AccountId: 011433970860
ContactId: 039d7b64-2979-424d-a162-ed3ea4c906f0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 372579 ms
Total Talk Time (AGENT): 104652 ms
Total Talk Time (CUSTOMER): 171320 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/039d7b64-2979-424d-a162-ed3ea4c906f0_20250416T20:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, are you in claims?
[AGENT][NEUTRAL] I am.
[CUSTOMER][POSITIVE] OK, perfect. This is [PII] from NAS.
[CUSTOMER][NEUTRAL] And I need to check on whether you received, we're trying to confirm whether whether this broker's office submitted a claim to you guys we think she sent it somewhere else.
[CUSTOMER][NEUTRAL] Um, can you look this up for me?
[AGENT][NEUTRAL] OK, [PII], so you're wanting to see if we've received a claim for a member, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, ma'am, I can help you with that. And what is your last name, [PII]?
[CUSTOMER][NEUTRAL] Um, it's a long one. It's just put um [PII]
[AGENT][NEUTRAL] Say that one more time, [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] BA OK, alright, thank you and your callback number please? Yes, ma'am, I got it.
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] Um, give me a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The group number is 26773.
[CUSTOMER][NEUTRAL] And let me pull up the number now hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] So the member's policy number is 257-0584.
[AGENT][NEUTRAL] OK, thank you. Give me a moment to get that pulled up and then I will have to verify a few things with you first, [PII], for security purposes.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome and also any information that I'm able to provide would be a verification of benefits and not a guarantee of payment. So first off, if you could verify the insured's name and date of birth.
[CUSTOMER][NEUTRAL] OK. So it's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And hold on, I'm gonna have
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] I don't I don't think you understand we're like a GA, but we're not a GA.
[CUSTOMER][NEUTRAL] So we're not um.
[CUSTOMER][NEUTRAL] We're not
[CUSTOMER][NEUTRAL] Like the actual, well not the individual, but we're not the.
[CUSTOMER][NEUTRAL] Group
[CUSTOMER][NEUTRAL] Per se.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I'm gonna have to pull down down the report from the from the APL portal. Give me a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Still downloading.
[AGENT][NEUTRAL] You're fine. It's just we have to verify certain things for security purposes.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] The group has 216 members, so it might take a little bit.
[CUSTOMER][NEUTRAL] Let me see if I see no.
[CUSTOMER][NEUTRAL] Did she think this was a wellness and be a manufacturing prosperity claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] It still hasn't downloaded, just give it a second.
[AGENT][NEUTRAL] You're fine. Yeah, you're fine. [PII], if you, while that's downloading, would you go ahead and verify your email address, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Oh my god, it's still downloading. What the heck?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Don't let me forget the date of service is [PII], OK?
[AGENT][NEUTRAL] Yeah, you can go ahead. I was gonna say you can go ahead and give me that. I just can't. Is it [PII] of this year?
[CUSTOMER][NEUTRAL] 2, no, um, 2 hold on [PII].
[CUSTOMER][NEUTRAL] [PII], yes, correct. And it's for an urgent care center.
[CUSTOMER][NEUTRAL] So hold on.
[CUSTOMER][NEUTRAL] Um, oh wait, she might have it. Oh, I might have it right here.
[CUSTOMER][NEUTRAL] Um, OK, her.
[CUSTOMER][NEUTRAL] I don't have to wait for the report. OK. Her date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you very much for verifying the information. OK, so you said that the data service is 226 of 2025?
[CUSTOMER][NEUTRAL] 226 2025, yes.
[AGENT][NEUTRAL] No, yes, ma'am, there is no claim on file for her for that data service.
[CUSTOMER][NEGATIVE] There is not.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Do you have any claim immediately before or after?
[AGENT][NEUTRAL] Mm, no.
[CUSTOMER][NEUTRAL] Or for, do you
[CUSTOMER][NEUTRAL] No, OK, that's what we needed to, to know. I'm gonna file it on the portal.
[AGENT][NEUTRAL] OK, and make sure to, yeah, sure, that'll be fine and just make sure to include the primary insurance company's explanation of benefits because we will have to have that.
[CUSTOMER][NEUTRAL] Just so you know.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][POSITIVE] Yeah, that's what she has. OK, thank you.
[AGENT][POSITIVE] OK, well, you're certainly welcome. So can I help you with anything? Oh, you too, [PII]. Can I help you with anything else?
[CUSTOMER][POSITIVE] Have a good day.
[CUSTOMER][POSITIVE] No, that's OK. Thank you so much.
[AGENT][POSITIVE] OK, well, you're welcome and thank you again for calling APL have a wonderful evening.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.