AccountId: 011433970860
ContactId: 19c19e2c-1372-4413-bff1-1e355399d627
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 491649 ms
Total Talk Time (AGENT): 220309 ms
Total Talk Time (CUSTOMER): 235550 ms
Interruptions: 5
Overall Sentiment: AGENT=0.4, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/19c19e2c-1372-4413-bff1-1e355399d627_20250305T15:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII], and I wanted to verify whether a bill was put through uh for coverage.
[CUSTOMER][NEUTRAL] Um, how do I start this? First I, I also need to verify my, uh, the numbers, my group number and all that, my member number if there's any such thing.
[AGENT][NEUTRAL] OK, Ms [PII], um.
[AGENT][NEUTRAL] Let me make sure I've got a good understanding. You're, you're a new group and you're calling to see if the um.
[AGENT][NEUTRAL] New enrollments have been submitted it.
[CUSTOMER][NEUTRAL] Mm, no, no, no, no, no, no, no, no, no, let's start all over again.
[CUSTOMER][NEUTRAL] Um, uh, we've, we've been an existing group, so no, that has nothing to do with it. I, I had a, a medical service.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It looks like it was in June of last year, and I'm being, and, and there's a bill that's coming in to me. And I, and I've asked them if they've put it through APL and they don't know. So that's why I'm calling. It went through my primary insurance, which is Healthy, but there's a balance due, and I, I thought it would have been covered through APL. So that's what I'm trying to, to confirm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright. So you're checking on a claim that was submitted for yourself.
[CUSTOMER][NEUTRAL] I'm hoping it was submitted. If it wasn't then I, I would need to, yes, mhm.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yes, OK, I, I got it then, thank you, Ms. [PII]. OK, you're welcome. And what is your policy number?
[CUSTOMER][POSITIVE] OK, thank you. OK.
[CUSTOMER][NEUTRAL] Uh, let's see if this is correct. 251-826-8.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, Ms. [PII], for security reasons, can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you ma'am and then I'm also gonna need for you to verify your address, phone number and email address that we have on the policy for you.
[CUSTOMER][NEUTRAL] Certainly. So it's [PII]. Um, I'm sorry, what else did you ask me for? Address and what?
[AGENT][NEUTRAL] Your, your email address and your phone number, please.
[CUSTOMER][NEUTRAL] Email, OK. Phone number is [PII], and email address is my full name, [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, looks like I have your um work email address.
[CUSTOMER][NEUTRAL] Uh, which, which I don't want on, on my policy. So it's [PII].
[AGENT][NEUTRAL] OK, so we're gonna change it to [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][NEUTRAL] Correct, yeah, that's my preferred email address, personal email address.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, let me get that updated for you.
[AGENT][NEUTRAL] OK, I've got that updated now, Ms. [PII] and looking at your policy, I do not see that any claims have ever been submitted on your on this policy, so I'm not showing that we have the claim.
[CUSTOMER][NEGATIVE] OK, so there was, yeah, so what information do I need to give them because now they've taken because I didn't think I had a balance due and I thought this was gonna get cleared up and now it's been turned over to MediCredit so that's what I'm dealing with now. What information do I need to give them?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, no. OK. Right.
[AGENT][NEUTRAL] You should be able to just to give them um your card and and let them know that it's a supplemental gap insurance that helps with deductible copay and co-insurance um if you give them the card, it also has our payer ID number on it and it has a um claims mailing address too if they decide to mail it in.
[CUSTOMER][NEUTRAL] So the copy of the card that I have is an old one. It's from [PII]. So can you confirm information for me because I don't know that I have all the correct information. Um, I'm definitely insured. My group number, what is that group number?
[AGENT][POSITIVE] Yes ma'am, you are.
[AGENT][NEUTRAL] It's 17605.
[CUSTOMER][NEUTRAL] OK, that's what I have and then the effective date of this policy should have been [PII]. Is that correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK, perfect, and the plan, what, what, what, what name is that under?
[AGENT][NEUTRAL] It's Medlik 9SM.
[CUSTOMER][NEUTRAL] 9 Medlink 9 S as in Sam.
[AGENT][NEUTRAL] Yes, and M as in Michael.
[CUSTOMER][NEUTRAL] And M as in Michael, OK.
[CUSTOMER][NEUTRAL] 9SM. OK, so Medlink, so get rid of select group med none of that matters anymore, right? So it says Medlink 9SN.
[AGENT][NEUTRAL] Yes, that's your product ID number.
[AGENT][NEUTRAL] That that's the type of coverages you meddling.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. OK, and I've got the group number and the policy number. Is there a separate member number or anything like that or no?
[AGENT][NEUTRAL] Uh, just the policy numbers should be all that that they need. It may say inpatient certificate number or outpatient certificate number, which is um.
[AGENT][NEUTRAL] The same policy number, it just has like an M.
[AGENT][NEUTRAL] Uh, 7 or an M8 at the end depending on if they're going outpatient or inpatient as far as the claim.
[CUSTOMER][NEUTRAL] OK, can we confirm these numbers? I have these on the card as well, so the inpatient one, alright, in hospital is 02304079 M as in Mary, L as in Larry 7.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Is that correct?
[AGENT][NEUTRAL] Let me see. That sounds, let me look real quick because that sounds.
[AGENT][NEUTRAL] You said 0230, I'm sorry, what was the number you just gave me again?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 023 04079
[AGENT][NEUTRAL] OK. That
[CUSTOMER][NEUTRAL] M as in Mary, L Larry 7.
[AGENT][NEUTRAL] Right, that is an old um policy number that you had in the past that um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Lapsed on 8-12023 because we issued a new one, so your new policy number.
[CUSTOMER][NEUTRAL] So do I
[CUSTOMER][NEUTRAL] OK. Yup.
[AGENT][NEUTRAL] It's 251-826-8.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 251-826-82518268 got it and so the old they'll have the same ML7 ML 8 at the end or no?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, the ML 7 means inpatient and the NL8 means outpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Inpatient
[CUSTOMER][POSITIVE] Perfect. Got it. 251-8268 is my policy number and that's what I need to have. OK, excellent. Let me give him a call back and have them run it through with this policy number. You're saying no claims whatsoever have been submitted to you all.
[AGENT][NEUTRAL] Not on this, not on this, um, new policy number.
[AGENT][NEUTRAL] That started in [PII].
[CUSTOMER][POSITIVE] OK, not on this policy, so my stent must have been the year before. OK, I'm confused, but OK, thank you very much for your help this morning. I really appreciate it.
[AGENT][NEUTRAL] You're very welcome, Ms. [PII] uh and uh we if you decide that you decide that you wanna file the claim yourself I can help you with that too if you'd like that information.
[CUSTOMER][NEUTRAL] Um, well, see, I, I have a statement. I don't have the actual itemized bill, so I don't know what information I'd be giving you.
[AGENT][NEUTRAL] OK, OK, yeah.
[AGENT][NEUTRAL] Yeah, you would have to get that from the um facility. Yes, ma'am.
[CUSTOMER][POSITIVE] Yeah, I'll, I'll need to have them do it.
[CUSTOMER][POSITIVE] I'll let them do that. Let me give them a call now then. Thank you very much. Appreciate your help today. Thanks. Bye-bye.
[AGENT][POSITIVE] Yes. OK. All right. You're very welcome. Thanks for calling APL. You have a great day. Bye bye.
[CUSTOMER][POSITIVE] You too. Bye-bye. Thanks.