AccountId: 011433970860
ContactId: f60d9706-8587-4473-b0c7-d3854bd5eb54
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 572809 ms
Total Talk Time (AGENT): 311919 ms
Total Talk Time (CUSTOMER): 255210 ms
Interruptions: 4
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/f60d9706-8587-4473-b0c7-d3854bd5eb54_20250106T16:42_UTC.wav
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[AGENT][POSITIVE] Good afternoon thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, [PII]. I'm trying to submit a claim on the website, but it's saying that something is wrong at the moment. So I won't be able, I wasn't able to submit it.
[AGENT][POSITIVE] All right, and I do apologize for any inconvenience. Do you have access to a fax machine?
[CUSTOMER][NEGATIVE] Uh, at this moment it's not working.
[AGENT][NEGATIVE] It's not working because the only other option is to either fax it or mail it.
[CUSTOMER][NEUTRAL] I can't email it, right?
[AGENT][NEGATIVE] Well, our email is not secure and they don't uh prefer that no excuse me, no personal health information is submitted by email.
[AGENT][NEUTRAL] So it needs to be either faxed or mailed.
[CUSTOMER][NEUTRAL] Oh, OK. So, so what do, what, if I, if I fax it, what, what are the requirements for that?
[AGENT][NEUTRAL] Um, you would just fax it to [PII].
[CUSTOMER][NEUTRAL] And then just, and send a copy of the APL card.
[AGENT][NEUTRAL] You can send a card with the claim information yes ma'am.
[CUSTOMER][NEUTRAL] Oh OK, because I called for the to make the the claim, but she told me I needed to submit the documents, but I wasn't able to log in online.
[AGENT][NEUTRAL] Were you not able to log in online? What's your policy number? Let's check and see. What's, do you have your policy number?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Um, it's, uh,
[CUSTOMER][NEUTRAL] Uh 02.
[CUSTOMER][NEUTRAL] 156559 M.
[CUSTOMER][NEUTRAL] L. 7.
[AGENT][NEUTRAL] All right, thank you. And what is your name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII]
[CUSTOMER][NEUTRAL] So [PII], um [PII].
[AGENT][POSITIVE] Alright, thank you.
[CUSTOMER][NEGATIVE] Cause as a new user I'm trying to register and it's saying that my information is not found like my email nothing like that.
[AGENT][NEUTRAL] Well, let me just verify your information. That may be the issue. What is your current mailing address?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what is your phone number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your
[AGENT][NEUTRAL] Your home address?
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright thank you let me check something real quick it might have been that we didn't have an email on file for you.
[CUSTOMER][NEUTRAL] Oh, OK, because it wouldn't let me like as a new register as a new user.
[AGENT][NEUTRAL] I think it will now because we did not have an email on file for you and it has to have an email to be able to link your information are you where you can try it again?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Going in as a new user?
[CUSTOMER][NEUTRAL] OK, and um she told me I needed to file um uh wait, she said a CMS.
[CUSTOMER][NEUTRAL] And the diagnosis of the, so it's 3 things, and the explanation of benefits for my actual insurance, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] So when it says the, the explanation of benefits, it's what, what's the deductible and all that stuff include? That's what it is?
[AGENT][NEUTRAL] Yes, ma'am. So that's how the explanation.
[CUSTOMER][NEUTRAL] So I just take a screenshot, right?
[AGENT][NEUTRAL] You can, you can, you can do it by uh screenshot if it's legible, we can use a screenshot. If not, you can go to the website. Who's your primary insurance with?
[CUSTOMER][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] Uh, United Healthcare.
[AGENT][NEUTRAL] OK, yeah, if you can also go to the website for United Healthcare and look up that claim information.
[AGENT][NEUTRAL] And submit the EOB or explanation of benefits. Now, also, the policy number you gave me, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Cause I'm trying to look, cause I'm sorry, cause I went on the, on the actual website for UnitedCare and it's not, it's giving me the deductible and all that stuff, but it's not giving me um the actual information. I'm not sure.
[AGENT][NEUTRAL] Can you, have you gone to your claims, um.
[AGENT][NEUTRAL] Option
[CUSTOMER][NEUTRAL] Oh, I can find it there.
[AGENT][NEUTRAL] You can now I'm not very familiar with the United website but normally if you go to the claims process what was the date of service?
[CUSTOMER][NEUTRAL] It was [PII].
[AGENT][NEUTRAL] OK, so it wasn't that long ago. So you could pro I think I know on my insurance website I can look at the claims processed in the last 6 months or last month and then I can look through the claims that were processed and find that claim.
[CUSTOMER][NEUTRAL] Cause they
[CUSTOMER][NEUTRAL] So I find that claim, I screenshot it and I send it, right? With this, with the information?
[AGENT][NEUTRAL] Well, you should.
[AGENT][NEUTRAL] Yeah, you should, there should be an option to click on the EOB or explanation of benefits.
[AGENT][NEUTRAL] And then that would you can save actually save that PDF file to your computer and upload it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Cause it's not, it's not giving me the option to like, to download it to my phone.
[AGENT][NEUTRAL] OK, so you can take a screenshot of it, make sure it shows what they applied to your deductible copay or co-insurance for that specific claim.
[CUSTOMER][NEUTRAL] OK, cause it's a normal, I think it's a doctor's visit.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] And also
[CUSTOMER][NEUTRAL] It's a um orthopedics.
[AGENT][NEUTRAL] OK. And also, the policy number you gave me is your old policy number. So,
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] Oh, OK. I don't have the new, I never received the new card for that.
[AGENT][NEUTRAL] OK. Would you like for us to mail it to you or I can email you a copy? Yeah, we'll mail it to you.
[CUSTOMER][NEUTRAL] Uh, please, or you can email it to me.
[AGENT][NEUTRAL] Now also when you set up that account.
[CUSTOMER][NEUTRAL] Mhm, I will need the new one, right? The new email, I mean the new number, same number.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] Yeah, but when you set up that account you can print cards from there as well.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Oh, OK, OK, good deal. Thank you so much for your help, [PII].
[AGENT][POSITIVE] It's my pleasure and also just to let you know in the future, if you give your policy information to the provider, they should be able to file a claim for you and we can pay them direct any benefit if it's payable and then.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because they, they had told me that it was gonna take longer than normal, so I pay out of pocket. So then they told me, oh you, I can, you can email it to them directly and maybe in your behalf it will be faster.
[AGENT][POSITIVE] I got you.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, so if
[CUSTOMER][NEUTRAL] So, yeah.
[AGENT][NEUTRAL] If they did that, then you definitely, if you've already paid it, you need to file for reimbursement. Don't give them double money. Let them do it. You do it.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm sure you already paid enough money.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, last year I paid 800, but I didn't know about the extra insurance I had, so I had to, you know, so my supervisor let me know on it, yeah.
[AGENT][POSITIVE] Oh my goodness.
[AGENT][POSITIVE] Well, I'm so glad she did because um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That way, now I, you can get, you can even go back and if there were services performed that are covered, you can file claims for those as well. So don't forget that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh yeah? Oh, OK. So let me see if I find it and then I'll, I'll see if I can submit it, if it's not too late.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yeah, and I will tell you that a lot of times uh the um portal does work better on a laptop or desktop.
[AGENT][NEUTRAL] So sometimes it
[CUSTOMER][POSITIVE] It will show better, right? Cause sometimes on the phone it doesn't. Yeah, you're right.
[AGENT][NEUTRAL] That's right, yeah, so if you've got a laptop or desktop, you might want to create that account on one of those versus your phone.
[CUSTOMER][POSITIVE] OK, thank you so much for your help.
[AGENT][POSITIVE] It's been my pleasure. Is there anything else I can help you with, Mr. [PII]? And I've already put in a request to mail you a copy of your new card.
[CUSTOMER][NEGATIVE] Uh, no.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] My pleasure. I uh and don't forget to show your APL card when you go for medical services, OK?
[CUSTOMER][NEUTRAL] Mm bye-bye.
[CUSTOMER][NEUTRAL] Oh, you can take these too when you go to to your actual doctor's office as well.
[AGENT][NEUTRAL] So what you'll need to do is to always show your APO card. Let me check your your benefits as well. Let's see if it's in a doctor's office. Now, when you set up that portal, you can also.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, click on the policy number and it will show you your benefits.
[CUSTOMER][POSITIVE] Oh, OK, good deal. Thank you. I didn't know anything, that's why I called.
[AGENT][NEUTRAL] So for the.
[AGENT][NEUTRAL] Yeah, so for the office visit co-pay, your policy does not pay for that, but if they do any services in the doctor's office, treatment, diagnostic testing, that could be covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh, OK, OK, good deal. Thank you so much.
[AGENT][POSITIVE] It's my pleasure, Mr. [PII]. Anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that will be all. Thanks so much. You have a good evening.
[AGENT][POSITIVE] I hope you have a wonderful evening as well. Thank you for calling APL. Take care. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye. Bye bye. You too, bye bye.