AccountId: 011433970860
ContactId: 00275dc3-7a5a-4f65-815a-bdde5aa66f93
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 512840 ms
Total Talk Time (AGENT): 217936 ms
Total Talk Time (CUSTOMER): 261188 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/00275dc3-7a5a-4f65-815a-bdde5aa66f93_20250102T22:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Yes, [PII], thank you for picking up my call. My name is, uh, [PII]. I am currently, uh, insured with you, and, uh, that's through my employer. He, they, they, they gave me this insurance for my co-payments, deductible, emergency assistance, and so on.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I have here, I'm in the web of my, uh, in my account in the web. I have here policy number 22.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 33
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 045.
[CUSTOMER][NEUTRAL] For one, but I think that's a claim number.
[AGENT][NEUTRAL] For
[AGENT][NEUTRAL] OK sorry that was 223-3045?
[CUSTOMER][NEUTRAL] 4141.
[AGENT][NEUTRAL] For one, OK.
[AGENT][POSITIVE] Let's see, and I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, that's my policy number looks like.
[AGENT][NEUTRAL] OK, yeah.
[AGENT][POSITIVE] Alright, and really quick, [PII], if you don't mind, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, my number actually [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what was your last name [PII]?
[CUSTOMER][NEUTRAL] [PII]. My date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. I'm just gonna verify a couple other pieces of information really quick if I can get your mailing address please.
[CUSTOMER][NEUTRAL] The postal one?
[AGENT][NEUTRAL] Um, let's see, I've got an address for, uh, [PII].
[CUSTOMER][NEUTRAL] Yeah, that's me, the [PII].
[AGENT][NEUTRAL] That's it. OK, yes, thanks for verifying that, right, last thing I need is the email address that we've got on file for you. uh, looks like it is a Yahoo account.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm. Yeah, that's [PII], one of them.
[AGENT][POSITIVE] Yes, it's [PII]. OK, yes, thank you so much for verifying that information, [PII]. Alright, and uh what can we help you with today?
[CUSTOMER][NEUTRAL] Yeah, I'm just uh looking around my claims uh of the last year I understand my my benefit just renewed now on uh [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And um as I see, well, uh, I don't know if um I had a surgery on.
[CUSTOMER][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] And I don't know, I'm not aware if they already filed this uh claims, uh, the doctor at least, well, they were, um, somehow verifying with you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And according to the verification back then, they just told me, OK, uh the $800 with the doctor, with the doctor, with the surgeon, I mean, uh, are covered by you, that's my, my co-pay, that's my participation and the facility wanted, oh not that they wanted like 3000.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And a little bit more and then I didn't have so much more benefits and and you were going to call back a part of it and I was responsible for 1000 and something but I don't know if they already submitted this claim. The surgeon at least is billing me is billing me for the.
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For the copay and uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, just to verify, [PII], I'm sorry, you did say that was [PII] of last year, correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so yeah, I did look um we've not received anything for that date of service uh so if I were you I would definitely reach out to them see if they're planning on filing with us if not um or if they're seems like they're giving you a run around or you're not sure, um, you can absolutely still file those claims.
[CUSTOMER][NEUTRAL] I can submit the claim on my own, right?
[AGENT][POSITIVE] Oh yes, absolutely.
[CUSTOMER][NEUTRAL] OK, then they already sent me a bill. I can send you this bill and then the EOB from the insurance.
[AGENT][NEUTRAL] Uh, yeah, yes.
[CUSTOMER][NEUTRAL] And should I have a payment received or uh or not?
[AGENT][NEUTRAL] OK, so just uh backing up just a minute just so that you are aware um I'm not sure what all information they did send you so on the itemized statement it also does need to show any diagnosis or procedure codes if that's not something you've received.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, then they can give that to you so that with the explanation of benefits from your primary, that's perfect, um, so you've got a couple of different options of course you know I, I would think it'd be the easiest if they filed the claim for you just so that you didn't have to worry about all that um but again if not give us that information you have the option if you haven't already to set up direct deposit and we could put it directly into your bank account, otherwise we would be mailing a paper check to you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK then I should have a payment somehow uh with the provider and then um.
[CUSTOMER][NEUTRAL] Uh, yeah, I should submit a payment. I don't know, with my account or on my credit card, and then I can file with you the reimbursement, right?
[AGENT][NEUTRAL] Well of course I don't want you uh stressing about it um before you submit anything I would reach out to them and ask if they are planning on submitting a claim to us um just you know maybe they forgot.
[CUSTOMER][NEGATIVE] I don't know what they say something and then they don't do it. Uh, it's like, I don't know if they are really organized, you know.
[AGENT][NEUTRAL] Well, that's true, um.
[CUSTOMER][NEGATIVE] They, they were, uh, we, we arranged they submit they filed a claim with you and yes, that's OK, but now they are billing me and they didn't file a claim to you that's uh.
[AGENT][NEUTRAL] OK. Now,
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] I will say um I do see that today we did receive a couple of pieces of claim information for you. It does say [PII], um, and it is in line for processing so I'm unable to see what it is at the moment, um, but that could very well be them unless you're expecting something else.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm. OK, I'm better I wait, so like a week or more, and then we'll see.
[AGENT][NEUTRAL] So yeah, so typically it takes um it can take up to 7 to 10 business days for claim information to process uh but if you wanna be safe I mean you can call whenever you'd like and we can check on it for you so you know you could call back um Monday even um and we'll see if we've got an update for you at least so you can see what it is.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] No, I, I will let it a couple of days so that you can process it and then I will uh reach out again, OK?
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Absolutely sounds good. Was there anything else I can help you with, [PII]?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well, no, I was going to ask what was the remaining benefit for my last year, but uh since uh we have.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Let's check that out.
[AGENT][NEUTRAL] Uh, this was for outpatient, correct?
[CUSTOMER][NEUTRAL] Outpatient, yes. I was, uh, thanks [PII] not admitted.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, OK, give me just a moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the total benefit amount was 4500 and you used.
[AGENT][NEUTRAL] $1,062.89. So, remaining for last year is $3,437.11.
[CUSTOMER][POSITIVE] OK, perfect. Then in this case, I think, yes, I will have some.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Yeah, some benefit on that, uh, with the deductible for this surgery. Thank you.
[AGENT][POSITIVE] Of course, yes, definitely.
[CUSTOMER][NEUTRAL] Uh, OK, I will allow some days, some days until, uh.
[CUSTOMER][NEUTRAL] Things are processed or they file it I don't know.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] We will see.
[AGENT][POSITIVE] Alright, yes ma'am, sounds good.
[CUSTOMER][POSITIVE] OK then thank you very much and have a great afternoon, right?
[AGENT][NEUTRAL] All right, yeah.
[AGENT][POSITIVE] Thanks for calling APL. Thank you. You too. Bye-bye.
[CUSTOMER][NEUTRAL] But