AccountId: 011433970860
ContactId: de0308a8-c888-4744-8520-292d7bcf89aa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1707680 ms
Total Talk Time (AGENT): 369219 ms
Total Talk Time (CUSTOMER): 860470 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/de0308a8-c888-4744-8520-292d7bcf89aa_20250611T16:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, I'm, um, I have been a user of, well, I have been an insured of APL for a few years and I have, um, I have created an account, an online account.
[CUSTOMER][NEGATIVE] And have file and had filed a claim before. Um, this year, I was about to uh file a claim and I, when I try to log into my APL account, it asked me to rather than putting my username in, ask me to put my email address in. Um, I did it and then the system said that I do not have an active um account or something like that. I think maybe it said um basically said it couldn't find my.
[CUSTOMER][NEUTRAL] Uh, information in the system. Um, so I'm just calling to see if you could help me, um, to send my, um, login information.
[AGENT][NEUTRAL] OK, do you have your policy number?
[CUSTOMER][NEUTRAL] My policy number, um, yes.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Give me 1 2nd, let me find my card.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] I'm looking it up by your last name or social as well if that's easier.
[CUSTOMER][NEUTRAL] Oh yeah, actually, you know what, I, I just, I found it. OK. So policy number.
[CUSTOMER][NEUTRAL] Um, I, I think you meant the group. Did you mean the group number or just, um, or the benefit certificate number?
[AGENT][NEUTRAL] Uh, the benefit certificate number.
[CUSTOMER][NEUTRAL] Got it. OK. So I'll give you the outpatient benefit certificate number. It is 02214964.
[CUSTOMER][NEUTRAL] M as in
[CUSTOMER][NEUTRAL] Uh, Mary, L as in Linda, 8.
[AGENT][NEUTRAL] OK. And can you give me your first and last name and your date of birth, please?
[CUSTOMER][NEUTRAL] First name is spelled as [PII]
[CUSTOMER][NEUTRAL] Last name is [PII]
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK. And then can you verify your address and your email address?
[CUSTOMER][NEUTRAL] Um my email address is um [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] My home address is [PII]. ZIP code is [PII].
[AGENT][NEUTRAL] OK. Um, just to confirm on your email, is that your [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK, just wanna make sure. OK, so when you go to the [PII], we have updated our websites. You're gonna have to create your OSC account over again.
[CUSTOMER][NEUTRAL] Oh, OK, that makes sense. OK.
[CUSTOMER][NEUTRAL] Um, so when I, so yesterday I
[AGENT][NEUTRAL] Yeah, so
[CUSTOMER][NEUTRAL] I did try to create an account.
[CUSTOMER][NEUTRAL] I still said like they couldn't send my information, but I think I'm gonna try it again.
[AGENT][NEUTRAL] Yeah, so you'll put your last name and then you'll need your social, your full social security number, no dashes.
[AGENT][NEUTRAL] Um, zip code, email you provided me, and then your date of birth.
[AGENT][NEUTRAL] And then you should be able to hit next and it'll take you to the next steps.
[CUSTOMER][NEUTRAL] Oh, OK. Interesting. I don't think you asked me for my Social Security. OK, let me, let me do it again while you're here. Um, so first of all, you ask me which role best describes you. And since
[CUSTOMER][NEUTRAL] I have
[AGENT][NEUTRAL] You'll be, you'll be insured.
[CUSTOMER][NEUTRAL] is that
[CUSTOMER][NEUTRAL] Is insurance?
[AGENT][POSITIVE] Insured, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then they asked me my last name, uh.
[CUSTOMER][NEUTRAL] Social Security.
[CUSTOMER][NEUTRAL] Oh yeah, you did ask me. OK, um, and then you said for social security number there's no dashes.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, um, OK. Date of birth.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK it's good.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Code next.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] OK, it looks like I am.
[CUSTOMER][NEUTRAL] OK, it looks like.
[CUSTOMER][NEUTRAL] I might be able to create it this time. Maybe because yesterday when I tried to create an account, I maybe I did not.
[CUSTOMER][NEGATIVE] Maybe I hate the wrong describer, maybe I hate group.
[AGENT][NEUTRAL] Oh, right, yeah.
[CUSTOMER][NEUTRAL] Uh, OK, verification.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Send the verification code. OK, now it's gonna.
[AGENT][NEUTRAL] So it will um in initially it'll send a you'll ask to send a verification code when you enter your email and create that password and then it's gonna ask you to log in and and it's gonna ask for another verification code. So just want to make you aware, it will ask twice.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, got it, got it. And this is also when where I, OK, so I just put the verification.
[CUSTOMER][NEUTRAL] Oh right. OK, never mind. OK. So, verify code.
[CUSTOMER][NEUTRAL] OK, now you can continue. Got it. And so now I create my password.
[CUSTOMER][NEUTRAL] Display name.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, one, OK, so there's one box that asked me to put a display name. So do I just put whatever name?
[AGENT][NEUTRAL] Yeah, it's just whatever you when you pull up your account each time it'll say hello whatever display name you want it to say be your first name or whatever you want.
[CUSTOMER][NEUTRAL] To this.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh yeah, you're right. OK. Yeah. You asked me for another verification code. Um.
[CUSTOMER][NEUTRAL] Oh, wait. OK, I just created account.
[CUSTOMER][NEUTRAL] Now I logged in.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and then the dashboard shows that we are experiencing an issue retrieving your data.
[CUSTOMER][NEUTRAL] Please try again later. I'll contact customer service at this number option 4.
[AGENT][NEUTRAL] OK, it, it didn't ask for another verification code?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] It, it, yeah, it did so, so I put my email in it asked me for another verification code. So I put it in, verified it, and then I was able to log in. So during the whole registration process, I have put in two verification codes so far.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Right. So, so now I, I, I logged in.
[CUSTOMER][NEGATIVE] But the dashboard says that the system is having problems.
[CUSTOMER][NEUTRAL] Retrieving my data.
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] So now my, so.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Um, let me get something pulled up.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So, will it let you if you try to log in again, um, can you try to log in again and see if you get the same message?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Yes, OK. I, I, it's all good. I think now it's uh
[CUSTOMER][NEUTRAL] Um, let me see, uh, OK, OK, seems like the dashboard is still loading, but then if I go to a tab called my policy, everything is there.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, it does, it does take a while to pull all the information in, so.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Right, yeah, yeah, OK, so maybe it was processing, uh, pointing information earlier.
[CUSTOMER][NEUTRAL] Um, OK, that's good. Oh, OK. Well, I, yeah, is it the interface is different from last year because last year I remember last time I used, I log into my account was sometime last year, like last October or so, so it does look very different. Um, so I guess in that case I have just a few questions about starting a claim.
[CUSTOMER][NEUTRAL] Um, so it looks like, so, so last year I remember I, every time that I, um, file a claim, I had to submit a form called the Medin, Min form, um, in which I filled in the information, uh, my contact information, then I, I submit the form along with a receipt, um, for the medical bills I paid for and
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] An explanation of benefits, um,
[CUSTOMER][NEUTRAL] So, so I guess my question now is that, do, do, so for this year, do I do the same? Do I go through the same procedure?
[AGENT][NEUTRAL] Um, no, you don't need to submit a form. Um, you can just simply go to your dashboard, start a new claim, and then for claim submission, you know, we'll need your primary explanation of benefits and then the claim details. You don't have to fill out an actual form.
[CUSTOMER][POSITIVE] Oh, OK, OK. Uh, OK, that's easier than how, how it was done before. That's great.
[CUSTOMER][NEUTRAL] Um, the other question is, so I actually have, so I have had a hospital bill, um,
[CUSTOMER][NEUTRAL] But the and I have an explanation of benefits from my primary insurance.
[CUSTOMER][NEUTRAL] The explanation of benefits has the CPT code.
[CUSTOMER][NEUTRAL] Um, but it doesn't have a diagnostic code. And I remember in the past, whenever I submitted a claim, I always had to contact the provider to get diagnostic code. So, so is, is this, so are diagnostic codes still required this um moving forward in order to submit a claim?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, they are. Um, 11 tip I give people, if you have access, like if you have access to the hospital portal, whatever hospital you've gotten services from, sometimes you can look in the itemized bill or the notes from that visit, and it will contain the diagnosis code. Um, so you might check there, um, and see if it's in there because we can accept that too. It just has to be a document that shows the diagnosis.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it. OK. OK. Uh, OK. I, I, so, uh, so diagnostic codes are in the asthma cell, right?
[AGENT][NEUTRAL] Yeah, the diagnosis quotes are required.
[CUSTOMER][NEUTRAL] Right, right, right, and, and usually they are in the, cause they, I don't think they usually are the explanation of benefits.
[AGENT][NEUTRAL] They're not usually on the explanation of benefits. Sometimes they're on the bill, sometimes not. It just, it just depends on how the provider bills, um, but, um, I've, I've had some luck if people go to, like I said, their own personal hospital portal, they might be able to check on that date and see the diagnosis in there if you're having an issue like getting the information from the healthcare provider, so.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] I see. OK. OK. I, I, yeah, I think I'll, um, yeah, I'll, I'll contact them.
[CUSTOMER][NEUTRAL] Uh, just to see, yeah, I'll contact them to get diagnostic.
[CUSTOMER][NEUTRAL] Then one more question.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Give me one minute. It was, it was, I was, I was, it was in my mind like one minute ago, but now it's gone.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, yes. OK. So, so, um, so I'm expect, so I'm, so I'm expecting a hospital bill, but I think I'm going to talk to the hospital first to see if they could give me a discount uh if I make a full payment. Um, so I guess my question is, if the hospital is OK with giving me a discount, uh, and then I
[CUSTOMER][NEUTRAL] I pay for, I pay the discounted price. Um, would I still be able to seek reimbursement, um, assuming that the hospital bill is eligible for reimbursement? Would I be able to still seek reimbursement even if the bill is discounted?
[AGENT][NEUTRAL] Yes, so we go off of the primary explanation of benefits, and that's what we will look at is how they considered the claim and what was left over. So any, any side, um, you know, contract you have with the doctor's office, we're, we're just looking at your, um, explanation of benefits and then the itemization of charges. So yes, it would still be eligible, yes.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, OK, that's good. That's good. So I think I'll probably try to negotiate my bill first, um, and if I can get a discount, I'll just pay the discounted bill, and then I will submit the explanation of benefits.
[CUSTOMER][NEUTRAL] And the receipt to APL, um, doesn't matter that what I pay, say, say if my explanation of benefit shows that my out of pocket.
[CUSTOMER][NEUTRAL] Um, my, my out of pocket, my, my, my the patients responsibility, say it's $3000 but I was able to negotiate and only pay $2500. Then despite the despite that, I pay $2500 despite that the receipt so I'm paying 2 I only pay $2500.
[CUSTOMER][NEUTRAL] But the explanation of benefit shows that my patient responsibility is 3000, I will still get reimbursed.
[CUSTOMER][NEUTRAL] For the 2500. 0, actually that's a bad example because I think I don't get, uh, OK, so the cost of that say if it is.
[AGENT][NEUTRAL] I understand, yeah, it, it's, it is strictly based on the primary explanation of benefits. So for example, if, yes, so if you had $1000 applied towards your primary deductible and then you negotiated to only pay $750 but your policy allows for $1000 then we would reimburse the $1000.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, you're reimbursed the 1000, not 750?
[AGENT][NEUTRAL] Right, so it's, it's based on whatever is considered from your primary explanation of benefits.
[CUSTOMER][POSITIVE] Oh, I see. OK. OK. Got it. OK. That, that's OK. Well, I'm surprised. Um, OK, that's good to know. Thank you so much. I appreciate the information.
[AGENT][NEUTRAL] OK. Anything else I can help with Miss [PII]?
[CUSTOMER][POSITIVE] Um, no, I think, I think I am good.
[CUSTOMER][NEUTRAL] Um, I maybe I'm not good because now I go back to the APF dashboard and then again it shows me that we're experiencing an issue retrieving your data. Do you think it's
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you think, yeah, do you think, I think I'm having difficulty actually on the website.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But then earlier, so this message showed up at first when I logged in, and then all my information was retrieved and displayed.
[CUSTOMER][NEUTRAL] On the website?
[CUSTOMER][NEGATIVE] And now it's, and then, and now I, those, the information is gone and it again it shows that we are experiencing an issue retrieving our data. Please try again later or contact customer service.
[AGENT][NEUTRAL] Um, I know it times out after a certain amount. Um, could you try logging in again?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, I'll try that.
[CUSTOMER][NEUTRAL] So what is supposed to show on the dashboard?
[AGENT][NEUTRAL] So on the dashboard, you'll see um let me pull up the description real quick.
[AGENT][NEUTRAL] So on your dashboard you'll you'll see on the left hand side dashboard my policy resource center and help and then when you click on the dashboard it should say would you like to review coverage details of your policy um do you need access to your ID card and then on the right hand side it'll say need to file a wellness or traditional claim and then start your claim.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] OK. Well, my dashboard doesn't show.
[CUSTOMER][NEUTRAL] Uh, do you want to start your claim? It does show that, but it doesn't have other information that you just mentioned. Well, it, right, yeah, it doesn't say anything about the ID card or.
[CUSTOMER][NEUTRAL] I think you mentioned something else.
[AGENT][NEUTRAL] OK, so it just says do you need to file a claim?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, it does have that.
[AGENT][NEUTRAL] OK, it doesn't say, do you need to access your ID card?
[CUSTOMER][NEUTRAL] No, it doesn't. Just ask me if I wanna file a wellness or traditional claim, and then it has a green button. I can click on it. The green button says start your claim.
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] I mean, I guess it doesn't really matter because I have my um
[CUSTOMER][NEUTRAL] ID, so, and, and I don't really need to see the the policy.
[CUSTOMER][NEUTRAL] Um, documents.
[AGENT][NEUTRAL] Um, well, it should, it should show you your policy details. Um, so when you click on dashboard, it just has one box.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, I think that, yeah, it only has one box asking me if I want to start my claim, and then in the middle of the page.
[CUSTOMER][NEGATIVE] I can clearly tell something is loading, but it's just taking forever to load.
[AGENT][NEUTRAL] OK, that's the policy details. Um, we just, we just launched our site last Monday, so we're still kind of working out a few bugs and stuff, so it is running probably a little bit slower than it's meant to. Um, and the older your policy is, the more information will have to load. So, um,
[AGENT][NEUTRAL] But that's what that spinning in the in the middle would be your policy details, um, and then your card, um, that's what should pop up.
[CUSTOMER][NEUTRAL] Mm, I see.
[AGENT][NEUTRAL] If you give it just a bit of time, um.
[CUSTOMER][NEUTRAL] Got it. OK. Maybe I'll try later. Um, but just, but just, I just wanna make a note that, um, and, so on the left-hand side, there's a dashboard, my policy resource center and help. There are 4 buttons on the top left side. So, and my policy, I just, I, I'm currently in the page of my policy and to.
[AGENT][NEUTRAL] Yes. Uh-huh.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] And yeah, so in that under the page of my click on my policy, it also doesn't show me anything. It, it looks like it, it's going, I have, there are two buttons one says my details, one says claims, but there's nothing under them.
[CUSTOMER][NEUTRAL] Um, so,
[AGENT][NEUTRAL] Is it, is it spinning?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It's not spinning.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's just, it's complete blank under my my details and the claim. No matter which one I click, it's complete blank.
[AGENT][NEUTRAL] OK. Um, let me see.
[AGENT][NEUTRAL] Do you know what browser you're using?
[CUSTOMER][NEUTRAL] Sorry, what was your question?
[AGENT][NEUTRAL] Um, are you on like Google Chrome or Microsoft Edge or?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Chrome.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] I'm double checking to see if we're still loading information under the all of these policies. Um, give me just one moment.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I, I'm not getting a response back so, um, can I take your number down and I can give you a call back and see if we're still working on loading that information.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, of course. So my phone number is.
[AGENT][NEUTRAL] That [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, let me uh get a little bit of update on that and then I can give you a call back. And anything else I can help with today?
[CUSTOMER][NEUTRAL] Um, no, I think I'm good. Um, and if, cause since I'm in the office and you're in my phone got really signal in the office, um, so if I do not pick up the call, um, could you please just give me a voice message so I can, um, listen to it after I get off work?
[AGENT][POSITIVE] Yes, absolutely. I'll leave a message um with the information that I have, OK?
[CUSTOMER][POSITIVE] OK, awesome. Thank you so much for your help.
[AGENT][POSITIVE] OK, thank you for calling APL. I hope you have a good afternoon.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye.