AccountId: 011433970860
ContactId: 3e438642-75d1-499e-9c4a-f1eb5be4a556
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 513717 ms
Total Talk Time (AGENT): 182724 ms
Total Talk Time (CUSTOMER): 270794 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/3e438642-75d1-499e-9c4a-f1eb5be4a556_20250324T20:41_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I was calling to see if you all received some claims that I um sent in last week.
[AGENT][NEUTRAL] OK, I can definitely check and see if the claims are here. May I have your name and a good contact number?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes [PII].
[CUSTOMER][NEUTRAL] My number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] Yes, now when, when you say policy number, that's member number, right?
[AGENT][NEUTRAL] Well, no, uh, if you have your ID card, it should say like in hospitals or outpatient policy certification number.
[CUSTOMER][NEUTRAL] Um, no, my card says group. I have a group ID number and I have a uh member number.
[AGENT][NEUTRAL] Is it, does it start with a 02 or a 01?
[CUSTOMER][NEUTRAL] Neither one of them. Mm mm.
[AGENT][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] My plan is basic care and yeah neither one of them start with a 0.
[AGENT][NEUTRAL] OK, and it says APL to the top left?
[CUSTOMER][NEUTRAL] No, my plan is um.
[CUSTOMER][NEUTRAL] Managed care.
[CUSTOMER][NEUTRAL] And my plan is uh basic core, and so this is where I had to send my claims to for um.
[CUSTOMER][NEUTRAL] For um.
[CUSTOMER][NEUTRAL] Wait, let me see, do I have the right number? Yeah, I got the right number I think.
[AGENT][NEUTRAL] Did you call [PII] or [PII]?
[CUSTOMER][NEUTRAL] I called [PII].
[AGENT][NEUTRAL] OK, well, let me, that is the number for APL, um, but we're not, this is not managed care. Um, let me
[CUSTOMER][NEUTRAL] Is that wrong?
[CUSTOMER][NEUTRAL] Well, I have another one that says.
[AGENT][NEUTRAL] I can look it up with the
[CUSTOMER][NEUTRAL] OK, OK, I'm sorry, go ahead.
[AGENT][NEUTRAL] No, you're OK. I can look it up with your um social or I can try with your first and last name. You want to do first and last name first?
[CUSTOMER][NEUTRAL] Yeah, [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. I'm just waiting for the policies to come up.
[CUSTOMER][POSITIVE] OK, great.
[AGENT][NEUTRAL] Here it is. I think I just found you. Hold on one moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] All right, now I have you here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Oh, you said I need to verify that with you now?
[AGENT][NEUTRAL] Yes, um, so that I can get into the policy.
[CUSTOMER][NEUTRAL] OK, alright, well, my birthday is [PII].
[CUSTOMER][NEUTRAL] Email address is my [PII], so that's [PII].
[CUSTOMER][NEUTRAL] And then what was the 3rd thing you said?
[AGENT][NEUTRAL] Your mailing address?
[CUSTOMER][NEUTRAL] My mailing address is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So the um policy number is 259.
[AGENT][NEUTRAL] 16. OK.
[CUSTOMER][NEUTRAL] Wait, let me get a pen. Let me get something to write, let me write that down.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Right quick, so my policy number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, 259.
[AGENT][NEUTRAL] Mhm. 2591638.
[CUSTOMER][NEUTRAL] 163, no that is not on this card. I only have a group ID and um a member number wow.
[CUSTOMER][POSITIVE] That's interesting.
[CUSTOMER][POSITIVE] OK, thank you for that.
[AGENT][NEUTRAL] Hm.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][POSITIVE] That's interesting.
[AGENT][NEUTRAL] Um, but I did, it did, I did take a look at um the claims, and yes, we did receive documents on [PII]. They are in processing now. So it's usually about 7 to 10 business days from the day that we received the claim that you should receive a turnaround unless there's some type of delay which will notify you if there is, but we haven't seen anything yet.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, and then I, I do have to ask normally how does, how does it pay? Do, does it pay 50%, 80%, or do you know?
[AGENT][NEUTRAL] No, it depends on what, uh, it depends on what's being submitted. So basically you have a list of benefits and a dollar amount that each benefit would pay. So depending on what's being filed, that dollar amount would be applied, but I can't access the documents to see what it is, um, but yes, it depends on, you know, what the benefit is for what you're filing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right. Well, I'm trying to to to use this as a gauge if I'm gonna because I pay this insurance monthly to see if, if I need to switch to something else because I, my cardiologist does not accept this, this plan so when I see the cardiologist I have to pay out of pocket or maybe I just need to find somebody else that does accept it. I don't know.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] So you want to see how this pays out so that you can, you know, how it's handled so that you know what you need to do.
[CUSTOMER][NEUTRAL] Yeah, no, you know what I need to do going forward because I mean my, my plan is $217 a month so I mean if I mean the month of well you from the claim one test was $754 and I had to pay that up front they wouldn't do a uh a a plan or anything so I just need to see how it's gonna pay out if it's not gonna.
[AGENT][NEUTRAL] I understand.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know, give me the majority of my money back then I probably need to find another insurance that where, where it is accepted with the carriers that I go to, yeah, mhm, right, OK, so 7 to 10 business days.
[AGENT][POSITIVE] More beneficial, right. Mhm.
[AGENT][NEUTRAL] OK, well, if you sign up.
[AGENT][NEUTRAL] Yes, ma'am, and if you, you know, you're fine. Um, if you, I don't know if you um use the, let me go back to that claim, if you use the online service center to send your claim or if it was mailed, but um you will receive notification um through the mail and text message if you use the online service center of when the claim is finished processing.
[CUSTOMER][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Oh, I faxed it. I faxed all the information in and I did something, mhm, I did something extra too. I attached my receipts, uh, because then you know I needed the itemized bill, so I did that and I attached the receipts that I paid for each one as well so I was just trying to be, you know, I guess, uh.
[AGENT][NEUTRAL] Oh, you faxed it, OK.
[AGENT][NEUTRAL] Proactive.
[CUSTOMER][POSITIVE] As thorough, you know, you know, as thorough as I possibly could be, so that's what I was trying for, yeah.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Well, if you.
[CUSTOMER][NEUTRAL] OK, alright, so 7 to 10 days before I know anything. OK, sounds good.
[AGENT][NEUTRAL] And was there anything else I can help you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] No ma'am, just thank you so much for giving me a policy number and actually I need to get in touch with them because the back of the card, all the information is like the numbers I need they've been, they're smudge so I don't even really know how I did that so I don't have um.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Oh, yeah, and get a new copy.
[CUSTOMER][NEUTRAL] Yeah, I need a new card, so I, I need to get in touch with somebody. OK.
[CUSTOMER][POSITIVE] Alright then, well thank you so much. I really do appreciate your help and uh so they get you got on the [PII] so I should be knowing something by the end of the month, OK, by next week probably.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All righty. Well, thank
[CUSTOMER][POSITIVE] All right, thank you so much, [PII], and I appreciate your help.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a great week.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.