AccountId: 011433970860
ContactId: e0da32c3-35f5-4e36-be4d-0c3dd2e585a8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1680689 ms
Total Talk Time (AGENT): 386352 ms
Total Talk Time (CUSTOMER): 554203 ms
Interruptions: 5
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/e0da32c3-35f5-4e36-be4d-0c3dd2e585a8_20250604T13:26_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes, my name is [PII].
[CUSTOMER][NEUTRAL] I have the, the, the gap insurance with you guys, the medical gap insurance with you guys.
[AGENT][NEUTRAL] OK, do you have a policy number?
[CUSTOMER][NEGATIVE] I don't have it with me right now.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] You want my social?
[AGENT][NEUTRAL] Uh yes, please. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what is your social?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you sir one moment.
[AGENT][NEUTRAL] And Mr. [PII], verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and your callback number if we were disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK thank you so much one moment please. I wanna have you to also verify your mailing and email addresses please.
[CUSTOMER][NEUTRAL] [PII]. [PII].
[AGENT][POSITIVE] Thank you, Mr. [PII] for the information. I have your policy pulled up.
[AGENT][NEUTRAL] And how can I help you sir?
[CUSTOMER][NEUTRAL] I'm calling because I did a claim, um, I had gone to the ER.
[CUSTOMER][NEUTRAL] And um my insurance covered a portion, and then I was paying, um, I owed them $300 but um I have the gap insurance. So I was paying them $50 like every month. But then, um, I have gap insurance, so, you know, um, and they said, and I did a claim like a week ago, a week or so ago.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And um they sent me a letter that it got denied, but I don't understand because I went to the emergency ER because of the injury that I had that it should cover all my benefits and
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And it was not like I went to a clinic or something, you know, this is, I went to the ER. Like I don't understand why it got denied, you know?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so you're calling for claim status. I can certainly help you with that. Now. I show that you did receive, excuse me, submit a claim, and that date of service for the ER visit was just the [PII] of last year. Is that correct?
[CUSTOMER][POSITIVE] Yeah, correct.
[AGENT][NEUTRAL] OK, OK, we did receive the claim and we are asking.
[CUSTOMER][NEUTRAL] And then, and this is the, the, the, the, the only time that
[CUSTOMER][NEUTRAL] Yes, sorry.
[AGENT][NEUTRAL] No problem. um we are asking for the diagnosis code for that that was not submitted when the claim was um submitted to us so we're asking for the diagnosis code.
[CUSTOMER][NEUTRAL] They know or you know.
[CUSTOMER][NEUTRAL] Where can I find that at? Yes, right.
[AGENT][NEUTRAL] Yes, we're asking for the diagnosis.
[AGENT][NEUTRAL] And you can
[AGENT][NEUTRAL] Fund that um actually
[AGENT][NEUTRAL] You can get that from the ER where you visited the ER.
[AGENT][NEUTRAL] They should be able to provide the information to you. And normally when they um sometimes when they give you the bill or send you a bill, they should have the diagnosis code, the reason why you had to visit the ER that's what we're looking for or requesting.
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] Diagnosis cos, you said.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Oh
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] I was having trouble like logging back into my um.
[CUSTOMER][NEUTRAL] Account that I did online with you guys.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see one moment.
[AGENT][NEUTRAL] When was the last time you tried to log in this?
[AGENT][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] A couple of days ago.
[AGENT][NEUTRAL] A couple of days ago, OK.
[CUSTOMER][NEUTRAL] I'm trying to find um I'm trying to see if I, if I could log in to the to the hospital. I think they made they made me an account.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I could give you that information.
[AGENT][NEUTRAL] Well, you wouldn't be of course give it to me verbally over the phone. You would have to submit the information into us, but um in regards to your online service center account.
[CUSTOMER][NEUTRAL] Understood.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] So look into my emails and.
[CUSTOMER][NEUTRAL] On my chart a second. Let me see if I can find it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm logging in right now to the, to their portal. Let me see if so where it says test result, where we're gonna find this visit.
[AGENT][NEUTRAL] OK, so you're logged into the your website with the um.
[AGENT][NEUTRAL] The ER is that
[AGENT][NEUTRAL] Is that what you're stating?
[CUSTOMER][NEUTRAL] Yeah, so
[CUSTOMER][NEUTRAL] What? When, when I put notes it says.
[AGENT][NEUTRAL] Or with your insurance, OK.
[CUSTOMER][NEUTRAL] Yeah, when I put notes, it says um.
[CUSTOMER][NEUTRAL] Emergency visit, [PII], notes, um, eye pain.
[CUSTOMER][NEGATIVE] Patience was cleaning with bleeds 3 days ago, left eye on discomfort.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So what exactly do they need?
[AGENT][NEUTRAL] We need the is it anywhere on there as far as the notes where it has maybe a diagnosis code it normally it starts with a letter um and then followed by numbers.
[AGENT][NEUTRAL] So it may say something like maybe, uh, maybe like E. OK.
[CUSTOMER][NEUTRAL] One sec.
[CUSTOMER][NEUTRAL] I think it should be here on notes. I don't know they, they put a bunch of things. I don't know how to really um see this.
[CUSTOMER][NEUTRAL] This or not.
[CUSTOMER][NEUTRAL] this is just the notes of everything that happened.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Or the after visit summary, um.
[AGENT][NEUTRAL] What what does it say in the after visit summary?
[CUSTOMER][NEUTRAL] Is the one that
[CUSTOMER][NEUTRAL] Blood pressure, BMI, weight, pulse, oxygen, temperature, respiratory redness on left eye, chemical of left eye, um, a reason for the visit. And start, they gave me um.
[AGENT][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Diclofenac.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Chemical, pick up the medication, schedule a visit.
[CUSTOMER][NEUTRAL] Uh, follow.
[AGENT][NEUTRAL] But what you said reason for visit.
[CUSTOMER][NEUTRAL] It didn't say like nothing about 000.
[CUSTOMER][NEUTRAL] Excuse me?
[AGENT][NEUTRAL] I'm sorry, you're about to say what now? Go ahead.
[CUSTOMER][NEUTRAL] Oh, it has more things to say. It has, it shows uh.
[AGENT][NEUTRAL] OK, so what it was saying, reason for visit.
[CUSTOMER][NEUTRAL] I don't know, I don't know if it's this or not.
[AGENT][NEUTRAL] I'm sorry, excuse me.
[CUSTOMER][NEUTRAL] Your reason for visit you know almost like I was.
[CUSTOMER][NEUTRAL] It's just so many things.
[CUSTOMER][NEUTRAL] Reason for visit um eye pain, uh, redness of left eye, chemical conjunction of left eye, eye pain, bilateral medicines given, fluorescent, um.
[CUSTOMER][NEUTRAL] Yeah, right, and it shows right here my blood pressure, weight and all that stuff, and it says here that I should visit a doctor and um.
[CUSTOMER][NEUTRAL] I don't know, I don't know if it's this or not, and it's changes to your medication and start taking these medications, medications that I should take.
[CUSTOMER][NEUTRAL] Um, it says to keep, to keep at least 6 inches away from um the cellphone.
[CUSTOMER][NEUTRAL] And something about a suicide line, um.
[CUSTOMER][NEUTRAL] And medication side effect, the side effect of the medications.
[CUSTOMER][NEUTRAL] Um, attachment information, chemical congestion, adult.
[CUSTOMER][NEUTRAL] Um, it shows, you know, what happens.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How is it diagnosed this condition diagnosed based on your, your medical history and the food.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know, is this one?
[AGENT][NEUTRAL] I'm sorry. I'm sorry. Can you read that again where it says diagnosis? I'm sorry.
[CUSTOMER][NEUTRAL] Uh, one second.
[CUSTOMER][NEUTRAL] How is this diagnosed? So this condition is diagnosed based on your symptoms, your medical history, and a physical exam. During the exam, your healthcare provider may use medical instru instruments. Yeah, but this is just like, there's nothing, nothing.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Just saying, well, what I should do after, you know?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so back where you were saying, bringing the reason for your, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] And then on summary.
[CUSTOMER][NEUTRAL] Then on summary, it says um chemical um pink eye is infla inflammation caused by a chemical irritant. The is clear covering of the white part of the eye and the eye and the.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] In your eyelid. The condition is based on your system, your medical history, and the physical exam.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah, what do I need to show you guys.
[AGENT][NEUTRAL] OK. So did you have pink eye?
[CUSTOMER][NEUTRAL] Um, no, this is what happens to a chemical, um, I was cleaning the house on a chemical, um.
[CUSTOMER][NEUTRAL] Like, um, I had a chemical reaction on, on, on, on my left eye, and it, it was red. It wasn't pink eye, it was red. It was like happened, um, um, I was cleaning uh uh accidentally.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So what you can send in, um, the reason for your visit.
[CUSTOMER][NEUTRAL] And that
[AGENT][NEUTRAL] You can send the reason for your visit. So typically, the reason for your visit is the diagnosis. It's typically, that's the reason why you had
[AGENT][NEUTRAL] To go to the ER.
[AGENT][NEUTRAL] So if you could submit the reason for your visit.
[AGENT][NEUTRAL] To us
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Of course we will uh view that once we get it in and then process the claim then continue processing the claim, but again the reason for your visit is typically.
[AGENT][NEUTRAL] Why you had to go to the ER, the diagnosis. Because you stated that if you could go back to the reason for your visit and read that to me again, I'm so sorry, Mr. [PII]. I'm just sorry.
[CUSTOMER][NEUTRAL] Yeah, so, so what do I do?
[AGENT][NEUTRAL] You'll submit the reason for your visit to us for review, so we can see if that's what we need for the diagnosis.
[AGENT][POSITIVE] That's what you yeah yes please submit that to us.
[CUSTOMER][NEUTRAL] OK, so I submit that that that that I that I just read.
[AGENT][NEUTRAL] Yes, the reason for your visit, yes, you'll submit that to us for review, yes sir.
[CUSTOMER][NEGATIVE] Well, I, I don't understand how I didn't cover last time because it shows that I went to the ER and it showed everything, you know, I don't understand.
[AGENT][NEUTRAL] We have to have a diagnosis when you submit the claim to us, what we always need would need would be the itemized bill that has the procedure and diagnosis code. We have to make sure it's due to a sickness, so that's the importance of having a diagnosis code. So whenever you submit a claim, it's very important to include the diagnosis uh code or the reason why you had to go to see, uh, go to the ER in this case. So that would be the diagnosis.
[CUSTOMER][NEUTRAL] OK, well, I, I'm, I'm trying to log in to my, to my thing, the APL thingy, and, and I can't log in.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Just wanna make sure everything matches.
[CUSTOMER][NEUTRAL] Excuse me?
[AGENT][NEUTRAL] I'm trying to see if everything matches one moment please I'm trying to get to where you are, one moment.
[CUSTOMER][NEUTRAL] Oh, are, are, are they send it to my work email, I don't know what, oh, I think they send it to my work email. I think that might be the.
[CUSTOMER][NEGATIVE] That might be the problem. I'm not at work today.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, we have.
[AGENT][NEUTRAL] In our system we have your, well, the Marvin Rivas.
[CUSTOMER][NEUTRAL] I didn't know.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] You, you got the margaritas?
[CUSTOMER][NEUTRAL] So we can't seem to find your account.
[AGENT][NEUTRAL] Yes, that's what we had as far as your email.
[CUSTOMER][NEUTRAL] Uh so.
[CUSTOMER][NEUTRAL] It it's a social learning but I.
[CUSTOMER][NEUTRAL] You want.
[CUSTOMER][NEGATIVE] Um, having a little trouble logging in here to this thing.
[CUSTOMER][NEUTRAL] I, I just sent it right now. Let me see.
[AGENT][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] No [PII].
[CUSTOMER][NEUTRAL] What I said, what I saw.
[CUSTOMER][NEUTRAL] Throw it away.
[CUSTOMER][NEUTRAL] The account cannot be found in your provider user ID.
[CUSTOMER][NEUTRAL] And I put my email [PII].
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] Come here.
[AGENT][NEUTRAL] Let see.
[AGENT][NEUTRAL] Can I put you on hold for a moment, please?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mr. just gonna put you on hold. OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mr. [PII], Mr. [PII].
[CUSTOMER][NEUTRAL] Yes, yes, ma'am, well.
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] OK, I'm so sorry, sorry about that. OK, thank you. um, we've updated, I'm sorry, we've updated our online service center so you'll have to create a new account actually.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] What happened? Sorry about that.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] What was that man?
[AGENT][NEUTRAL] We have updated our online service center. You will have to create a new account.
[CUSTOMER][NEUTRAL] Oh yeah?
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] Yeah, so I can wait on the phone while you do that if you're able to do that, please, or to try to do that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just give me one second let me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Which will describes you best? I'm not insured, right?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Yes, you are insured. Yes, it's just that we have, we've made some updates to our online service center and we just our users have to use or create a new account in order to go forward, so there's been some updates.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, yes, you are covered.
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEGATIVE] No wonder I was like I I can't log into this.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] OK, email address.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It says claim now verify email.
[AGENT][POSITIVE] OK, it says again, I'm sorry.
[CUSTOMER][NEUTRAL] Oh, did they have, they're sending me an email. Hold on one second. Did you send me an email to confirm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] There's a lot, it's a, it's a lot of security too, you know.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Say notify.
[CUSTOMER][NEUTRAL] 35, agree, agree.
[CUSTOMER][NEUTRAL] OK dashboard OK log in.
[CUSTOMER][NEUTRAL] Same verification.
[CUSTOMER][NEUTRAL] Is this normal or just so many verification?
[CUSTOMER][POSITIVE] Bless you.
[AGENT][NEUTRAL] Yes, again, we had some updates to our online service centers, so excuse me, just extra security, of course.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Be careful.
[AGENT][NEUTRAL] Can I place you on hold for a moment just to give me a sip of water, OK, Mrs. [PII].
[CUSTOMER][NEUTRAL] OK, I'm, I'm
[CUSTOMER][NEUTRAL] I'm, I'm in the dashboard let me see.
[AGENT][NEUTRAL] I'm sorry, sir?
[AGENT][NEUTRAL] Oh, you're in the dashboard, OK.
[CUSTOMER][POSITIVE] Great
[CUSTOMER][NEUTRAL] Start your claim?
[AGENT][NEUTRAL] Yeah, so that's what you'll need to do and if you would upload that.
[CUSTOMER][NEUTRAL] I go to start.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Um, injury, right? Injury, injury.
[CUSTOMER][NEUTRAL] Do I have to upload the other documents or you guys have that? Do I have to download every um document or you guys have that?
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] The only thing that we need in regards to your ER visit is your diagnosis code. That's what we need.
[CUSTOMER][NEUTRAL] And OK, next step.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Claimant's name. I put my name.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, you're the claimant.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And to the claim it please try the, I, I'm keeping my name and doesn't allow me. OK, oh, OK, now it does.
[CUSTOMER][POSITIVE] It's the leg coverage, OK.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Next up, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else I can help you with, Ms. [PII]?
[CUSTOMER][NEUTRAL] Um, I'm, I'm submitting it. I'm just waiting right now. Did you get a receiving your end? I don't know.
[CUSTOMER][NEGATIVE] It's taking a little long.
[CUSTOMER][NEUTRAL] You wanna make sure it's there, huh?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What are you doing?
[CUSTOMER][NEUTRAL] Oh, OK, so yeah, uh, claim successfully submitted.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That, that, that's all that was needed from your end.
[AGENT][NEUTRAL] And of course once the claim is in office.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] What was it? Excuse me?
[AGENT][NEUTRAL] I'm sorry, you're saying something?
[CUSTOMER][NEUTRAL] Um, that's all that's needed to process my claim fully.
[AGENT][NEUTRAL] Correct, we were asking for the diagnosis code is what we're asking for your visit for the ER.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] So I should be good now?
[AGENT][NEUTRAL] Yes, you should be good now. Yes, once we receive that document, of course it, it, there's a process to waiting, of course, but once we receive that document in our, in our system, um, the processing time is typically, um, it can take up to 7 to 10 business days. It may not take that long.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But that's the processing time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, well, thank you, thank you so much, OK.
[AGENT][POSITIVE] OK, you're welcome, Mr. [PII] and anything else I can help you with?
[CUSTOMER][POSITIVE] That well, thank you.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day and take care bye.
[CUSTOMER][NEUTRAL] Right, right.