AccountId: 011433970860
ContactId: f0c8396e-3202-4397-aefd-1ec9e54c03e2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1407819 ms
Total Talk Time (AGENT): 399918 ms
Total Talk Time (CUSTOMER): 335239 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/f0c8396e-3202-4397-aefd-1ec9e54c03e2_20250121T15:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. Um, I have my claim number in front of me if um that's helpful. I just wanted to, I got a letter saying that you guys, you guys needed more information and I have that now, so.
[AGENT][NEUTRAL] OK, what's the claim number?
[CUSTOMER][NEUTRAL] 354-031-3
[AGENT][NEUTRAL] And what's a good phone number for you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Verify your date of birth and your complete mailing address for me?
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] And your email address on file?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Mm I show a [PII] account but it's a different address.
[CUSTOMER][NEUTRAL] OK then it's probably [PII].
[AGENT][POSITIVE] OK, that's correct. Thank you for verifying.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You gave me claim number 3540313 which you said that we were needing additional information that you now have. Let me look at that remark.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so you have the itemized charges?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And did you get that from your provider's office?
[CUSTOMER][NEUTRAL] Uh, yeah, the doctor's office for a couple of days, but.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. On that itemized bill, does it have the diagnosis code and procedure codes?
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I forward it to you?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Oh, can I forward it to you?
[AGENT][NEUTRAL] Sure you could you could uh upload it online or fax it to us.
[AGENT][NEUTRAL] And I was just asking to make sure that it has the information on there that we need in order to process that claim, review the claim.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yep, it has, I mean, it's hard to kind of read this, but like.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Diagnosis pointer and see.
[AGENT][NEUTRAL] OK. Do me a favor. At the bottom, I think the bottom left of that form, does it say CMS 1500 or HIFA 1500?
[CUSTOMER][NEUTRAL] TT
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] N U N UCC.
[CUSTOMER][NEUTRAL] Oh, wait, let's see.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mm, I don't, I don't see that, but I did see like the codes and the diagnostic, diagnosis, diagnosis, diagnosis pointer.
[AGENT][NEUTRAL] OK, you can
[AGENT][NEUTRAL] You can go ahead and send it and we could take a look at it. I just wanted to make sure so we wouldn't have to, you know, deny it and request more information so I was just trying to make sure that it had the pertinent information on there.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I always try to do that.
[CUSTOMER][NEUTRAL] 100%
[AGENT][NEUTRAL] Um, the.
[CUSTOMER][NEUTRAL] Um, is it possible to send it to your email?
[AGENT][NEUTRAL] Are the total charges?
[CUSTOMER][NEUTRAL] Oh I'm sorry, what?
[AGENT][NEUTRAL] You ask if you could send it via email?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, it's not secure site to send your claim documentation via email.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Faxing it
[CUSTOMER][NEUTRAL] So I would upload it.
[AGENT][NEUTRAL] You can upload it online or you can fax it.
[CUSTOMER][NEUTRAL] OK, let's see, I've never faxed anything, um, and yeah, the charges were on there.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have an online account set up already?
[CUSTOMER][NEUTRAL] I do not, um.
[AGENT][NEUTRAL] OK, do you want to set one up?
[AGENT][NEUTRAL] I can help you.
[CUSTOMER][NEUTRAL] Um, I also just, I guess there's, um, a way to send free faxing for my phone, so I think um.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh, that's nice.
[CUSTOMER][NEUTRAL] Gotta try to do that. Yeah, I'm gonna try to do that if if that's the thing, um.
[AGENT][NEUTRAL] How do you do that? Do you have Adobe or something like that that allows you to fax it?
[CUSTOMER][NEUTRAL] Guess it's an app. It's just called Facts.
[AGENT][POSITIVE] Oh, that's pretty cool.
[CUSTOMER][NEUTRAL] Yeah, yeah, so um I'd rather just do that to make a whole account, um.
[AGENT][NEUTRAL] OK. I'll give you the fax number. Let me know when you're ready.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, what's the phone number?
[AGENT][NEUTRAL] The fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 942 [PII].
[AGENT][NEUTRAL] Attention claims.
[CUSTOMER][NEUTRAL] Oh, I don't know if I could do that.
[CUSTOMER][NEUTRAL] I knew the number.
[AGENT][NEUTRAL] I'm sorry? Well, just enter the number. Yeah, just enter the number. That's fine. That's fine.
[CUSTOMER][NEUTRAL] I don't know if I can
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's actually if you put a cover page with it. If not, that's fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I just sent it, so.
[AGENT][NEUTRAL] OK. And so it usually takes about 24 to 48 hours to be uploaded into your file where you know it could be seen, so allow at least that time.
[AGENT][NEUTRAL] And then you may wanna call back to verify that we received it or that it's in your file.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] OK, fantastic.
[CUSTOMER][NEUTRAL] Sorry, one moment.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Does that give you a confirmation that it was sent successful?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, it said it, it's, oh, it said it's gonna take upwards of 4 minutes, but um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I just wanna make sure you guys get it [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How's your day going?
[AGENT][POSITIVE] It's going good.
[AGENT][NEUTRAL] And yours?
[CUSTOMER][NEUTRAL] Great, um, by the way, this, this app does cost money, but they let me do the first one free, for free, so that was.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, that's good. How much is it, is it like a monthly subscription or something like that?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Yeah, like 30 a month, which is ridiculous because I can fax for free for my job, but I just, I'm not.
[AGENT][NEUTRAL] That is
[AGENT][NEUTRAL] Exactly, and you may not have that many faxes.
[AGENT][POSITIVE] You know, worth $30.
[CUSTOMER][NEUTRAL] Never. this is the first time I've ever had to, you know.
[AGENT][POSITIVE] Yes, exactly. That's a lot.
[CUSTOMER][NEUTRAL] OK, they sent it, they said it delivered. Oh wait, what the heck?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] No, they didn't even send over what I had to send shoot, OK, um.
[CUSTOMER][NEUTRAL] It was like an actual.
[AGENT][NEUTRAL] You should get a confirmation that says, um, approved or something.
[CUSTOMER][NEUTRAL] Yeah, but they sent like a photo that said like it was just saying that this is a a test fax.
[CUSTOMER][NEUTRAL] Um, OK, so.
[CUSTOMER][NEUTRAL] Maybe set up an account online.
[AGENT][NEUTRAL] Uh-huh, it's not hard, it's real quick. Um, let me give you the address.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me know when you're ready.
[CUSTOMER][NEUTRAL] OK, what is it?
[AGENT][NEUTRAL] Um, it's [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] The word [PII], so that should be secured. [PII].
[CUSTOMER][NEUTRAL] Alrighty and then um log in.
[AGENT][NEUTRAL] You're gonna, you're going to feel, uh-huh.
[CUSTOMER][NEUTRAL] Um, this new user.
[AGENT][NEUTRAL] And then the information that you verify, you'll select which role that best describes you.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then
[CUSTOMER][POSITIVE] Perfect
[AGENT][NEUTRAL] Uh, the, the answers that you answer has to match basically what you verified.
[CUSTOMER][POSITIVE] Got it. Alrighty.
[CUSTOMER][NEUTRAL] Almost done.
[AGENT][NEUTRAL] No rush.
[CUSTOMER][NEGATIVE] Oops, there seems to be a problem. Yeah, because I tried this yesterday and it didn't work too. I put in my last [PII]
[AGENT][NEUTRAL] Can you spell your last name?
[AGENT][NEUTRAL] OK, that's what we have. And your social security number, is that what you entered or did you enter the policy number?
[CUSTOMER][NEUTRAL] Yeah, I entered my social security number.
[AGENT][NEUTRAL] OK. And what is your social?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] We do not have that as your social. Give me a second.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] 46 times
[CUSTOMER][POSITIVE] I'm almost 100% positive that it's my social.
[CUSTOMER][NEUTRAL] Was it, was it off by a number?
[AGENT][NEUTRAL] Give me, give me
[AGENT][NEUTRAL] Uh-huh, give me that one more time.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Who is your employer?
[CUSTOMER][NEUTRAL] I'm self-employed.
[AGENT][NEUTRAL] Who did you enroll through?
[CUSTOMER][NEUTRAL] Myself.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Like I don't, yeah.
[CUSTOMER][NEGATIVE] No one's helping me pay for this.
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] C
[AGENT][NEUTRAL] you
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm gonna give you your member ID.
[CUSTOMER][NEUTRAL] Oh, I'm sorry, I can't hear. I, oh, I can't hear you very well.
[AGENT][NEUTRAL] What about now?
[AGENT][NEUTRAL] Is that better?
[CUSTOMER][NEUTRAL] Oh yes, yes, now I can hear you.
[AGENT][NEUTRAL] OK, with my earphone. OK, so, um, you have a member, a unique member ID under your policy, so instead of using your social, I'm gonna give you the member ID number to to put in there in place of the social.
[CUSTOMER][POSITIVE] Perfect. OK, what is that?
[AGENT][NEUTRAL] It's 681.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, that works.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Fantastic. OK, I'm gonna make a username very quickly it sounds like it can just be my.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And no rush, and then I'll um
[AGENT][NEUTRAL] Show you how to set up the account.
[AGENT][NEUTRAL] Or where to go to upload your claim, you're setting up the account now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] How is it going?
[CUSTOMER][POSITIVE] Amazing. I just logged in. Sorry, I, OK, the password. I just got the tag. Oh wait.
[AGENT][NEUTRAL] OK. That's OK.
[CUSTOMER][NEUTRAL] No, I did not, yeah.
[CUSTOMER][NEUTRAL] Oh, I do not need to get that actually just get that stuff.
[CUSTOMER][NEUTRAL] OK, so now upload file.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] OK, I just uploaded it.
[AGENT][NEUTRAL] OK, so let me go back to your file.
[AGENT][NEUTRAL] Let me give it a few seconds because sometimes we're able to see it, it uploads pretty quick.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] O
[AGENT][NEUTRAL] And you gave me your claim number. Do you want to write down your policy number or do you have that?
[CUSTOMER][NEUTRAL] I'll write that down.
[AGENT][NEUTRAL] Um, it is 246.
[AGENT][NEUTRAL] 9551.
[AGENT][NEUTRAL] And I do see the claim in your file so let me take a look at it.
[AGENT][NEUTRAL] OK, so, OK, let's see.
[AGENT][NEUTRAL] Is it 4 pages?
[AGENT][NEUTRAL] Of the claims?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so this is the CMS 1500 form and I don't see that code on this form.
[AGENT][NEUTRAL] At the bottom. So this is it. This has all the information.
[CUSTOMER][POSITIVE] Oh fantastic, that is great news, thank you.
[AGENT][POSITIVE] You're very welcome. And did you have any other questions? So,
[AGENT][NEUTRAL] Do you have any other, OK, so our standard processing time is uh 7 to 10 business days from the date that we receive it.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] And it could be processed before then, but that's just our standard turnaround time.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you could call back within 2 or 3 days, maybe 4, and see if it's been processed, but give a maximum of 1010 business days, 10 days.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect, that sounds great.
[AGENT][NEUTRAL] All right, anything else I can help out with today, [PII]?
[CUSTOMER][NEUTRAL] Uh, nope, um, wondering if you could give me any insight of like possibly if you have a feeling of what could be done or is that like a premature question?
[AGENT][NEUTRAL] What can be done as far as.
[CUSTOMER][NEUTRAL] Like, I guess, claim.
[AGENT][NEUTRAL] What do you mean? Like a payment?
[CUSTOMER][NEUTRAL] I don't know, maybe, yeah, yeah.
[AGENT][NEUTRAL] Yeah, yeah, it'll have to be reviewed uh by the examining team and we correspond via mail, so you'll receive an explanation of benefits, um.
[AGENT][NEUTRAL] In the mail
[AGENT][NEUTRAL] Um,
[CUSTOMER][POSITIVE] OK great.
[AGENT][NEUTRAL] Yeah, once it's processed, uh, the explanation of benefits is mailed out the next business day.
[CUSTOMER][NEUTRAL] OK, perfect and there's so there's no um.
[CUSTOMER][NEGATIVE] I'm not gonna be able to check this portal for anything really.
[AGENT][NEUTRAL] Um, so once the claim is processed, the explanation of benefits will be uploaded in your, your account, your online service account the next business day.
[CUSTOMER][NEUTRAL] Oh, but then also you'll.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] And we mail it out as well we mail it out as what well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, so I'll be able to find it on the portal once it's posted.
[AGENT][NEUTRAL] Right, and did you notice there was a feature that um you could opt in to receive a text message when the claim is processed?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Did you opt in for that?
[CUSTOMER][NEUTRAL] I didn't, but I assume you know you guys would also send an email, so I think that's plenty.
[AGENT][NEUTRAL] Yeah, we will not send an email you'll get correspondence via mail in the mail.
[CUSTOMER][POSITIVE] Oh, that's fine, no worries. Thank you so much for all your help. I appreciate it.
[AGENT][NEUTRAL] OK, all right.
[AGENT][POSITIVE] All right, [PII], no other questions, thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Uh bye bye.