AccountId: 011433970860
ContactId: 0c9bc0a9-9262-4b97-8304-cfdf61d50423
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 627500 ms
Total Talk Time (AGENT): 198314 ms
Total Talk Time (CUSTOMER): 171068 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/0c9bc0a9-9262-4b97-8304-cfdf61d50423_20250106T21:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], I'm hoping you can help me out. I've been struggling with a claim for a year now and I still have not gotten it settled, so um I'm hoping you can help me out um I no longer, I no longer am with APL at the time of service I was.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So what do you need from me in order to pull up my record?
[AGENT][NEUTRAL] OK, um, first I'm going to need your name.
[CUSTOMER][POSITIVE] [PII]
[AGENT][NEUTRAL] OK, and then what is your callback number, Miss [PII], just in case our call is disconnected?
[CUSTOMER][NEUTRAL] [PII] I don't know my phone number offhand 5 um [PII].
[AGENT][NEUTRAL] OK, and then do you know what your policy number was when you were with us?
[CUSTOMER][NEUTRAL] It's on my card it says 02443147.
[AGENT][NEUTRAL] OK, let me look that up real quick, Ms. [PII].
[AGENT][NEUTRAL] Alright, Ms. [PII], um, can you please verify your date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you ma'am and then I'll also need for you to verify your address, phone number and email address that we have on file for you.
[CUSTOMER][NEUTRAL] [PII]. Um, the phone number you have on file is probably [PII] and my email is [PII].
[AGENT][NEUTRAL] OK thank you I appreciate you verifying that information for me. So is it a claim that you have already filed or are you wanting to file it new?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEGATIVE] No, it's gone to collection, um, you, you apparently denied it because you are my primary, but you never notified my secondary so my secondary hasn't paid it and now it has gone to collection so I need APL to notify.
[CUSTOMER][NEGATIVE] Try care that you denied the claim.
[AGENT][NEUTRAL] OK, now APL is not a primary insurance. We're not a primary insurance we are secondary insurance and the policy that you have is a limited benefit hospital indemnity plan that you had with us, um.
[CUSTOMER][NEUTRAL] But at the time of service, you were my insurance through my employer, whereas TriCare was my insurance through my marriage, so that makes APL my primary insurance.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEGATIVE] And we're supposed to send something to your Tricare to let them know that you're no longer with us, is that what you need?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Know that you denied that you denied the claim.
[CUSTOMER][NEUTRAL] So that Tricare will pick up the balance of the claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so what I'm gonna need to do is I need to do some research to see what kind of letter that we need to send um this is not a question that I have been asked since I've been here um so I wanna make sure that I get it correct, Ms. [PII], this number that you gave me is a good call back number for somebody to call you back and let you know what the status of your request is.
[CUSTOMER][NEUTRAL] The [PII] number, yes.
[AGENT][NEUTRAL] Yes, ma'am. OK, we'll research into it and then we'll give you a call back and let you know um what has been decided, OK?
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] Oh, all right. Thank you, Ms. [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] Would you like the data service?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that was 2
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] sorry.
[AGENT][NEUTRAL] OK, and that was January.
[CUSTOMER][NEUTRAL] And it's for 763.
[CUSTOMER][NEUTRAL] [PII] for $763 it was lab work at Commonwealth Health Wilkes-Barre General Hospital.
[AGENT][NEUTRAL] Commonwealth Health.
[AGENT][NEUTRAL] And can you spell that [PII]? Can you spell that for me, please?
[CUSTOMER][NEUTRAL] [PII], [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, alright, I've got it written down so that we can make sure that we get this just to verify the data service was [PII] for $763 and that was Commonwealth Wilkes-Barre Hospital.
[CUSTOMER][NEUTRAL] Yeah, can you just tell me if, if you have pulled up my, my account, I mean, I assume I'm still in your system. Do you not see the denial letter? Can you just not forward me that letter and I will send it on to to Strikeare? I just need to show Strikecare that you haven't paid the bill and that you denied it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You are, yes, ma'am.
[AGENT][NEUTRAL] Uh, I
[AGENT][NEUTRAL] OK, all right. So what I can do is.
[CUSTOMER][NEUTRAL] So whatever
[AGENT][NEUTRAL] What I can do is send an explanation of benefits that we send out um when the claim is denied I can send that to your email address if you'd like for me to do that for you.
[CUSTOMER][POSITIVE] Yes, that would be lovely.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I can do that for you and just to verify we're gonna make sure that we send it to email address.
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, I'm gonna do that while I've got you on the phone, so I'm gonna put you on a brief hold so I can get that straight to you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Hi, Ms. [PII], I'm back with you again. I've got that on its way through email to you.
[CUSTOMER][POSITIVE] OK, [PII]eat. Thank you.
[AGENT][POSITIVE] You're so very welcome. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] No ma'am.
[AGENT][POSITIVE] OK, thank you for calling APL Ms. [PII]. You have a wonderful rest of your night.
[CUSTOMER][NEUTRAL] Alright you too bye bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.