AccountId: 011433970860
ContactId: f2e271f5-e345-4d59-87be-3360ca2d2498
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 330440 ms
Total Talk Time (AGENT): 170074 ms
Total Talk Time (CUSTOMER): 115795 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/f2e271f5-e345-4d59-87be-3360ca2d2498_20250606T14:17_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, I wanted to check on a claim. Um, I have to give you my information.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status. Are you the insured or you're calling with the provider's office?
[CUSTOMER][NEUTRAL] Um, I'm insured under my husband, uh-huh.
[AGENT][NEUTRAL] OK. May I have your name and a good contact number?
[CUSTOMER][NEUTRAL] Contact number [PII]. My name is [PII].
[AGENT][NEUTRAL] And Ms. [PII], may I have a good I'm sorry, good contact. May I have your policy number?
[CUSTOMER][NEUTRAL] Policy number 025174775.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And I just need you to verify your date of birth and the mailing address on file.
[CUSTOMER][NEUTRAL] Date of birth is [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And would this be the most recent claim for you, looks like it came in on [PII].
[CUSTOMER][NEUTRAL] Yeah, I got the claim number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's uh 3609838.
[AGENT][NEUTRAL] Mhm hold on one moment.
[AGENT][NEUTRAL] Um, so it was denied requesting additional information. So we received your claim, but we need the itemized bill with the admission and discharge dates and times, and once we receive that, we can go ahead and continue processing.
[CUSTOMER][POSITIVE] So, so y'all have applied for that. I don't have to send that to you?
[AGENT][NEUTRAL] Um, well, we sent this to the provider, like the explanation of benefits. So yes, they, they, they have received it as well as, you know, you've received it as well.
[AGENT][NEUTRAL] So they they know that we need this to send to us.
[CUSTOMER][NEUTRAL] So they'll they'll send you.
[CUSTOMER][NEUTRAL] OK, so they'll send you the information. I don't need to do anything.
[AGENT][NEUTRAL] Right, you don't need to. I mean, if you have it and it'll be because if you have it and can upload it, that would be fine, you know, we'll get it quicker and can process it or you can wait for them to send it to us, whichever you prefer.
[CUSTOMER][NEUTRAL] Yeah, just wait. I don't, I don't have it so um.
[CUSTOMER][NEUTRAL] Let them send it to you so um I'll have to uh check back, OK? And also I wanted to ask you, I was trying to log in online to the website and it's the night I, I don't know if I set up an account set up the account or not. I don't remember.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, well, there's a few things with that. So we just launched our new website last Friday and we've been having a lot of issues. So are you getting like an error message saying no user found?
[AGENT][NEUTRAL] Because that's one of the known. OK.
[CUSTOMER][NEUTRAL] Yeah, I was one, but I can't remember. I can't remember if I set it up or not. Can you check and see if I set one up? I can't, I can't remember where I set it up.
[AGENT][NEUTRAL] Let me see. Mhm, hold on one.
[AGENT][NEUTRAL] Oh it's OK. Hold on one second.
[AGENT][NEUTRAL] Yes, you do. Um, so on the online service center that you're seeing now, um, go ahead and click create a new account. You, everyone has to create a new account because the old system uses the username and password where this one uses your email and password, but it's going to sync and send all the information over to the new system. Um, so just use the create um an OSC account option right there under login.
[AGENT][NEUTRAL] And put that you're an individual and go ahead and go through the prompts and the email is uh Mr. [PII] email.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I need to use he since he's the um cardholder.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um, I need to use his, his phone number and his email address and stuff. OK, alright, I'll go ahead and do that, uh, sometime today and reset the account back up.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now, if you, once you finish that, if you still get the no user found error, then you know it's not anything you're entering. It's what we're trying to work on and fix on our end because that is one of the issues with the login.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, maybe I should just wait a while to y'all get that fixed in, OK, but I can just call and check on with you.
[AGENT][NEUTRAL] Uh, it depends. Some
[AGENT][NEUTRAL] Yeah, cause some, I would still try because some members, once they do do that and they put their their um email and they're able to get in, some members aren't. It's just kind of like touch and go. So I would try it and then if you do get the know user found still, then you know it's not you.
[CUSTOMER][NEUTRAL] OK, so y'all have sent the uh stuff that you need to the doctor's hospital. OK, so um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Just wait, I mean you just wait a couple of weeks and y'all just send me another um text.
[AGENT][POSITIVE] Yes, ma'am. You'll get another text and explanation of benefits with the new decision once we uh reprocess.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] OK, that sounds good. Thank you so much.
[AGENT][NEUTRAL] You're welcome, Ms. [PII]. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Uh, no, I'm, I'm fine with everything. Thank you.
[AGENT][POSITIVE] All right. You're welcome. Thanks for calling APL. Have a great weekend.
[CUSTOMER][POSITIVE] Thank you, you too.
[AGENT][POSITIVE] Thank you, bye bye.