AccountId: 011433970860
ContactId: d8f78ad6-3cc8-4396-98c4-826296df1022
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 785840 ms
Total Talk Time (AGENT): 308386 ms
Total Talk Time (CUSTOMER): 336785 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/d8f78ad6-3cc8-4396-98c4-826296df1022_20250414T13:30_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yeah, I have a, a claim that came back and said that it needs a diagnose a diagnosis code.
[CUSTOMER][NEUTRAL] Which I now have
[AGENT][NEUTRAL] OK, so you, we can't accept it over the phone, but you can upload it or send it in. We need it on the medical documentation, but I can note the policy that you have it.
[CUSTOMER][NEUTRAL] OK, how do I, how do I send that then? Do I have to fill out a whole new claim or can I, uh, reply with the claim that I've been sent? How does that work?
[AGENT][NEGATIVE] Oh no.
[AGENT][NEUTRAL] Well, how do you like, do you post your claims like on the online servicing or do you like fax them or mail it?
[CUSTOMER][NEUTRAL] Um, I, I faxed it and I got a I got a, uh, paper. I got a paper response in the mail that, that, uh, said it needs a a diagnosis code.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, well, you can just um whatever the like the document that it's on, you can just fax it in if you like.
[AGENT][NEUTRAL] And then as soon as we receive it,
[CUSTOMER][NEUTRAL] OK, so print out the same document, right, right, OK, and just fax it back.
[AGENT][NEUTRAL] Yes, sir, and then we'll just continue processing as soon as we get it.
[CUSTOMER][NEUTRAL] OK, what is the uh fax number?
[AGENT][NEUTRAL] So let me see what type of policy you have because that will determine where it's sent. Um, may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, [PII].
[AGENT][NEUTRAL] All right, and then just a good contact number and your um policy number.
[CUSTOMER][NEUTRAL] The contact number is [PII].
[CUSTOMER][NEUTRAL] Policy number is 02471531.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] All right, and I have you here and I just need you to verify your date of birth and the mailing and email address on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] And then just your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And so the fax number is 877.
[CUSTOMER][NEUTRAL] 877.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 942-3 OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now if I don't have a fax number at my I'm at my at my home I don't have a fax machine in my home, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can I scan this and send it by email or anything like that?
[AGENT][NEUTRAL] Well, we can't accept um claims through email because of HIPAA laws.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Alright, so I have to figure out a place to fax it from.
[AGENT][NEUTRAL] Yes, or
[CUSTOMER][NEUTRAL] Alright
[AGENT][NEUTRAL] Well, wait a minute. So you have the actual physical paper?
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah, it came in the it came in the mail.
[AGENT][NEUTRAL] You said can you scan it and email, can you can scan it and upload it to the online service center. Would that help?
[CUSTOMER][NEUTRAL] Yeah, how do, how do I upload it?
[CUSTOMER][NEUTRAL] Or to where
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Um, on our website, [PII].
[AGENT][NEUTRAL] When you go to the website, the top right corner, you'll see it says sign in.
[AGENT][NEUTRAL] You'll click on that sign in button and that takes you to the straight to the online portal. I'm checking right now to see if you have like a login or anything.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I'm already logged into the actually no, it looks like it logged me out, but I'm still here I am. I don't think I'm still logged in, uh, let's double check.
[CUSTOMER][NEUTRAL] So there's an upload area on here?
[AGENT][NEUTRAL] Mhm. So once you sign in and you get, you know, you see your dashboard and everything, you'll see a button that says upload, it might say upload files or upload documents.
[AGENT][NEUTRAL] Um, but you'll just click on that and then that's how you file a claim.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, it says file claims online and I have to sign in and register again.
[AGENT][NEUTRAL] Uh, you already have an account. What do you see on your screen?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Oh looks like I'm signed out. Let me, let me log in again. I thought I was logged.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] But it may have to log in again let's see.
[CUSTOMER][NEUTRAL] No, there's my name. I'm logged in.
[CUSTOMER][NEUTRAL] So if I go to
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEGATIVE] Weird.
[AGENT][NEUTRAL] You said you are logged in?
[CUSTOMER][NEUTRAL] It says I'm logged in, but when I click.
[CUSTOMER][NEUTRAL] I click claim forms.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It looks like it's, it says it it says sign in, so it looks like I'm logged out or I have to I have to sign in again.
[AGENT][NEUTRAL] Oh, maybe it's like, maybe, yeah, that is weird. Um, I would log out and log back in. You got it?
[CUSTOMER][NEUTRAL] That's weird.
[CUSTOMER][NEUTRAL] OK, no, no, no, it's, it's OK.
[CUSTOMER][NEUTRAL] No, it, it worked yeah I clicked on that sign and and it took me right to my information and I'm seeing my, I'm seeing that, yeah, I'm seeing that claim that was denied because of the lack of information, so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Um, oh, here it says upload files. OK, good, so I can, uh.
[AGENT][POSITIVE] Yes, there you go.
[CUSTOMER][NEUTRAL] I can reupload that.
[AGENT][NEUTRAL] Mhm. And then now when you submit it, it's going to look like it's a new claim and you're going to get a new confirmation number, but don't worry about that. That's just how how it is when you submit on the online service and when the examiner gets it, they'll see that that's the additional information for that claim that um was denied.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK great.
[CUSTOMER][POSITIVE] All right thank you very much I appreciate your help.
[AGENT][POSITIVE] You're very welcome. Was there anything else I could assist you with today?
[CUSTOMER][NEGATIVE] Uh, yeah, I had a, uh, a lapse in coverage last year. There was a payment issue and I was denied coverage, uh, on, on a procedure.
[CUSTOMER][NEGATIVE] Because it looked like I did not have coverage and it was uh some sort of a lapse in payment. I don't understand what happened so I had to reapply and get I actually got new uh a new policy a number and a new card and everything.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Through the uh
[CUSTOMER][NEUTRAL] Multi-plan
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm trying to see what
[CUSTOMER][NEUTRAL] Do you see that?
[AGENT][NEUTRAL] Well, the policy, hold on, let me open it over here. Hold on one second.
[CUSTOMER][NEGATIVE] This is very convoluted. I signed up to a, um, to a multi plan and then I got uh I got a plan name and a number and it said it was part of something called EnovaCare, but now it's APL and I have to like two different plan numbers.
[AGENT][NEUTRAL] So the only
[CUSTOMER][NEGATIVE] It's very confusing.
[AGENT][NEUTRAL] The only thing I see on my side um is the policy number that you gave me and it's been active since [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Interesting.
[CUSTOMER][NEUTRAL] Active since [PII] all right.
[AGENT][NEUTRAL] There was a, let me see, looks like there was a brief lapse in August.
[CUSTOMER][NEUTRAL] Yes, that's what happened.
[AGENT][NEUTRAL] Policy higher date. Oh, the higher date. Oh, OK, so the higher date changed from [PII] to [PII], so.
[AGENT][NEUTRAL] Because hire date change, so that may be why with the lapse, but
[AGENT][NEUTRAL] Yeah, that's, I, I don't know, but that's been rectified and everything is active show in January.
[CUSTOMER][NEUTRAL] OK, so if, if
[CUSTOMER][NEUTRAL] If there were any um
[CUSTOMER][NEUTRAL] If there were any service dates of service.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] In say in August, July or August they should be able to get those covered, right?
[AGENT][NEUTRAL] Yes, as long as your policy is active on the data service, you can file claims at any time.
[CUSTOMER][NEUTRAL] OK, so according, but according to this, the policy has been active since January, so there should not be any trouble.
[AGENT][NEUTRAL] Correct, that's what, yes, from what I'm seeing, it's show in January.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and the policy number is that uh the one I gave you.
[AGENT][NEUTRAL] Yes, sir, the 247.
[CUSTOMER][NEUTRAL] The 2471531.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, is there a uh a card uh that I could, uh, print out or or get a copy of to have that that policy information readily available?
[AGENT][NEUTRAL] Sure, let me make sure that it's here and then I can email it to you. Hold on one second.
[CUSTOMER][NEUTRAL] Or
[AGENT][NEUTRAL] Did you want like an email copy or like a physical copy because we can do both.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah, let's do a physical copy that way I have something that will go in my wallet.
[AGENT][NEUTRAL] OK, and I don't see it here, so I'll have to send over for the card to be generated and then have them mail it to your home address. And um did you need your policy breakdown as well?
[AGENT][NEUTRAL] Or just the card?
[CUSTOMER][NEUTRAL] Uh, no, I have, I have the policy info. I was able to find that. Um, I have the, it's a PDF file with several, several pages, uh, so I have that.
[AGENT][NEUTRAL] Yes, OK.
[CUSTOMER][POSITIVE] But yeah, you could send me 2 of those cards, one for me and one for my wife, that'd be great.
[AGENT][POSITIVE] OK. Well, I can definitely do that. I'm putting the request in for you now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Alrighty, and was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Um, so if, if I, uh, go to a doctor and they, and I give them this information and they have trouble, but they need to know how to, uh, how to process it from there and through their, you know, as a provider, uh, what information do they, do they provide, should, should they provide to you? What, what, uh, what's the information you need from the provider?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Like if they were to call to verify benefits or something.
[CUSTOMER][NEUTRAL] Because people
[CUSTOMER][NEUTRAL] Yeah, or, or to submit it to send a claim through from the doctor because they've been having trouble uh uh making contact or sending the right sending it to the right location.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, the best thing to do would be to give them our phone number, um, and then we can help them with filing a claim, but
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Typically, we'll always need the their claim form and their itemized bill and if there's any other insurance.
[CUSTOMER][NEUTRAL] OK, and that'll be
[CUSTOMER][NEUTRAL] Alright, so the information you're gonna send me on the card should be sufficient for them if I give them that card, [PII]t?
[AGENT][NEUTRAL] Right. Once you give them the card, it's gonna have the policy number and our phone number, and then if they have any questions, need to verify benefits or need help with claims, they can definitely give us a call.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, that'd be great. Thank you. I'll just, uh, wait till I get that card and I'll give that to the doctor, uh, to the doctor's office as an as an updated uh benefits.
[AGENT][NEUTRAL] And it
[AGENT][NEUTRAL] Yes, and in the meantime, um, because you know, the card is going to be mailed to you, but if you wanted to give them our phone number, this [PII], and we can help them now, um, I mean, it's just up to you.
[CUSTOMER][POSITIVE] Great, OK.
[CUSTOMER][NEUTRAL] Yeah, no, that's fine. I'll, I'll keep that on, uh, I'll keep that handy, um, because the uh multi-playing card that I got initially.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] With that in overcare information you know they seem to have trouble with that every time so I'm hoping this will be a better contact information for them.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And then we'll be, we'll definitely show them, um, you know, show them how APL works and then um once your card gets here, all they'll need is your first and last name, your date of birth, and the policy number and we can go through everything with them.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Great thank you very much for your help I appreciate it.
[AGENT][POSITIVE] You're very welcome, Mr. [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Uh, no, I think that's it.
[AGENT][POSITIVE] Alrighty. Well, thank you so much for calling APL. Hope you have a great week.
[CUSTOMER][POSITIVE] Thanks you too.
[AGENT][POSITIVE] Thank you. Bye bye.