AccountId: 011433970860
ContactId: 1d810fe4-2447-4740-b01c-7a468f0b044e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 923320 ms
Total Talk Time (AGENT): 461267 ms
Total Talk Time (CUSTOMER): 202928 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/1d810fe4-2447-4740-b01c-7a468f0b044e_20250321T14:03_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] in Broker Resources. How are you?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][POSITIVE] Pretty good. Um, I have got a broker's office online and they are calling about a claim for an insured, um.
[CUSTOMER][NEUTRAL] The insured is [PII] and her policy is 182.
[CUSTOMER][NEUTRAL] 23 or let's see 182-3316 sorry.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it's a claim for her um and they did uh [PII] did verify the last four of her social. Can you, can you speak with her?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thanks, [PII].
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Thank you for calling American Public Life. Am I speaking with [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Hi [PII]. Hi, [PII], this is [PII] in the claims department. Uh, you had a question in regards to a claim for one of um our insured.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, for [PII], for, uh, it's under [PII], so and I can get her.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I can get her on the phone with us too if we need to she said her.
[AGENT][POSITIVE] Oh, no problem.
[CUSTOMER][NEUTRAL] Her benefit is I think it was 6000. I didn't pull it up, but I think it was 6000.
[AGENT][NEUTRAL] Mhm. Let me check that.
[CUSTOMER][NEUTRAL] That a couple of 9 coins.
[CUSTOMER][NEUTRAL] And she said she doesn't think she reached the entire 6000, but are you able to tell me that? I don't know if you know.
[AGENT][NEUTRAL] Yes, OK, so for, yes, so for outpatient benefits she did have a maximum of $6000 a calendar year and.
[AGENT][NEUTRAL] Let me check that.
[CUSTOMER][NEUTRAL] There was a big claim from United on [PII], so that may help you get more.
[AGENT][NEUTRAL] And it
[AGENT][NEUTRAL] OK. I was about to ask about the year. So, based on what I show, she did meet her uh she did meet the 6000 for 2024.
[CUSTOMER][NEUTRAL] OK. Was it paid off now with the, um, let me, do you mind if I get her on the phone?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, hang on one second.
[CUSTOMER][NEUTRAL] And then that way, I don't, uh she'll.
[CUSTOMER][POSITIVE] She'll be able to hear everything and understand everything because I think the hospital's come to her so.
[AGENT][NEUTRAL] Yeah, it looks like we did max it out on a hospital claim in [PII]. Uh, let me see what.
[CUSTOMER][NEUTRAL] In August, like [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll get her on the phone right now. Hang on one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hey, [PII], yes, OK, so I have American Public Life on the phone. The rep is telling me that they did max out that $6000 benefit and it was paid on that one the big hospital claim in August.
[CUSTOMER][NEGATIVE] So that's all they're gonna pay, they don't have anything. I wonder if they charge me for something that I did not use it.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I don't know, but that was the whole 6000 paid out in August, or it would.
[AGENT][NEUTRAL] No, so it looks like uh by the time we received the claim for [PII], um,
[AGENT][NEUTRAL] She only had $3,307.94 remaining of the $6000. And so it looks like of this claim, the patient responsibility was 4,28982. We paid the $3,307.94.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Since which would have left her a balance because it wasn't paid in full of 981 88, so I'm not sure if that's what they are billing her for because we did not pay the total amount. We, she only had the $3,307.94 remaining of the $6000 for that calendar year.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] He has, uh, let me ask you a question. He has a.
[CUSTOMER][NEGATIVE] That's the balance they are charging me for. Uh, how can I get, um, the statement showing everything that you pay for the year.
[AGENT][NEUTRAL] Uh, now, request can, uh, be, um, put in and, uh, our customer service department can send you uh all the explanation of benefits. Um, you can also, well, let's see, your policy has been canceled, so.
[CUSTOMER][NEGATIVE] I think, I think I already requested that, but I never received.
[AGENT][NEUTRAL] OK, let me check the notes.
[CUSTOMER][NEUTRAL] Yeah, the policy is turned now, so.
[CUSTOMER][POSITIVE] If you could request that that would be awesome.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] But OK, I do show you did call.
[AGENT][NEUTRAL] On [PII], so I will follow up with her.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Customer service department and see where they are on that, um.
[AGENT][NEUTRAL] Yeah, I, it shows they were mailed out on.
[AGENT][NEUTRAL] [PII], so it, it shows here on [PII] mailed insured copies of all ELBs that paid out for [PII].
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Can, can we get that email? Can you email it to me and I can send it to her or just send it directly to uh [PII] if we give you her.
[AGENT][NEUTRAL] Uh, that, I, I will check, I believe they can email it. Um, what is, I'll put you, let me put you on hold so I can make sure. Um, and what is your mailing address? Did they verify your mailing address prior to?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that is what we have. Uh, hold one moment, let me see if that information can be emailed.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome, hold one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] What's client support OK.
[AGENT][NEUTRAL] OK, wait, who did this?
[AGENT][NEUTRAL] Who is [PII].
[AGENT][NEUTRAL] Who is that?
[AGENT][NEUTRAL] Oh my Lord.
[AGENT][NEUTRAL] Is it look I am.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] I'm good. How are you? I have a question.
[AGENT][NEUTRAL] Uh no. Yes. Uh, I have a broker and an insured on the line. Um.
[AGENT][NEUTRAL] She had called back in March and requested copies of all her ELBs for [PII] be sent to her. Um, I think this is [PII] is [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK. So it, it shows her, her notes say she mailed the copies of the ELBs on [PII].
[AGENT][NEUTRAL] OK. It is [PII]. OK. So I guess she hasn't gotten them.
[AGENT][NEUTRAL] And now
[AGENT][NEUTRAL] How she met the outpatient benefit. Mhm.
[AGENT][NEUTRAL] OK, so,
[AGENT][NEUTRAL] Right. OK, I did tell them it was mailed. They haven't received them. Um, the broker is asking if they can be emailed to her and she get them to the insured.
[AGENT][NEUTRAL] I don't know.
[AGENT][NEUTRAL] It was too many to email. OK, OK, um.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so do I tell her?
[AGENT][NEUTRAL] Should I tell her they can be email or just?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Information through email, OK.
[AGENT][NEUTRAL] Can she would, well, I didn't, not, well, she's, she's no longer.
[AGENT][NEUTRAL] She's no longer active. Yeah, cause that's what I was gonna tell her, but I'm like, well, your policy, yeah, OK. So what do I say?
[AGENT][NEUTRAL] Have one what? I don't know. I can check and see.
[AGENT][NEUTRAL] 182.
[AGENT][NEUTRAL] 331 6.
[AGENT][NEUTRAL] No, there's no email on file, so.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] It just said on the [PII].
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Got them by now, yeah.
[AGENT][NEUTRAL] Mhm. So I tell her at least give it, yeah, give it till Monday, at least. OK. OK. And if not.
[AGENT][NEUTRAL] OK, what was the [PII] was a what?
[AGENT][NEUTRAL] OK, so she had the weekend. OK, I'm gonna, OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK. OK. I will.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Friday, OK, so it's still, maybe just give it a few more days.
[AGENT][NEUTRAL] OK, alrighty, I'll let him know. OK.
[AGENT][NEUTRAL] Male.
[AGENT][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] Yeah, yeah, OK.
[AGENT][POSITIVE] Will do. OK, thank you.
[AGENT][NEUTRAL] Bye
[AGENT][NEUTRAL] OK, thank you for holding. I do apologize for the wait. Um, so I did check uh with um our lead, uh, in the department and because of the size of, you know, the amount of EOBs and emails not really being secure, we don't like to email claims information, um, based on, you know, the, you know, are looking into it and the dates, um.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So it shows around the [PII], they would have been mailed out, which is closer to the weekend. Um, she, she asked if we could give it a few more days to, to be received, uh, because they did go out. They did, uh, check and verify that they were mailed out, um, and, you know, if not received at least by Monday.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, you know, we can try to get those mailed out again.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] But they
[CUSTOMER][NEUTRAL] What about can [PII], uh, does she still have access to her claims online or is that shut down?
[AGENT][NEUTRAL] Well, no, so that was gonna be when you first, we first started talking about it, you know, I was gonna suggest that she could go online, but it looks like, uh, now, did you, because we don't show that you ever created an account and because your, your policy is now term, you can't create an account because you're no longer active. But if you had had an account already,
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, you would be able to go in and access that information, uh, but my lead did check to see if you had ever, uh, created an account, and we don't show you ever created one prior to the policy.
[CUSTOMER][NEUTRAL] OK, OK, I understand that, so I'll wait 2 more, you know, a few more days.
[AGENT][NEUTRAL] Yes, ma'am. If you could give it a couple more days to, you know, let's just make sure, you know, they just haven't reached you at this time, but we do show that they were mailed out. And if not, we can resend that information to you.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Thank you so much. I appreciate your help.
[AGENT][POSITIVE] You're welcome. You're welcome. Is there anything else I can help you guys with?
[CUSTOMER][NEUTRAL] That we don't hung up.
[CUSTOMER][POSITIVE] That that's it for now. If we don't receive them, we'll call back next week. Thank you so much.
[AGENT][POSITIVE] OK. Yes, ma'am. You guys have a wonderful weekend and thank you for calling APL.
[CUSTOMER][POSITIVE] You too thank you bye bye bye.
[AGENT][NEUTRAL] Bye bye.