AccountId: 011433970860
ContactId: 3d9f537f-7ed5-48fc-8825-932958491a63
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 322019 ms
Total Talk Time (AGENT): 110865 ms
Total Talk Time (CUSTOMER): 177975 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/3d9f537f-7ed5-48fc-8825-932958491a63_20250402T15:47_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Uh, good morning. How are you?
[AGENT][NEUTRAL] I'm doing fine. How are you?
[CUSTOMER][NEUTRAL] Can't complain. Um, I had a question uh the first time I'm gonna use the benefits and how it works is the question I have. Um, I have deductible, uh, copays I have to make for my, um, with my health insurance. Um, the question is, the coverage, what's not covered by my, my regular health insurance, would those, um, claims be covered by this insurance that I have?
[AGENT][POSITIVE] OK, I'll help you with that. Do you have a phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, I do, ma'am. I have, uh, I have the payer ID is the or the group numbers is what you need.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Do do you have a inpatient outpatient certificate number?
[CUSTOMER][NEUTRAL] Like a payer ID?
[AGENT][NEUTRAL] No, sir. It wouldn't be the payer ID. Do you have a copy of your card in front of you?
[CUSTOMER][NEUTRAL] Yes, I do, ma'am.
[AGENT][NEUTRAL] OK, does it have an inpatient outpatient certificate number?
[CUSTOMER][NEUTRAL] I have the outpatient certificate number.
[AGENT][NEUTRAL] Yes, sir. That's the policy number.
[CUSTOMER][NEUTRAL] Sure, 0258.
[CUSTOMER][NEUTRAL] 9489 ML 8
[AGENT][NEUTRAL] And I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And can I verify your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And can I verify your address and your email address, please?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, address is [PII] and my email is [PII].
[AGENT][NEUTRAL] Thank you, Mr. [PII]. And you wanted to know how this policy coordinated with your primary?
[CUSTOMER][NEUTRAL] Yes, my priority is health health insurance.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can help you with that. The effective date of your policy is [PII].
[AGENT][NEUTRAL] And any benefits given over the phone is not a guarantee of payment. It does coordinate.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, I understand.
[AGENT][NEUTRAL] Thank you. And it does coordinate with your primary insurance. We only pick up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What is applied to your deductible, co-pay, or co-insurance?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I, I've already met my deductible for the year.
[CUSTOMER][NEUTRAL] So I have right now about $2100 of claims that need to be paid.
[CUSTOMER][NEUTRAL] Um, how do I go about to send you the information for the claim and see what's covered and not covered?
[AGENT][NEUTRAL] OK, you can mail it, fax it or upload it to our online service center.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, now the question, so I would have to send you the copy of the claim and what they're telling me that I owe correct?
[AGENT][NEUTRAL] You would have to send an itemized bill.
[AGENT][NEUTRAL] With procedure codes, diagnosis code.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the charges
[AGENT][NEUTRAL] Along with your
[CUSTOMER][NEUTRAL] I think I have that.
[AGENT][NEUTRAL] Along with your explanation of benefit from your primary.
[CUSTOMER][NEUTRAL] I was.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I have to figure out how that, OK, I have to.
[CUSTOMER][NEUTRAL] Figure that out, but OK, so.
[CUSTOMER][POSITIVE] I will definitely print out the stuff that I have.
[CUSTOMER][NEUTRAL] And get that to you guys and then with that we could see what else I need to, you know, what other information will be necessary.
[AGENT][NEGATIVE] Right, whatever you.
[CUSTOMER][NEUTRAL] Um, because I do have, I have here like the.
[CUSTOMER][NEUTRAL] I have like here I have the explanation of benefits, a copy of it, and then I have the claim that was processed and then it has.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The the claim code and everything that it was, I think, I think that would work with that I think.
[AGENT][NEUTRAL] OK, um, you can just send it to us and we'll go through it and if we need anything else, we'll let you know.
[CUSTOMER][NEUTRAL] Let me, what I'll do is I'll.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK, that sounds perfect. That's, that's at least a start.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] You know, but I appreciate the help. So I'll get start getting that going and uh thank you very much for your help today. Have a great day.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, I think you pretty much answered my questions that I had, so now I know how to use this plan and, and cover some of the expenses. I mean it's $2100.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Of, of, of plan expenses, so see what gets covered and whatnot, what's not covered. So I really appreciate the help. Have a great day, ma'am.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] You're welcome. Thank you, Mr. [PII], for calling APLU as well.
[CUSTOMER][NEUTRAL] OK, bye bye.
[AGENT][NEUTRAL] Bye bye.