=0, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/d649be23-c57a-450a-9eae-91b693c0ce02_20250606T14:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEGATIVE] Good morning. I was trying to submit a claim online and uh I, I have a an attached file and when I hit submit it says error.
[CUSTOMER][NEUTRAL] And says to please call you.
[AGENT][NEUTRAL] OK, um, can I get your name and a callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] My name is [PII], the number [PII].
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] 204, excuse me, let me start over. 204-529-6.
[AGENT][NEUTRAL] Alright, let me see if I can look that up for you.
[CUSTOMER][NEUTRAL] OK, it's for [PII]
[AGENT][NEUTRAL] And what is his date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then are you calling on behalf of a provider?
[CUSTOMER][NEUTRAL] No, the, the, uh, insured.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He's my husband.
[AGENT][NEUTRAL] OK, and you tried to submit it today or was it yesterday?
[CUSTOMER][NEUTRAL] Both last night and just now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Because I am showing that something um came in yesterday. It's currently being processed, so I can't um look at it.
[CUSTOMER][MIXED] OK, that one's fine. That one went through OK, but I have 4 more, 5, and the second one I tried did not work. I don't know if it's the format.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Excuse me, it's saved as an HEIC file. I don't know what that is. I don't know if it has to be specific format.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You said what was the what was the format that it asked?
[CUSTOMER][NEUTRAL] No, it's.
[CUSTOMER][NEUTRAL] I have it as HCIC. It's not asking for anything. I'm asking you if maybe there's a specific format I should be using.
[AGENT][NEUTRAL] OK. Um, it should accept most. Let me go ahead and check.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you know what the file size was?
[CUSTOMER][NEUTRAL] 47 megabytes.
[AGENT][NEUTRAL] OK, so not that much.
[AGENT][NEUTRAL] I'm sorry, did you say 7 or 27?
[CUSTOMER][NEUTRAL] No, it's a tiny receipt, no, 0.7.
[AGENT][NEUTRAL] Oh, points, OK, so yeah, it was pretty small. Let me see.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] It's smaller than last night.
[AGENT][NEGATIVE] Yeah and so you weren't even able to put in the the claimant details or anything it just would not let you upload anything correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And was it, did you say uh it was a PDF or what kind, what what was the format?
[CUSTOMER][NEUTRAL] H E I C
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Because I'm not showing that it has any.
[AGENT][NEUTRAL] Issues with that, but let me go ahead and check or double check.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Are you able to um convert it to a PDF?
[CUSTOMER][NEGATIVE] I haven't been able to, no, I'm having, I am having a hard time with it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] With that, OK.
[CUSTOMER][NEGATIVE] Going from my phone to the laptop and it's just, I don't know, it's just not working with me.
[AGENT][NEUTRAL] OK, that's OK. I just want to check.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm not seeing that as a um as unsupported. Um, are you able to fax it to us at all?
[CUSTOMER][POSITIVE] Yeah, that I can do uh when I get to the office, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Do you need our fax number?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh wait you gonna write 10, uh.
[CUSTOMER][NEGATIVE] You know, when you wanna write, they don't work. OK, go ahead.
[AGENT][NEUTRAL] OK. 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK, that was [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So online I just uh huh attention claim.
[AGENT][NEUTRAL] And you'll put attention claims department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, what else do I need to include because online you just click on the, the little box and you click on the policyholder name and insurance number and attach the receipt and, and hit go. So I guess the um obviously the insured name and do you need a social or do you need the group number or what do you need along with the name?
[AGENT][NEUTRAL] And what type of oh it's just for OK it's for your secondary gap um any supporting documents showing um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Anything about the claim or the visit, you'll need an itemized bill um with procedure codes sometimes hospitals won't just give you that you have to ask for it, uh, depending on what it's for, uh, yes, you'll need an itemized bill.
[CUSTOMER][NEUTRAL] Oh my gosh, really?
[CUSTOMER][NEUTRAL] It's for physical therapy co-payments.
[AGENT][NEUTRAL] Yes, because we'll, we'll want the procedure codes.
[CUSTOMER][NEUTRAL] OK, all I have is a receipt.
[CUSTOMER][POSITIVE] Oh my gosh.
[CUSTOMER][NEUTRAL] OK, alright, let me see what I can get.
[AGENT][NEUTRAL] And um this is secondary insurance so it will have to go, well this is secondary so if you have an EOB or an explanation of benefits from your primary insurance, you can send that in.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Because we'll need something to show that you're primary paid first.
[CUSTOMER][NEUTRAL] OK, so I don't have it. Let me, let me.
[CUSTOMER][NEUTRAL] But it's not a secondary insurance. I thought it was a gap insurance.
[AGENT][NEUTRAL] It's secondary to your primary, so it covers, oh, go ahead.
[CUSTOMER][NEUTRAL] So we were told by the
[CUSTOMER][NEUTRAL] OK, we were told by the employer that he presents his card at the location and then they don't charge him the co-payment.
[CUSTOMER][NEUTRAL] So when he did that, they're like, oh no, you have to put in the claim directly. So that's what we're trying to do. They didn't say anything about um so to me it's not the same gap and secondary, and I'm, I'm not sure if it's, it is the same.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Because I know how secondary insurance works, but nobody said, oh, you may have to get an EOB and all that, so like just go to the, you know, wherever you're getting service and show them the card.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Yeah, so this policy is secondary, is secondary gap. So this policy will cover um any of the covered poli or any of the covered services in the policy, but we need to have a primary EOB um to show that some benefits have been paid. um so if your primary doesn't cover it, this insurance won't cover it, but um it is gap insurance, so it does help with co-pay, co-insurance and co-deductible, um.
[AGENT][NEUTRAL] But yes, it is, it is gap insurance, but it's to help pick up after primary picks up first.
[CUSTOMER][NEUTRAL] OK, so he has the receipt for the co-payment, not enough is what you're saying.
[AGENT][NEUTRAL] Um, I would include that in the claim.
[CUSTOMER][NEUTRAL] I mean that's the only thing I have.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] That that's what I was asking just the name and insured. That's what they ask online name and insured and insured a number and you hit, you know, you submit the receipt. Oh, so it's more complicated because you know EOB could take months.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I, it, I'm sorry, it's, it, it is frustrating at times. Um, if you call your primary, they should be able to send it over to you once they've processed the claim. Have they processed it yet or do you know? Has it been sent to them?
[CUSTOMER][NEUTRAL] No, he just, he just went, no, he just went yesterday to the, to the physical therapist.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Is a physical therapist um submitting the claim because then it might
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] You might be able to ask for it.
[CUSTOMER][NEUTRAL] I mean, I assume they have to submit it so they can get paid, right, yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I'm sure they don't just want $40. I'm sure they want more for their visit.
[CUSTOMER][NEUTRAL] The co-payment is 40, um, gosh, I pay.
[AGENT][NEUTRAL] Yeah, and include that in your, your claim.
[CUSTOMER][POSITIVE] OK, thanks so much.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, that's it. I got the info I need and you know what I need to get.
[CUSTOMER][NEUTRAL] So it won't be that it could be weeks.
[CUSTOMER][POSITIVE] Oh goodness. OK, thank you.
[AGENT][POSITIVE] Thank you for calling APL. I hope you have a great day bye.
[CUSTOMER][NEUTRAL] Alright, bye bye.
[CUSTOMER][NEUTRAL] You too bye bye.
[CUSTOMER][NEUTRAL] OK.