AccountId: 011433970860
ContactId: 0a40db53-93d2-4b94-ac67-cf3ecfa45b37
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 363410 ms
Total Talk Time (AGENT): 232219 ms
Total Talk Time (CUSTOMER): 138695 ms
Interruptions: 6
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/0a40db53-93d2-4b94-ac67-cf3ecfa45b37_20250102T15:29_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] Oh hi um my name is [PII] I hope I um pushed the right number to get to where I need to be but so I have um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] American Public Life as a gap insurance. Um,
[AGENT][NEUTRAL] Yes, I am.
[CUSTOMER][NEUTRAL] OK, so I am having a PET scan scheduled for me and they just called and said that when they contacted you guys you didn't know about my community care primary and that you needed that information so I'm just calling to give you that.
[AGENT][NEUTRAL] OK, so you're going to be having a scan done, but someone told you that APL needed your primary insurance information?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, so I can.
[CUSTOMER][NEUTRAL] They said you guys didn't know about my primary and that it would be important when it came to billing so.
[AGENT][NEUTRAL] OK, so I can, I can help you with this. I can answer some questions for you, Miss [PII], but what we'll need to do is to pull up your policy information and I'll have to verify some things with you first for security. So what is a good call back number for you in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it's [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Thank you and your policy number with APL?
[CUSTOMER][NEUTRAL] Oh, OK, um, 024722229.
[AGENT][NEUTRAL] OK, thank you. So give me just one moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information also Miss [PII] that I provide for you today would be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, my date of birth is [PII].
[AGENT][NEUTRAL] OK, and the primary insured's name and date of birth?
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] OK, that's um [PII] and um [PII].
[AGENT][NEUTRAL] Thank you, your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we would have on file for Mr. [PII]?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] Thank you and lastly his email address.
[CUSTOMER][NEUTRAL] Um, it should be [PII].
[AGENT][POSITIVE] Thank you very much. So give me just.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this is a supplemental policy, Ms. [PII], to your, you know, your primary insurance. I'm not quite sure why they told you that. Um,
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] We would it, I actually talked to someone from a provider's office myself earlier. I explained to her that when the
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim is filed with APL and this would be uh so this would apply whether the provider files the claim or you file the claim, but we will have to have a copy of the primary insurance company's explanation of benefits along with the review.
[CUSTOMER][NEUTRAL] Oh, I think I see what you're saying.
[AGENT][NEUTRAL] And I don't know because she and I didn't even discuss.
[AGENT][NEUTRAL] Um, anything about your primary ins yeah, I don't, yeah, I think that's what happened, but we didn't even
[CUSTOMER][NEUTRAL] OK, so there was just a misunderstanding.
[CUSTOMER][NEUTRAL] OK, so when I go through.
[AGENT][NEUTRAL] Discuss that.
[CUSTOMER][NEUTRAL] It'll be after the scan they will send me an explanation of benefits I will have to somehow get you a copy of that before you will pay anything additional, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Unless
[AGENT][NEUTRAL] Right, any claim that we review on this type of policy you have with us, we always have to have a copy of the primary insurance company's explanation of benefits because this plan is designed to help you with your co-pays, deductibles and co-insurance amounts of coverage services and also, you know, what is covered by this supplemental policy so.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, she and I actually, we didn't discuss like who your major medical carrier was or anything like that. I just, because most providers, most providers will file both claims. They'll file your primary and your secondary, but a lot of times they don't send us the explanation of benefits for the primary. And so
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] You know, then we have to review it and it gets denied just stating that this is what we need. So I try to be proactive.
[CUSTOMER][NEUTRAL] Stop, I
[CUSTOMER][NEUTRAL] OK, I think I understand what you're saying.
[AGENT][NEUTRAL] And letting her know. So yeah, you could just, just make sure.
[CUSTOMER][NEUTRAL] I think I understand so it'll be kind of on me to make sure that I get you guys that if you're saying hey we're not gonna cover this then I'll go, well, here's this, does that help?
[AGENT][NEUTRAL] Yeah, if for any reason they file your both claims but don't provide us that and you get an explanation of benefits stating that's what we need, then yes, that's all you would have to send us, but just make sure to give them.
[CUSTOMER][NEUTRAL] So I, OK.
[AGENT][NEUTRAL] Your APO information and your primary information and ask them if they're, you know, going to be filing both.
[CUSTOMER][NEUTRAL] Yes, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, all right, but I think that makes sense um yeah, she definitely told me to to call you and give you that, but I think I understand what you're saying that makes sense so thank you for being proactive about that, even though I know it causes confusion so OK well thank you so much that helps.
[AGENT][NEUTRAL] Yeah. Yes, ma'am. That's, were you uh
[AGENT][NEUTRAL] Yeah, so.
[AGENT][POSITIVE] Well, you are certainly very welcome and is there anything else that I can help you with this morning, Ms. [PII]?
[CUSTOMER][POSITIVE] Um, no, I think that's it. Thank you.
[AGENT][POSITIVE] OK, well then, you are certainly very welcome. Thank you again for calling APL and I hope that you have a very uh nice day and I hope everything goes well with your test for you, Ms. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right. OK. All right, thank you so much. OK, bye-bye.
[AGENT][NEUTRAL] Yes ma'am. Bye-bye.