AccountId: 011433970860
ContactId: e0bfc303-87c5-4b23-894f-477a899885b4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 553580 ms
Total Talk Time (AGENT): 203551 ms
Total Talk Time (CUSTOMER): 195653 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/e0bfc303-87c5-4b23-894f-477a899885b4_20250424T19:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I keep getting, we have not had your services in about 1 year, but I keep getting the same EOBs, I would say maybe once a month for the past like 3 months, and I want to see if maybe the vendor.
[CUSTOMER][NEUTRAL] has not updated the record, but I don't know who the vendor is.
[AGENT][NEUTRAL] OK. Do you have your policy number?
[CUSTOMER][NEUTRAL] I have a claim number on this EOB that we keep getting.
[AGENT][NEUTRAL] OK, what's that?
[CUSTOMER][NEUTRAL] I have a, oh yeah, I have a claim number, a policy number, a reference number, a name.
[AGENT][NEUTRAL] OK, what's the policy?
[CUSTOMER][NEUTRAL] Which will
[CUSTOMER][NEUTRAL] Policy is going to be 02465639.
[AGENT][NEUTRAL] And I'm sorry, I missed your name. What was that?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And what's your date of birth?
[CUSTOMER][NEUTRAL] Mine is [PII].
[AGENT][NEUTRAL] OK and then um do you have a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes ma'am, [PII].
[AGENT][NEUTRAL] OK, thank you. Just need two other pieces of information, your address and your email address.
[CUSTOMER][NEUTRAL] Uh, [PII] uh email [PII].
[AGENT][POSITIVE] OK, perfect. Thank you so much. And was the claim for yourself or another family member?
[CUSTOMER][NEUTRAL] Another family, uh, [PII], my wife.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] You have the claim number?
[CUSTOMER][NEUTRAL] Yes, ma'am, uh, 358-932-2.
[AGENT][NEUTRAL] OK, looks like, let's see.
[AGENT][NEUTRAL] Well, they, they did submit it within the policy plan time. Um, it looks like the coverage was from 2124 to 6124.
[AGENT][NEUTRAL] Um, then that claim was for 4-12-2024.
[AGENT][NEUTRAL] And it looks like.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Duplicate, let me see where the original is.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Now they keep submitting the claim, but we need the primary explanation of benefits for the in order to process the claim, and it looks like it's for provider.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] MUSC physicians.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you're saying you need the.
[CUSTOMER][NEUTRAL] EOB from the insurance company, correct?
[AGENT][NEUTRAL] Yeah, your primary insurance, did you have United Healthcare, Blue Cross Blue Shield, or Aetna or something like that?
[CUSTOMER][NEUTRAL] Yeah, and some Blue Cross Blue Shield, yep.
[AGENT][NEUTRAL] OK, yeah, we're looking for that primary explanation of benefits in order to potentially process the claim, and that's what we're missing.
[CUSTOMER][NEUTRAL] So I, I actually see it, have it downloaded it. Am I able to email it to somebody so we can square it up?
[AGENT][POSITIVE] Uh, you can actually upload it on our portal or fax or mail it.
[CUSTOMER][NEUTRAL] I would say upload on portal will probably be the easiest, huh?
[AGENT][NEUTRAL] Yeah, did you ever create an account when you were with us?
[CUSTOMER][NEUTRAL] Oh, I maybe. Um, let me see first is EOB is dated [PII], so crazy. AO EOB.
[AGENT][NEUTRAL] Let me see here.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Let's hit save on downloads. Alright, what is the website that for the portal?
[AGENT][NEUTRAL] Uh the portal is secured at [PII]. So secured. [PII].
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] You a [PII]. It's loading. Let's see if I get lucky username, uh, let's try that. I'm gonna say no.
[CUSTOMER][NEUTRAL] Maybe. No.
[AGENT][NEUTRAL] Uh, doesn't look like yeah, doesn't look like you ever created an account so you can actually do that now um and and even if, even though your policy is not active, but um you'll just click that new user.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, you'll need to enter your social, there's no member ID.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And then the rest of the
[CUSTOMER][NEUTRAL] Alright, uh, I, I would guess I'm an individual with APL insurance policy.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Perfect. Social Security.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The user was found with that information.
[AGENT][NEUTRAL] Um, so did you use?
[CUSTOMER][NEUTRAL] Uh, the only other stuff.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] It'll be, let me see.
[AGENT][NEUTRAL] So your zip code, the [PII] and then the [PII]. OK, so here it is, here I found out what it is.
[AGENT][NEUTRAL] I guess you were born on a leap year, is that right?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so I don't know why our system wouldn't let us put in your birth date, but we put [PII].
[AGENT][NEUTRAL] No, because of the
[CUSTOMER][NEUTRAL] Uh, it appears you're not eligible to create an account.
[AGENT][NEUTRAL] Oh, that's weird.
[AGENT][NEUTRAL] But you could still create an account, even if you're not active.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see. I guess you cannot create an account, cause your policy is not active, but that's really strange.
[AGENT][NEUTRAL] Mm hm.
[AGENT][NEUTRAL] Hatch [PII]. OK.
[AGENT][NEUTRAL] OK, do you have access to um a fax?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] No, OK.
[AGENT][NEUTRAL] Um, yeah, let me go ahead and give you our email address. We don't typically allow that, but since the policy is termed and this specific situation.
[AGENT][NEUTRAL] Um, go ahead and email, um, the explanation of benefits.
[AGENT][NEUTRAL] And I'll notify somebody on that department um so it's care team.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] At let me get the address real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] [PII]
[CUSTOMER][POSITIVE] [PII]. Perfect.
[AGENT][NEUTRAL] OK, and then you can attach that EOB and then if you wanna reference this claim number.
[AGENT][NEUTRAL] Um, let me give you that.
[CUSTOMER][POSITIVE] Yeah, I'll tell you I'll do one better.
[CUSTOMER][NEUTRAL] I will actually um scan in what I got from y'all so that it's all one PDF.
[AGENT][POSITIVE] OK, yeah, that'd be perfect.
[CUSTOMER][POSITIVE] Awesome and then that's all you need is just the EOB and I'm guessing the EOB just kind of showing for sure that there's a $900 and some dollars deductible and then we can get that taken care of and everybody can stop billing each other, right?
[AGENT][POSITIVE] Correct. Yes, that's correct.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Awesome. Let me get busy uh putting the scan into the computer, combining the files, and I'll fire it off ASAP.
[AGENT][POSITIVE] OK, well, thank you so much. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] That's gonna be it.
[AGENT][POSITIVE] OK, thank you for calling APL. I hope you have a good afternoon.
[CUSTOMER][POSITIVE] You as well thanks again.
[AGENT][POSITIVE] Thank you, bye.
[CUSTOMER][NEUTRAL] Bye.