AccountId: 011433970860
ContactId: 1bb7d7a0-95ad-4d68-aa3f-4a01a2b6a0aa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 340600 ms
Total Talk Time (AGENT): 174089 ms
Total Talk Time (CUSTOMER): 106783 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/1bb7d7a0-95ad-4d68-aa3f-4a01a2b6a0aa_20250418T14:57_UTC.wav
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[AGENT][POSITIVE] Thanks for calling ATO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I'm calling to find out, um, I have the gap insurance through my job and I was in the hospital, um, had surgery last year in May.
[CUSTOMER][NEUTRAL] And I was calling to find out um and I have the paperwork faxed over to me for um the claim to be submitted.
[AGENT][NEUTRAL] Um, yes, ma'am. I can assist you with filing a claim. Um, first, I'll need your name and a good callback number in case we're disconnected.
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] Thank you, [PII]. Now could I get your policy number, please?
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] And if you don't have it, I could look it up by your social.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Is that the end hospital benefit number or is it the group number?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] The hospital.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] 015422
[CUSTOMER][NEUTRAL] 68 ML 7
[AGENT][NEUTRAL] OK, thank you. Now, please verify your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] [PII] mailing address [PII].
[AGENT][NEUTRAL] OK. Now please verify your email address.
[CUSTOMER][NEUTRAL] First name [PII].
[AGENT][NEUTRAL] OK, I'm showing a different email address. This may be your work email.
[CUSTOMER][NEUTRAL] OK, my work email is [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And yes, in order to file a claim, normally um the provider files the claim. Um, do the provider know that you have um secondary gap insurance with us?
[CUSTOMER][NEUTRAL] The provider
[AGENT][NEUTRAL] Yes, ma'am. The hospital, you want to file the claim for your hospital charges.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, they, they know that I have the um gap.
[AGENT][NEUTRAL] OK, because they can file the claim for you, but if you'd like to file the claim yourself, you wouldn't need any paperwork from us. All we would need for you to do is submit um the explanation of benefits from your primary insurance company.
[AGENT][NEUTRAL] Um, for the dates of services that you're filing a claim for. And we would also need your diagnosis code and you can get that information from the hospital or your doctor's office. And um you can either fax us that information, you can upload it on.
[AGENT][NEUTRAL] Online or you can send it through regular mail, but normally the provider like I said files the claim all you would need to do is um give them your policy number and our phone number so they can call to verify your benefits and see how to file a claim if they're not familiar with us.
[CUSTOMER][NEUTRAL] So, I called the hospital that I had the surgery.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So, OK, call them and ask them to.
[CUSTOMER][NEUTRAL] Submit the claim.
[AGENT][NEUTRAL] Um, yes, ma'am. Let them know that you have secondary gap insurance, um, to cover the additional charges. Once your primary insurance filed the claim, give them your policy number and our phone number, and yes, they'll give us a call to see how to file the claim if they're not familiar with us, and they'll file the claim themselves and we'll pay them.
[CUSTOMER][NEUTRAL] So if I wanted to
[CUSTOMER][NEUTRAL] Get the money myself.
[CUSTOMER][NEUTRAL] What would I do?
[AGENT][NEUTRAL] You would need to um get the EO.
[CUSTOMER][NEUTRAL] If I want to check
[AGENT][NEUTRAL] Right. You would need to get the explanation of benefits from your primary insurance company for the dates of services that you're filing a claim for.
[AGENT][NEUTRAL] And you would need to get documentation from your doctor's office with your diagnosis code.
[AGENT][NEUTRAL] And um submit that information to us. You can fax it to us or you can file the claim online. Which way do you prefer to file the claim?
[CUSTOMER][NEUTRAL] Um, the fax it.
[AGENT][NEUTRAL] OK, um, here's our fax number.
[AGENT][NEUTRAL] If you're ready to write it down.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] The OK, the fax number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, ma'am, and please attention it to the claims department and make sure that you reference your policy number.
[CUSTOMER][NEUTRAL] And reference policy number.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so I just get the explanation of benefits from my insurance, my, my primary insurance.
[AGENT][NEUTRAL] That's correct. And we would also need documentation from your um doctor's office um with your diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No ma'am, that's it thank you so much.
[AGENT][POSITIVE] OK. I thank you again, [PII] for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You do the same bye bye.
[AGENT][POSITIVE] Thank you.