AccountId: 011433970860
ContactId: f6f291f2-6b92-408c-b466-45f9fcb0070c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1205050 ms
Total Talk Time (AGENT): 307574 ms
Total Talk Time (CUSTOMER): 407229 ms
Interruptions: 3
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/f6f291f2-6b92-408c-b466-45f9fcb0070c_20250107T14:39_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] Hi, yes, um, I'm trying to get, um, some of my, uh, uh, download some of my claims from my account, and I'm getting an error message on some of them.
[AGENT][NEUTRAL] OK, um, I can assist you with the online service center. Um, may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII], and the phone number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have your policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, let me grab it.
[AGENT][POSITIVE] OK, take your time.
[CUSTOMER][NEUTRAL] Actually.
[CUSTOMER][NEUTRAL] In my email.
[CUSTOMER][NEUTRAL] OK. It is
[CUSTOMER][NEUTRAL] 02111316
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the um your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] Uh, yeah, [PII], um, mailing address is [PII].
[CUSTOMER][NEUTRAL] [PII] and email is my name [PII].
[AGENT][POSITIVE] Alright, and thank you so much for verifying. So for the mailing address we have on file, it's uh
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] It's stemming, yeah, I moved so I can, we can update that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then can you repeat the new address? I'll type it in here.
[CUSTOMER][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] North Dayton, D A Y T O N.
[CUSTOMER][NEUTRAL] Street
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Apartment 2.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And zip code [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, so I've updated that for you.
[AGENT][NEUTRAL] And then which claims um are giving you an error?
[CUSTOMER][NEUTRAL] Let's see, um.
[CUSTOMER][NEUTRAL] 354-700-05
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Then there's 350-1310.
[CUSTOMER][NEUTRAL] And then.
[CUSTOMER][NEUTRAL] Um, there's one that comes up. Let me make sure I'm not giving you the one that comes up.
[CUSTOMER][NEUTRAL] Let me check this one quickly.
[CUSTOMER][NEUTRAL] See.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] OK, that one does come up. OK, so it looks like it is those.
[CUSTOMER][NEUTRAL] 2.
[AGENT][NEUTRAL] Just those two?
[CUSTOMER][NEUTRAL] They aren't coming, yeah.
[AGENT][NEUTRAL] OK, and what type of error is it giving you?
[CUSTOMER][NEUTRAL] It just says I'm getting the message that says getting your file and then it'll go to a screen that's like we're having, oh wait.
[CUSTOMER][NEGATIVE] I just did it to get an example and now that's downloading which I've never been able to to hold on.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It just, you just needed to call me, that's all.
[CUSTOMER][NEGATIVE] Uh, sometimes that's how it works, right? It was like, oh no, I'm gonna get in trouble.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Like when you're trying to take your car to get fixed.
[CUSTOMER][NEUTRAL] Oh, OK, so I did get.
[CUSTOMER][NEUTRAL] Yeah, exactly. OK, so I did get an error message. So it says oops, there's been an error. It looks like we're experien technical difficulties. So do you mind if I just, because I have a few, but sometimes they work, sometimes I don't, so can I just confirm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, that I'm giving you the right ones that work and don't work.
[CUSTOMER][NEUTRAL] So let me see this one.
[AGENT][NEUTRAL] Yeah, and if you'd like, I can um I can email you a copy of your explanation of benefits. Um, the ones that you're giving me though, like the 7005. I was trying to see if it wasn't showing cause like those two were denied, but still you should still have the explanation of benefits on there. So something might be going on, but I can email it to you if you like.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Yeah, that would be great.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] See, see, now I can't find the ones that aren't see that one download, OK, let me see this.
[CUSTOMER][NEGATIVE] Oh, that's really frustrating.
[AGENT][POSITIVE] Oh, take your time. You're totally fine.
[CUSTOMER][NEUTRAL] Yeah, because now they're all downloading and I, I mean I've been trying like for a while, like multiple times, so I don't know.
[AGENT][NEUTRAL] Well, you know what, to be honest, so the online service center links with our, like it's linked with our server like system here and we've been having like system issues, so maybe that's why it's kind of spotty.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so yeah, so sometimes, sometimes if I click it, I get an error message and sometimes I don't. It's what I'm starting to figure out because the ones that were giving me problems before aren't, but now ones that I were able to download now I can't. So I think it's just a matter of the.
[AGENT][NEUTRAL] That might, that might be.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, that might be what's going on and it's making the online service center, yes.
[CUSTOMER][NEUTRAL] The portal.
[CUSTOMER][NEUTRAL] Yes, OK, so, um, that being said, I did.
[CUSTOMER][NEUTRAL] Let me see what I've been able to download.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so some of them I'm getting a message saying our records indicate that premium for this service date was not received. I'm trying to figure out.
[CUSTOMER][NEUTRAL] Why that is.
[AGENT][NEUTRAL] OK, so you know how your payments come through, um, like payroll deduction?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Like when your payments come out, it doesn't come straight to us. It goes out payroll deduction and then the like your group, your employer sends it to us. So somewhere between the payroll deduction and sending to us, um, that's just saying that we haven't received it yet.
[CUSTOMER][NEUTRAL] So do you think that
[CUSTOMER][NEUTRAL] It's something to do with my employer then?
[AGENT][NEUTRAL] Well, hold on one moment, let me go here and see.
[CUSTOMER][NEUTRAL] Because as far as I'm aware I've like it's been deducted from my payroll every week.
[AGENT][NEUTRAL] So, we, so there's two things. So we have to
[AGENT][NEUTRAL] Yes, we haven't received the funds yet, but we also have to check weekly, um, because you know how like, you know, if one week you might be working one week, depending on, you know, your contract or whatever. So that's when we work with the temp agencies, we just have to check weekly, but um for your particular
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I mean I was working that whole time there was one week in January where I wasn't but like these are not from January, so it wouldn't be an issue of me not working that day or if if you need to check, you would see that I, I was working that week and that I did have.
[CUSTOMER][NEUTRAL] A paycheck for that week.
[AGENT][NEUTRAL] Right, right, I don't mean like you specifically. I'm just saying any of our groups that are, we, we check with them weekly.
[AGENT][NEUTRAL] Because, yeah, not.
[CUSTOMER][NEUTRAL] Totally. OK, so how do I
[CUSTOMER][NEUTRAL] Yeah, yeah, of course, but how do I fix that? Because like, I like if I'm being denied coverage because
[CUSTOMER][NEGATIVE] Uh, you know, you're not getting a payment, but I'm getting.
[CUSTOMER][NEUTRAL] Deducted from my payroll. I like I'm just trying to figure out what I do with that.
[AGENT][NEUTRAL] It's taken out of your paycheck.
[AGENT][NEUTRAL] So the the only thing you can do is reach out to your benefits department and let them know that you um received an explanation of benefits from your insurance and it and just read them out that statement and
[AGENT][NEUTRAL] Get make them, they're gonna have to answer. They're gonna have to let you know what's going on. It could just be something of um
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, I don't even, I like the files, you know, it's just coming over and it hasn't hit. I mean like your policy is active for sure, but um that's the only, that's the only I guess option would be to reach out to them and let them know.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Are you able to see from um.
[CUSTOMER][NEUTRAL] The claims that I have that like were denied for this reason, like, if I were to like fix that and get, you know, um
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] Get it to show that the premium was.
[CUSTOMER][NEUTRAL] If I were able to fix it on that end, would it, yeah, would then that change some of the claims?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh yeah, so.
[CUSTOMER][NEUTRAL] Like, would you be able to cover, are you able to see if like some of the services that are on these claims that you guys would cover them then?
[AGENT][NEUTRAL] Well, we can't really guarantee anything until the examiner examines it, but for those two, well, actually it looks like it's 3 that have that denial reason, yes, once, once that for for whatever week that was, once that's rectified, yes, that claim can be reprocessed.
[CUSTOMER][NEUTRAL] No, of course. Right, of course.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK, well, this uh
[CUSTOMER][MIXED] It says another layer to a very messy situation, but OK, I'll follow up with them.
[AGENT][NEUTRAL] And did you, you want me to, did you still need the um explanation of benefits to you or those did come up? I wasn't sure.
[CUSTOMER][NEUTRAL] Yeah, um.
[CUSTOMER][NEUTRAL] Are you able to just send me all in one email all of the.
[AGENT][NEUTRAL] Explanation of benefits, yeah.
[CUSTOMER][NEUTRAL] Explanation of benefits for everything that's for the group hospital indemnity, not the dental. I don't need those.
[AGENT][NEUTRAL] Yeah, I can send you the explanation of benefits. I can send them to you in an email. I'll just attach them to the email. So it's a total of 245. So you'll have 5 different attachments, but it'll be all the explanation of benefits.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, and then I can send that to uh the ones that are being denied for that reason to them. OK, that would help thank you.
[AGENT][NEUTRAL] You're very welcome. So I'm typing that up for you now. Um, give me about maybe 5 minutes and I'll have that over to you. Or did you want to hold while I do it?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][POSITIVE] Um, yeah, that would be great.
[AGENT][NEUTRAL] OK, well, hold on one moment, OK?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yep, I know.
[AGENT][NEUTRAL] Oops, I clicked the provider. I'm glad I saw that. Hold on, wrong one.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Oh Lord, I thank you.
[AGENT][NEGATIVE] Oh, come on.
[AGENT][NEGATIVE] Not the last one on base.
[AGENT][POSITIVE] Yes, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What's up with on base?
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So I just sent the email over to you, um, so you should be receiving it. Let me know, um, you might have to look in your spam, but it's coming from care team.
[CUSTOMER][NEUTRAL] Uh, from, sorry, say that again. It's coming from.
[AGENT][NEUTRAL] From the care team?
[CUSTOMER][NEUTRAL] OK, [PII], OK.
[AGENT][NEUTRAL] So let me know when you receive it.
[CUSTOMER][NEUTRAL] All right, I'll yeah, let me see.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] No, I haven't talked to them about this.
[CUSTOMER][NEUTRAL] Ah, there it is.
[AGENT][NEUTRAL] You got it? OK.
[CUSTOMER][NEUTRAL] OK, thank you. And then you might be hearing from me again if uh cause I'm gonna talk to um the benefits provider next, so.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] OK. Well, if there's anything we can assist you with, just let us know, um, but that's all 5 of them there for you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK great thank you.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] That's it for now.
[AGENT][POSITIVE] Alright, well, thank you so much for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] Thanks you too.
[AGENT][POSITIVE] Thank you. Bye bye.