AccountId: 011433970860
ContactId: 0088c498-1cf9-4ee5-9a35-8d4f9e469111
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1142040 ms
Total Talk Time (AGENT): 471549 ms
Total Talk Time (CUSTOMER): 173444 ms
Interruptions: 5
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/0088c498-1cf9-4ee5-9a35-8d4f9e469111_20250424T12:04_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. I received a notice in the mail.
[CUSTOMER][NEUTRAL] Um, APL.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I think it might be uh.
[CUSTOMER][NEUTRAL] What can I call it miscommunication or fraud something?
[AGENT][NEUTRAL] OK, so you have, you said that you have received something from APL but you believe that it could be fraud. You should not have received it?
[CUSTOMER][NEUTRAL] Yeah, cause I never, I was never hospitalized.
[AGENT][NEUTRAL] OK, yes, I
[AGENT][POSITIVE] Well, I'll be happy to do you have a policy with our company?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] The number here is 02.
[AGENT][NEUTRAL] Yes, sir. Do you have a policy with AP?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] We keep breaking up.
[AGENT][NEUTRAL] Yes, sir, and unfortunately, I can't do anything about that. I'm so sorry.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And who am I speaking? Well, first off, before I can provide you any information or try and help you with this, who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, mhm. OK, thank you. And Mr. [PII], what is a good callback number for you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And the policy number that's on the information you received?
[CUSTOMER][NEUTRAL] 02501263
[AGENT][NEUTRAL] OK, thank you. So give me a moment please to get that information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. So, Mr. [PII], I will have to verify several things with you first, for security purposes.
[AGENT][NEUTRAL] So first off, if you could, because you do have a policy with us, uh, what is your date of birth?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you. Also your home mailing address, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Huh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. The phone number that that we have on file for you is different than the one you gave me. What is another phone number we could have?
[AGENT][NEUTRAL] Ends in [PII].
[CUSTOMER][NEUTRAL] I don't know what other number you can have.
[AGENT][NEUTRAL] And maybe it's a work number. I'm not sure. Yes, sir.
[CUSTOMER][NEUTRAL] And then [PII]?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Nope, that's the only number I have. That's my cell number and that's all.
[AGENT][NEUTRAL] OK, what is your email?
[CUSTOMER][NEUTRAL] There is no other phone number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][POSITIVE] OK, did you, please repeat that one more time. I'm so sorry. I think I missed part of it.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] No, it's OK. [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] The number [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, thank you, and the last four of your social.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. So the phone number that we have on file that we received with your enrollment information is [PII].
[CUSTOMER][NEUTRAL] I never put that number. I don't know where that number came from.
[AGENT][NEUTRAL] And that's not a work number maybe?
[AGENT][NEUTRAL] Sometimes we receive work phone numbers. OK.
[CUSTOMER][NEUTRAL] Nope, sure ain't.
[CUSTOMER][NEGATIVE] Nowhere near it.
[AGENT][NEGATIVE] So let me get, let me get rid of this.
[AGENT][NEUTRAL] Alright, so [PII] is your correct number.
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And we show that you're employed with Fisher Island correct?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] Alright, so this claim that we have on file for you, we only have one claim. Is there a claim number? I wanna make sure that.
[CUSTOMER][NEUTRAL] 35
[AGENT][NEUTRAL] Of what I'm looking at and what you have are the exact same. Uh-huh.
[CUSTOMER][NEUTRAL] 89.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 358-92229.
[AGENT][NEUTRAL] OK, thank you. So yes, sir. So I see that this is for a date of service back in December.
[AGENT][NEUTRAL] For plantation general.
[CUSTOMER][NEUTRAL] I was never hotspot in December.
[AGENT][NEUTRAL] Oh hospital.
[CUSTOMER][NEUTRAL] I was never there. I was never hospitalized.
[AGENT][NEUTRAL] All right. So give me a moment to look at uh some things.
[AGENT][POSITIVE] OK, well, that's great. Nobody ever wants to be hospitalized. So, let me see, um,
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You did not, were you there on an outpatient basis?
[AGENT][NEUTRAL] Did you have any type of outpatient procedure done?
[CUSTOMER][NEGATIVE] I was never there. I was never there. I was never ever in my life, never, ever, ever there.
[AGENT][NEUTRAL] Never ever there.
[AGENT][NEUTRAL] OK. All right. So let me just look at what we received.
[AGENT][NEUTRAL] It's gonna take just a moment.
[AGENT][NEUTRAL] Um, for this information to load.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] I can see where this is gonna be an interesting day to have a call.
[AGENT][NEUTRAL] I'll start out with, um, you're my first person night today.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And, uh, Mr. [PII], we
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And we've received a claim that you say you were never at this facility.
[CUSTOMER][NEUTRAL] Nope.
[AGENT][NEUTRAL] And just while I'm waiting on this information to load for [PII], have you ever set up your profile in the APL online service center so that you can have access to your information online?
[AGENT][NEUTRAL] As far as like if you needed.
[CUSTOMER][NEUTRAL] Sure they're not.
[AGENT][NEUTRAL] Additional ID cards or a question information. OK, if you think that that is something you would be interested in, I would be happy to.
[AGENT][NEUTRAL] Email you the user guide that explains that.
[AGENT][NEUTRAL] And the different things that you can do in the portal once it has been set up if you would like for me to do that if you think that is something you would be interested in.
[CUSTOMER][POSITIVE] No, not right now, thank you.
[AGENT][NEUTRAL] Setting up.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, Mr. [PII]. I'm gonna have
[AGENT][NEUTRAL] A look, um, give me just a moment, a different way.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you for your patience.
[AGENT][NEUTRAL] OK, Mr. [PII], so I'm honestly not sure based on the information we received.
[AGENT][NEUTRAL] What I have on here is
[AGENT][POSITIVE] Looking out with an explanation of benefits.
[AGENT][NEUTRAL] From a United Healthcare. The name.
[AGENT][NEUTRAL] It has [PII] on here.
[AGENT][NEUTRAL] So what we need to do is to do some research to see if there is another [PII] Valley that this should have been put on there.
[AGENT][NEUTRAL] Um,
[AGENT][NEGATIVE] Information instead of yours on what I'm looking at, I'm not able to tell that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I can take it up my.
[AGENT][NEUTRAL] That appears to
[CUSTOMER][NEUTRAL] My HR office and let them be aware of as well.
[AGENT][NEUTRAL] Yes, because all I'm looking at is an yeah, let's see.
[CUSTOMER][NEUTRAL] So they have an idea what's going on.
[AGENT][NEUTRAL] Let me look to see how many other potential members we may have.
[AGENT][NEUTRAL] With the same name.
[AGENT][NEUTRAL] And I'm so sorry. I'm on a different screen now. Could you please repeat the last four of your social for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so yeah, I, I don't see another individual by the same name as you in our system.
[AGENT][NEUTRAL] And again, based on this in the explanation, I I'll just say the explanation of the of benefits that we received.
[AGENT][NEUTRAL] It's from United Healthcare.
[AGENT][NEUTRAL] Uh, let me look at, and your employer shows United Healthcare.
[CUSTOMER][NEUTRAL] Weird
[CUSTOMER][NEUTRAL] I'm gonna have to take it with identify what happened.
[AGENT][NEUTRAL] So you've not received any medicals on that data service.
[AGENT][NEUTRAL] Yeah, you haven't received any type of medical services.
[CUSTOMER][NEUTRAL] None.
[AGENT][NEUTRAL] Um, what, let me go back to that data service.
[CUSTOMER][NEGATIVE] None at all.
[AGENT][NEUTRAL] Well, you said none at all, so I don't guess the state of service really matters. 12 9.
[AGENT][NEUTRAL] In back in December.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK. So, yes, sir. I mean, I guess you, if I were you, I would reach out to my HR department.
[AGENT][NEUTRAL] Because again what I'm looking at is an explanation of benefits.
[AGENT][NEUTRAL] From United Healthcare.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][POSITIVE] No worries. I can go to my HR department and have them see if they can fix it for me.
[AGENT][NEUTRAL] Yes, sir, I would say that that's a little.
[AGENT][NEUTRAL] Yes, sir. I would say that that is odd, um.
[CUSTOMER][NEGATIVE] Very odd.
[CUSTOMER][POSITIVE] All right, no harm done. I'll take it up with them and then let's see what happens after that.
[AGENT][NEUTRAL] Um, now, let me ask you one thing. Do you happen to have
[AGENT][NEUTRAL] I don't know if this is your
[AGENT][NEUTRAL] Primary
[AGENT][NEUTRAL] Insurances
[AGENT][NEUTRAL] ID number. It has insured ID and it is an explanation of benefits from United Healthcare. Do you happen to have your ID?
[AGENT][NEUTRAL] card for your primary insurance handy matches.
[AGENT][NEUTRAL] What the explanation of benefits shows.
[CUSTOMER][NEUTRAL] Let's see here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh do do do do.
[CUSTOMER][NEUTRAL] He doesn't say anything.
[AGENT][NEUTRAL] On your United Healthcare?
[CUSTOMER][NEUTRAL] That's my member ID number and group number.
[AGENT][NEUTRAL] What does
[AGENT][NEUTRAL] On your um United Healthcare, what does it show as your mem maybe it's just worded a little different. What is the member ID?
[CUSTOMER][NEUTRAL] 468
[CUSTOMER][NEUTRAL] 67565
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm. And that's the only number that's on your ID card for?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, sir. I don't see that number on this information.
[CUSTOMER][NEUTRAL] No worries. I'll just go to my HR office and uh.
[AGENT][NEGATIVE] At all.
[AGENT][NEUTRAL] That we received.
[CUSTOMER][POSITIVE] We'll take care from there.
[CUSTOMER][NEUTRAL] Hopefully get this resolved.
[AGENT][POSITIVE] Oh, I'm so sorry about any confusion, but I
[AGENT][NEUTRAL] Yes, sir. I'm gonna send this back just a ticket, explaining that I had talked to you, um, you know, in just the circumstances.
[CUSTOMER][NEUTRAL] No, no heart or foul.
[AGENT][NEUTRAL] To see if they can look into this a little more themselves, but yes, sir, based on the information that you have provided for me and the.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The number that you just gave me is your is your your United Healthcare, and you said that's your ID number, correct?
[AGENT][NEUTRAL] Our member ID?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK. Yes. OK, yeah, that doesn't match what we received. So, um,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, I will I I I'm kind of bumfuzzled at this because I, I just lost on it, but I will send a ticket asking them to research this a little further based on our conversation.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Sounds good and I'll take it on my end.
[AGENT][NEUTRAL] OK, Mr. [PII]. Well, is there anything else that I could help you with this morning?
[CUSTOMER][POSITIVE] Uh, nope, that was all. Thank you.
[AGENT][POSITIVE] OK. Well, thank you. You're very welcome. Thank you for calling APL. I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You as well. Bye-bye now.
[AGENT][POSITIVE] Thank you. Bye-bye