AccountId: 011433970860
ContactId: e0d9f1ba-b467-48eb-965c-d57e97b59e49
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1038108 ms
Total Talk Time (AGENT): 500936 ms
Total Talk Time (CUSTOMER): 300722 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/e0d9f1ba-b467-48eb-965c-d57e97b59e49_20250619T20:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good afternoon [PII]. Hi, this is [PII] in the claims department. I have a Mr. [PII] on the line with policy number 263-852-8.
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] You said one [PII]?
[CUSTOMER][NEUTRAL] Yes, yes, with a callback number of [PII].
[AGENT][NEUTRAL] And um what is he needing help with?
[CUSTOMER][NEUTRAL] He's a help with the OSC.
[AGENT][POSITIVE] OK, I can help him with that.
[CUSTOMER][NEUTRAL] Um, OK, but before I transfer you, OK, so he says that he's on the, um, OSC. He has an account created, but he's not able to upload a claim, but I tried to pull him up using the customer number and I do not show him what they an account created, but, um, that's why he's calling. Um, he said he's able to view the dashboard as far as um start claim, but anyway, OK, so here he comes, Mr. [PII], one moment please.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You too bye bye now.
[AGENT][NEUTRAL] This is [PII] with APL. I hear you needed help with uh your OSC account.
[CUSTOMER][NEUTRAL] Uh, sure.
[AGENT][NEUTRAL] OK, um, and you're able to log in already?
[CUSTOMER][NEUTRAL] Yes, I'm I'm staring at my dashboard.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And um um I apologize are you just trying to figure out how to how to file a claim?
[CUSTOMER][NEGATIVE] Well, I filed 3 claims Tuesday morning and I don't even see any record of them today.
[AGENT][NEUTRAL] OK, um, are they in regards to you or to someone else and I can check and see if we got them.
[CUSTOMER][NEUTRAL] Myself.
[AGENT][NEUTRAL] Yourself, OK.
[AGENT][NEUTRAL] OK, I'm not showing that any claims are.
[AGENT][NEUTRAL] are sent were sent in, um.
[CUSTOMER][NEUTRAL] Yeah that's what I was explaining to the young lady before you.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] OK, um, what I would do is, um, I would resubmit one, but first I would go um into your settings for your browser and clear all of your browser history and clear your cache.
[AGENT][NEUTRAL] And um if you have Google Chrome, I would try Google Chrome because that one has been working a lot better.
[CUSTOMER][NEUTRAL] So it's a computer issue.
[AGENT][POSITIVE] Um, I don't know. I just, I just know that I'm having a lot, I'm having more success with our clients whenever they use Google Chrome, um, for whatever reason.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Alright, but you do see me that I do have an account that my phone number, bank account and all that information is saved and accurate?
[AGENT][NEUTRAL] Let me pull it up.
[AGENT][NEUTRAL] I am showing that you have an account created.
[AGENT][NEUTRAL] Um, I'm not gonna be able to see your account information because I'm not in billing, but I do see that there is a an account created, um, with your customer number and everything.
[CUSTOMER][NEGATIVE] Yeah, because [PII] told me before that I didn't even have an account, so that obviously made zero sense to me. So, OK, um.
[AGENT][NEUTRAL] Yes, I, I am seeing one.
[CUSTOMER][NEUTRAL] Alright, so, well, we got Google Chrome right here, so if I submit one right now, will you see it?
[AGENT][NEUTRAL] Um, I should be able to, it would, it would take a couple of minutes I believe to, uh, transfer over to us, um, but you can definitely try it and see if I can see it. um, I might have to log out and log back in.
[CUSTOMER][NEUTRAL] In real time?
[AGENT][NEUTRAL] And if, if you'd like, go ahead and try and I can see.
[CUSTOMER][NEUTRAL] American life.
[CUSTOMER][NEUTRAL] Insurance.
[CUSTOMER][NEUTRAL] American public insurance American public life insurance.
[AGENT][NEUTRAL] If you're on Google Chrome, you'll go to secured. [PII], and then you'll be able to log in.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And there's no other way to submit a claim besides this online portal. I can't send an email of the receipt with my ID number.
[AGENT][NEUTRAL] Um, you can't email it to us because the email isn't secure. However, you can, um, mail it to us or fax it to us. Would either of those sound doable?
[CUSTOMER][MIXED] Mm, they're doable, but no, uh not this sounds exactly correct.
[AGENT][NEGATIVE] Not ideal.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And once you submit the claim.
[CUSTOMER][NEUTRAL] Alright, so now I'm logged.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Go ahead, I was gonna say once you submit the claim.
[CUSTOMER][NEUTRAL] No, I'm logged in and I'll just submit it now, yeah.
[AGENT][NEUTRAL] OK, OK, I was gonna say if I don't see it on my end but you see it on your end, um, it, it might take 24 hours. I haven't heard of that happening but um as long as you see it on your end, sometimes I have heard that it will uh it won't kick into our system until the next day, um, but you should be able to, um, you should be able to see it on your end um almost immediately afterwards.
[AGENT][NEGATIVE] Maybe a couple of minutes of a wait time, but it shouldn't take 24 hours in in your portal to show up.
[CUSTOMER][NEUTRAL] Alright, so I would do a wellness claim for something I paid out of pocket, correct?
[AGENT][NEUTRAL] Uh, if it was a routine wellness exam or or it went under that wellness claim, then yes, otherwise it will be a traditional claim.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And now it's asking me for my direct deposit information but it's already on file so I would just skip that, right? Right.
[AGENT][NEUTRAL] Um, it, it should be in there. You can go look by going up to the top, I believe right hand side, and it might say a J or an E, um, depending on what your name was what name you put in there for your display name.
[AGENT][NEUTRAL] And um you can click I believe it's settings or profile and check and make sure that your bank account um your bank information stayed the same.
[AGENT][NEUTRAL] I haven't heard of it not transferring over but just in case.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Alright, and then for service of wellness.
[AGENT][NEUTRAL] Because I am seeing it on my end.
[CUSTOMER][NEUTRAL] Uh, select type of wellness service. So this was, uh, a routine checkup. I would put general medicine accepted screening test not listed above because there is no wellness checkup under this list.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I'm done.
[CUSTOMER][NEUTRAL] And then I choose direct deposit.
[CUSTOMER][NEUTRAL] And I would just do check up.
[CUSTOMER][NEUTRAL] Next step.
[CUSTOMER][NEUTRAL] Please sign signing.
[CUSTOMER][NEUTRAL] Submit
[AGENT][NEUTRAL] No, it should give you a confirmation number after that.
[AGENT][NEUTRAL] That says claims successfully submitted.
[CUSTOMER][NEUTRAL] No, it's just spinning.
[AGENT][NEUTRAL] OK, give it a couple
[AGENT][NEUTRAL] Uh, give it a few minutes. Um, I will stay on the line though until we get that success note.
[CUSTOMER][POSITIVE] Alright, claim successfully submitted with a confirmation number and what all that good stuff.
[CUSTOMER][NEUTRAL] As a matter of fact, I, I got these confirmations on Tuesday morning and took a picture of them. If I give you these those confirmation numbers, would that help at all?
[AGENT][NEUTRAL] Um, well, I don't see any on, on here for you, but give me just a moment.
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Oh, here we go. I see.
[CUSTOMER][NEUTRAL] Actually no I don't have the confirmation numbers, but I'll take a picture of this one, OK.
[AGENT][NEUTRAL] OK, I do see one that was submitted just now.
[AGENT][NEUTRAL] Um, I have my confirmation. I don't know if it's the same confirmation as yours, but I have 97278.
[CUSTOMER][POSITIVE] Alright, cool, yeah, that's that one.
[CUSTOMER][NEUTRAL] Uh, no, the, the confirmation I have is OSC 99,710.
[AGENT][NEUTRAL] OK, yes, I have that number too.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, and so I do show that one.
[AGENT][NEUTRAL] And then if you ever wanna check the uh status of your claim.
[AGENT][NEUTRAL] You'll go to your, uh,
[AGENT][NEUTRAL] Go to the dashboard or my policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then you'll go to view my or view policy details um it's that one that has a little heart inside the hands and then there should be two tabs up there that say my details and then claims.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then you should be able to see that claim, but I am showing it on my end.
[CUSTOMER][NEUTRAL] Actually I do have, I have all the other claims from the [PII], so I do have 3 claims pending from the [PII]. You don't see those?
[AGENT][NEUTRAL] From the [PII], yes, I had to get into your other uh policy. Um, I went ahead and checked your other policy, and I do see the ones for the [PII].
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] I'm sorry, you say I have two policies?
[AGENT][NEUTRAL] You do. It looks like you have a Medlink policy, which is your secondary gap, and then you have, um, it looks like a group accident.
[CUSTOMER][NEUTRAL] Yeah, no, we just need the gap insurance. That's what I'm trying to file claims with.
[CUSTOMER][NEUTRAL] But yeah, so I do have 3 claims. I have.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] No confirmation numbers they all say pending and they all say status uploaded, so does that mean that they're not processed yet or that they maybe they weren't done correctly?
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] Correct, so it looks like I have one, let me see.
[AGENT][NEUTRAL] Uh, for your group accident is the one that I do have right now. Uh, it looks like we received it on [PII].
[AGENT][NEUTRAL] And it looks like it was for an accident screening.
[CUSTOMER][NEGATIVE] Accidental injury.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] No, that's not correct. It was an office check up.
[AGENT][NEUTRAL] OK, because it went to your it was submitted as.
[AGENT][NEUTRAL] It looks like a an accident screening and so the policy doesn't provide an accident screening benefit um if you're trying to get into your Medlink one.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Let me see what you submitted because for your meddling it's secondary.
[CUSTOMER][NEUTRAL] I submitted under under.
[CUSTOMER][NEUTRAL] I submitted it under wellness claim, not really sure how wellness claim goes to accident.
[AGENT][NEUTRAL] Right. Um,
[CUSTOMER][NEUTRAL] And under routine or preventative care.
[AGENT][NEUTRAL] And for your med link that is secondary gap, so when you do submit those claims, you will need to have your uh primary EOB.
[AGENT][NEUTRAL] With that one first.
[AGENT][NEUTRAL] Um, otherwise it'll get denied under the, under the note that we need to get your primary explanation of benefits.
[AGENT][NEUTRAL] Um, so let me see what's going on.
[CUSTOMER][NEUTRAL] Yeah, I'm sorry, I didn't understand anything you said, um, so, um.
[AGENT][NEUTRAL] OK, so your Medlink policy.
[CUSTOMER][NEUTRAL] Whatever, whatever you can do to help, yeah, mhm.
[AGENT][NEUTRAL] Right, so, um, you're trying if you're trying to file a wellness policy under your Medlink policy.
[AGENT][NEUTRAL] Um, because that is your secondary gap insurance, uh, for Medlink policies, that's your other policy, not your group accident.
[AGENT][NEUTRAL] You will need to have your primary explanation of benefits for that.
[AGENT][NEUTRAL] Um, because it's secondary gap, so.
[CUSTOMER][NEUTRAL] OK, how do I do that?
[AGENT][NEUTRAL] But once your primary uh insurance gets the claim for the initial service, so whenever you got your wellness visit, um, whoever is filing for your under your insurance.
[AGENT][NEUTRAL] Uh, once it gets filed under your primary insurance, they send you an explanation of benefits, um, saying if something got paid or not, and then it'll give you the reason why it was paid or denied and what they paid towards it.
[AGENT][NEUTRAL] And then once you get that explanation of benefits from your second or from your primary insurance, then it will go into your uh Medlink policy because it's, it's going, it's helping to pick up the rest from your primary, what your primary doesn't cover.
[CUSTOMER][NEUTRAL] Mm great, so I ended up paying those co-payments out of pocket, so now I'm trying to file a claim after the fact.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Then you'll want to um file you'll need to file with your primary first.
[AGENT][NEUTRAL] And um
[CUSTOMER][NEUTRAL] I did, yeah, I had a $55 co-payment, so I'm trying to come to APO for reimbursement of that $55.
[AGENT][NEUTRAL] OK, um, and did you get an explanation of benefits showing that you had to pay that co-pay?
[CUSTOMER][NEUTRAL] No, I just, the front lady just said my copayment for specialist is $55 and my co-payment for my PCP was $30 which I also paid.
[AGENT][NEUTRAL] OK. OK. Um, yeah, because it should be.
[AGENT][NEUTRAL] You might need to call your primary and ask them for a copy um see if they can email you a copy of your explanation of benefits because you will need that when in the claim.
[CUSTOMER][NEUTRAL] Alright, and then when I get that, who do I send that to? You?
[AGENT][NEUTRAL] Uh, you can, you can still submit it through the online the online portal, um.
[AGENT][NEUTRAL] And you'll file it under a claim.
[AGENT][NEUTRAL] Let me see, so United Healthcare is who you have. You wanna contact them and have them, uh, send you a copy of the EOB's for all of these past ones, um, let me see.
[AGENT][NEUTRAL] Because it looks like we have 1234 of them, so you'll want the EOB for all 4 of those claims that you submitted.
[CUSTOMER][NEUTRAL] Got you. So if I paid out of pocket, uh, without insurance, um, there's no, there's no going back on that.
[CUSTOMER][NEUTRAL] I'm out that cash.
[AGENT][NEUTRAL] Well, we should be able to reimburse you for that because the, the gap, the medi the Medlink policy helps cover the co-pay, co-insurance, and co-deductible. So, um, if you have the hospital file under your behalf, um, you'll want to give them your Medlink policy number which um.
[CUSTOMER][NEUTRAL] Because my
[AGENT][NEUTRAL] You have on your OSC or I can hand or I can give it to you.
[CUSTOMER][NEUTRAL] No, there was no hospital.
[AGENT][NEUTRAL] I, I meant the provider, the provider.
[CUSTOMER][NEUTRAL] This is just uh a primary care physician.
[AGENT][NEUTRAL] Yeah, yeah, and get it from your provider um if you need to give them a copy of this insurance and they can file it on your behalf, um, otherwise, if you have a receipt, um, showing that you paid the copay, then you'll want to bring in your receipt along with that, uh, explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] Alright, I will call you back when I have an EOB.
[AGENT][NEUTRAL] Alright, is there anything else I can help you with until then?
[CUSTOMER][NEUTRAL] That'll be all.
[AGENT][POSITIVE] Great, thank you for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thanks bye.