AccountId: 011433970860
ContactId: 266e07c6-624f-49cd-bdf2-7de8fd5f681b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 372359 ms
Total Talk Time (AGENT): 116633 ms
Total Talk Time (CUSTOMER): 164037 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/266e07c6-624f-49cd-bdf2-7de8fd5f681b_20250210T15:03_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Yes, good morning, ma'am. My name is [PII]. My date of birth is [PII].
[AGENT][NEUTRAL] OK, and Mr. [PII], do you have your policy number?
[CUSTOMER][NEUTRAL] Uh, well, I don't have it with me, the card right here, but let me go on the website. Come on, uh.
[CUSTOMER][NEUTRAL] OK, where am I, right? Where am I? I have to open again everything.
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] Yeah I'm going.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, come on up and up and up and up and up and up and.
[CUSTOMER][NEUTRAL] OK, uh, the ID where I can get it, where I can get it.
[CUSTOMER][NEUTRAL] Uh, no, I'm open it right here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Is take so long.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, the group number is 22974.
[AGENT][NEUTRAL] Uh, do you see a policy certificate number?
[CUSTOMER][NEUTRAL] And the, the policy is 02.
[CUSTOMER][NEUTRAL] 14
[CUSTOMER][NEUTRAL] 46
[CUSTOMER][NEUTRAL] 59 ML 8.
[AGENT][NEUTRAL] OK, let's see. And Mr. uh [PII], verify your mailing address and email address, please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And your email address? OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mine is [PII] [PII].
[AGENT][NEUTRAL] OK, I do show a different email address in our system.
[CUSTOMER][NEUTRAL] Uh, probably will be [PII].
[AGENT][NEUTRAL] Yes, sir. OK. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] That that's the company.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you so much. And how may I assist you today?
[CUSTOMER][NEUTRAL] Man, I've received a bill from uh TGH Imagines here in [PII] regarding a uh a test that was done to my spouse on uh last year on May.
[CUSTOMER][NEGATIVE] On April and they are billing me because uh APL hasn't respond to them.
[AGENT][NEUTRAL] OK, and what was that date of service? You said April, do you have the rest of it?
[CUSTOMER][NEUTRAL] Uh, the ser the service was on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEGATIVE] And uh my insurance pays the part and you guys hasn't respond to them.
[CUSTOMER][NEUTRAL] On that claim, I don't know if if you're ready to respond or not, but I received a letter telling me today that you guys haven't respond.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][POSITIVE] And the service was preferred to my wife.
[AGENT][NEUTRAL] And do you know the name of the provider?
[CUSTOMER][NEUTRAL] Uh, TGH I imagine.
[AGENT][NEUTRAL] OK, I show we received the claim but it processes the outpatient benefits of max for the year.
[AGENT][NEUTRAL] It's like you had an outpatient benefit max of up to 8700 and it's already been met for that year.
[CUSTOMER][NEUTRAL] But APL is paying my my gaps so I don't have to pay anything.
[AGENT][NEUTRAL] Well, you have a max benefit each year that is payable, that's 8700, and by the time that claim has been received, you've already met your max for the year. So the claim was processed as the outpatient benefits of max for the calendar year.
[CUSTOMER][NEGATIVE] I, I don't understand you guys supposed to be paying everything and, and now I have to pay. That's why they got this for.
[AGENT][NEUTRAL] Well, there's a limit of how much we pay. It's not a paying 100%. There is a calendar year max that is payable. So you have 8700, that's the max we pay of what primary applies towards deductible, co-pay or co-insurance. Once that max has been met, there's nothing for us to pay since the benefit has been exhausted.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah, but they, you guys, they that deal was submitted on on February or January and the of the of the last year. How is gonna be done by the by the time it was submitted to you guys?
[AGENT][NEUTRAL] Oh, well, we have received another claim for her where it matched the benefit.
[CUSTOMER][NEUTRAL] It's the beginning of the year.
[AGENT][NEUTRAL] Because the claim for her initially claim uh came in and we request the primary EOB. By the time they submitted that primary EOB, we already had another claim that come in that uh that matched that benefit.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, let me find out with my broker because I don't understand this.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK. Uh, is there, OK. Uh, thank you for calling APL. Have a great day. Bye.
[CUSTOMER][NEUTRAL] OK ma'am.
[CUSTOMER][POSITIVE] I appreciate it. OK, thank you.
[CUSTOMER][NEUTRAL] OK.