AccountId: 011433970860
ContactId: 1ef380d1-af75-4e90-b6a3-7eeff5c3f174
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 586880 ms
Total Talk Time (AGENT): 248652 ms
Total Talk Time (CUSTOMER): 289612 ms
Interruptions: 3
Overall Sentiment: AGENT=0.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/1ef380d1-af75-4e90-b6a3-7eeff5c3f174_20250207T13:38_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Yes, hi. Good morning.
[CUSTOMER][NEUTRAL] I have a friend who has a policy with you and we, we, we need to uh understand what is the coverage.
[AGENT][NEUTRAL] Are you, are you on the policy?
[CUSTOMER][NEUTRAL] I have uh uh-huh.
[CUSTOMER][POSITIVE] No, but my friend is here. I am here. She's helping me. She's helping me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I'll need to speak with the policy holder first if you don't mind.
[CUSTOMER][NEUTRAL] OK. Uh, yeah, I am [PII]. I'm here.
[AGENT][NEUTRAL] OK, spell your first name for me, ma'am. Did you say [PII]?
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] OK, and what's your policy number, [PII]?
[CUSTOMER][NEUTRAL] OK, OK, is, um, give me.
[AGENT][NEUTRAL] And I'll need to get the information from [PII] first, please.
[CUSTOMER][NEUTRAL] Yeah, uh, I have to, I know, the, the group number. I have a group number it's OK.
[AGENT][NEUTRAL] Uh, look for the policy cert number on the card. It should.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Well, I have because I have two numbers, OK, how about 021-61352 MLB as in boy. No, it's an 8.1 88, I'm sorry, 8.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, OK. And what's your phone number, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, give me one second to pull up your file, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, you know hospital benefits and outpatient. OK, yeah, thank you bye.
[AGENT][NEUTRAL] OK [PII], I'm gonna ask you to verify some information for me. Give me one moment.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You can look at those and put the APS.
[CUSTOMER][NEUTRAL] OK, so you're back in, OK.
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] It can be.
[CUSTOMER][POSITIVE] OK, thanks.
[CUSTOMER][NEUTRAL] And then solo.
[CUSTOMER][NEUTRAL] Florida tenia um BPO.
[CUSTOMER][NEUTRAL] Yeah I think I don't say nothing important but yours my car.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh that can be a you know porque so we say.
[CUSTOMER][NEUTRAL] PPO.
[CUSTOMER][NEUTRAL] No, y'all call me Broma yo.
[CUSTOMER][NEUTRAL] Just a PPO. I'm sorry I'm poquito yeah mhm.
[CUSTOMER][NEUTRAL] People get you noneita rife to order we had to get they gonna into [PII].
[CUSTOMER][NEUTRAL] [PII]. Mhm.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I'll see here.
[CUSTOMER][NEUTRAL] No, you said.
[AGENT][NEUTRAL] OK, [PII], I have your policy pulled up here. Can you verify your date of birth and then your mailing address for me, please?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] And the mailing is [PII].
[AGENT][NEUTRAL] And what is your email address?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. Perfect. And what concerns did you have today? And then I can get tell me what you, what you're requesting, and then we can get permission to speak with your friend. So tell me what information you need.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I need to know um what is the purpose of having this card? I mean, uh I never use it and uh what is it for? What, what can.
[AGENT][NEUTRAL] OK, I can answer your question for you. So this policy.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes, OK.
[AGENT][NEUTRAL] Its secondary to your major medical policy.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] So do you have a primary insurance coverage through Aetna or Humana?
[CUSTOMER][NEUTRAL] Clouda Bloom. Florida Bloom.
[AGENT][NEUTRAL] OK. So this policy is secondary to Florida Blue.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So any amount that Florida Blue.
[AGENT][NEUTRAL] Applies towards your deductible or your co-pay amount or co-insurance amount.
[AGENT][NEUTRAL] The policy that you have with APL will pick up those those fees.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For those amounts. So that's for if you were hospitalized, you have an inpatient hospital benefit under the APL policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] There is also an outpatient benefit under this plan. Outpatient, it could be emergency room visits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, outpatient hospital, if you had to have something done in a hospital setting or a diagnostic facility such as a diagnostic test.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. She has um outpatient situation emergency on [PII].
[AGENT][NEUTRAL] OK, wait a minute, ma'am. I first have to get her permission to speak with you. So [PII], if you could tell me who your friend is, her first and last name, and tell us what information we can give her or disclose to her.
[CUSTOMER][POSITIVE] Yes, yes. Yeah, no problem.
[CUSTOMER][POSITIVE] Yes yes.
[CUSTOMER][NEUTRAL] OK. Uh, her name is [PII].
[CUSTOMER][NEUTRAL] And you can give all the information to her. I am by her side.
[AGENT][NEUTRAL] OK, go ahead yourself.
[CUSTOMER][NEUTRAL] OK. Uh, she has an emergency on [PII].
[CUSTOMER][NEUTRAL] And we just received a huge bill, and we're trying to understand which one of the insurance policies are gonna cover.
[AGENT][NEUTRAL] OK, so it has to be submitted to her primary insurance first.
[CUSTOMER][NEUTRAL] To the Blue Cross.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And then uh you, uh, and do you, as a, what do you need in order for me to submit a claim?
[AGENT][NEUTRAL] The APL Metin claim form.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The itemized bill.
[AGENT][NEUTRAL] And are you, is it the facility ER charge or is it the ER physician's charge?
[CUSTOMER][NEUTRAL] No, it's a facility.
[AGENT][NEUTRAL] So we, you would need to contact the facility, [PII] and request a copy of their itemized bill, so that's the second document that we need.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The 3rd document
[CUSTOMER][NEUTRAL] So, what is the name of the document? What is the name of the document?
[AGENT][NEGATIVE] It's an itemized an itemized bill.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] And the itemized bill would need to include your diagnosis code, which is the reason that you report it to the emergency room. It has to have that information on there.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] The 3rd document is the primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] That makes sense?
[CUSTOMER][POSITIVE] Yeah, it makes sense, yeah.
[AGENT][NEUTRAL] And what, [PII], what day did you go to the, to the emergency room?
[CUSTOMER][NEUTRAL] [PII] last year.
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] I was [PII]. Yes, of [PII], [PII]. I'm sorry, [PII]. now you uh-huh.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I don't show that you had coverage. I don't show that you had coverage with us at that time.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] But this, this, this document says um oh my [PII].
[AGENT][NEUTRAL] Yeah, so let me tell you what I show in our system.
[CUSTOMER][NEUTRAL] Please.
[AGENT][NEUTRAL] So I'm showing, I'm showing that you had a policy with American Public Life from [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then I'm showing up your active policy wasn't effective until [PII] of this year.
[AGENT][NEUTRAL] So you did not have
[CUSTOMER][NEUTRAL] So it was from February to February to February and then the new one it starts in January.
[AGENT][NEUTRAL] Specifically, [PII].
[AGENT][NEUTRAL] To February 1, year 2024.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] That policy ended and then she re-enrolled uh [PII] of this year.
[AGENT][NEGATIVE] So there was no coverage.
[AGENT][NEUTRAL] Between [PII].
[AGENT][NEUTRAL] Which the state of service falls within that time period.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It doesn't make sense, you know why? Because all our policy starts effective [PII].
[AGENT][NEUTRAL] OK, so that's a that's a discussion to have with the employer. I'm just telling you what her eligibility dates are in our system. So [PII], if you feel that there is a discrepancy in your policy dates, then you would need to reach out to your employer to discuss.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so let's do the um the paychecks as of October to see if we we we have a deduction and then we'll.
[AGENT][NEUTRAL] Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, no, I think that uh you were very helpful. Thank you very much, OK.
[AGENT][POSITIVE] All right, [PII], thank you so much for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] OK. You said 2. OK.
[CUSTOMER][NEUTRAL] This time.