AccountId: 011433970860
ContactId: 22860c51-6d20-4c5f-866b-3436fa54b166
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 367140 ms
Total Talk Time (AGENT): 194947 ms
Total Talk Time (CUSTOMER): 165440 ms
Interruptions: 8
Overall Sentiment: AGENT=1.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/22860c51-6d20-4c5f-866b-3436fa54b166_20250304T16:48_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] I'm backing APO. My name is [PII]. How may I help you?
[CUSTOMER][NEGATIVE] No, I haven't got the flow um.
[CUSTOMER][NEUTRAL] [PII] has this plan with you guys and I just wanna make sure that he had an emergency room visit last summer and of course we need to pay the bill. hello, and I just wanna make sure that they filed that claim with you guys or this this, I'm not exactly sure what this APO does for him. I usually give it to the doctors, but I don't, I don't know.
[AGENT][NEUTRAL] Well, let's look at it, and I'm sorry, with whom am I speaking, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII]? OK. And is this, uh, your policy or is it?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, it's [PII]'s.
[CUSTOMER][POSITIVE] Yeah, I'm trying to, I'm trying my best.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the, the policy number?
[CUSTOMER][NEUTRAL] Sure, it's 1442493.
[AGENT][POSITIVE] OK, great. Thank you. And uh
[AGENT][NEUTRAL] His, his name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, he's there with you, is that correct?
[CUSTOMER][NEUTRAL] Yeah, he just got on the phone. Hang on.
[AGENT][NEUTRAL] OK, is, is it OK, [PII], if I, if I talk to [PII] about your policy?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hang on, he's, he's on the phone with the lady at the bank. Hang on, see if I can find him. He walked outside.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, he
[CUSTOMER][NEUTRAL] Might get windy, hang on.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] He's coming back. He went to check the mail. Hang on.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what, what, while he's doing that, could you give me a callback number in case I'm disconnected my phone's kind of cutting him out.
[CUSTOMER][NEUTRAL] Yeah, it.
[CUSTOMER][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] [PII] Hey babe, would you give this lady permission to talk to me please? Yeah, yeah, this is [PII] she has permission to to answer for me. Right.
[AGENT][POSITIVE] Great, thank you. I appreciate that.
[AGENT][POSITIVE] Oh, thank you. Great. Thank you. Um, [PII], what is that what is that data service that we're looking for?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yes, uh, the date of service is [PII].
[AGENT][POSITIVE] Oh, I'm sorry.
[CUSTOMER][NEUTRAL] But it was an overnight stay, so
[AGENT][NEUTRAL] [PII]. OK. Um.
[AGENT][NEUTRAL] Of course. Yeah, that would probably end up being um.
[CUSTOMER][NEUTRAL] I got to send for you.
[CUSTOMER][NEUTRAL] So the [PII] [PII].
[CUSTOMER][NEUTRAL] Now
[CUSTOMER][NEUTRAL] That's not it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can we wait and just pay it when I get my new card? She said I should get my new card that's fine, yeah.
[AGENT][NEUTRAL] OK, so the um
[AGENT][NEUTRAL] Uh, stay in [PII], uh, was not, uh, nobody sent in a bill for that. Um.
[CUSTOMER][NEUTRAL] I'm listening.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So we have not received a claim for that. Now, normally for an overnight stay in the hospital, we consider that to be if he was there for 18 hours or more, we consider that to be uh an inpatient stay and he has more benefits for that. That's $2000 per calendar year. So we'll pay up to $2000 for an in-hospital stay. but um as I mentioned before, I'm not seeing where they send it in at all. So, um, we have two options at this point. Uh, and, and what the policy does is it picks up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That work.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect, we'll do that.
[CUSTOMER][NEUTRAL] OK, alright, bye.
[AGENT][NEUTRAL] The deductible, co-payment or co-insurance from his major medical.
[AGENT][NEUTRAL] So the first thing that you want to do is you want to see whether they even filed it through his major medical. That's the very first thing they did. OK. So what you would do at that point, you have two options. Um, you can either submit the claim yourself.
[CUSTOMER][NEUTRAL] They did. They did.
[AGENT][NEUTRAL] Or you can contact the provider and ask them to submit it. Now, if you wish to submit it if [PII] or or or you wish to submit it.
[AGENT][NEUTRAL] Uh, we, uh, we will need a copy of his explanation of benefits from the primary insurance showing us what that deductible, co-payment or co-insurance is. We would also need uh an itemized bill or the, or, or something from the doctor stating why he went into the emergency room or why he was in overnight. Um, and they were using.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, it, it'd be easier if they just if the hospital just find filed it because they can, yeah, OK, and I know I gave this to them whenever we checked in there, but it's emergency room staff and there's like a million people in there and.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] Yes, absolutely. Yeah.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] You know, so I'll just call them and ask them if they filed the secondary, which this is technically a secondary policy, right?
[AGENT][NEUTRAL] Yes, yes, it is. That's correct, yes, um, the, the, the option is there if you wish to file it yourself and then we would end up paying you. But yes, by all means, I would contact their billing department and let them know uh there's no timely filing, which means that they that we can we can date it back to August. Um, there shouldn't be a problem with that and uh we just need to have them submit that to us. So if they will do that, we will be on the lookout for it. It usually takes 2 to 3 business days for those to be processed once we receive them.
[CUSTOMER][POSITIVE] Thank [PII].
[AGENT][NEUTRAL] So I would just contact the billing department at the hospital, make sure that they know that you've got that secondary insurance so that they can file it with us.
[CUSTOMER][POSITIVE] OK, that sounds good. I'll give him a call.
[AGENT][NEUTRAL] Yeah, is this the, is this the only thing that we need to look at? Are there any other claims that that you are getting bills for, but you, you don't know whether they submitted yet?
[CUSTOMER][NEUTRAL] I don't think so. I, I really think this one is it. Everything else seems to
[CUSTOMER][POSITIVE] seems to be doing fine. I know his primary care does fine with it and
[CUSTOMER][NEUTRAL] Does this have any pharmacy, but he only pays like a co-pay at the pharmacy and that's, that's manageable so.
[AGENT][NEUTRAL] OK, well, if there is anything, yeah, will, will there any in the future, is there any, if there is anything else, please let us know and, and uh we'll let you know whether it's been filed or not.
[CUSTOMER][NEUTRAL] I don't know if.
[CUSTOMER][NEUTRAL] has
[CUSTOMER][POSITIVE] Cool, thank you. I appreciate it.
[AGENT][POSITIVE] Thanks for contacting you too have a good