AccountId: 011433970860
ContactId: 4bcad306-3219-4a94-87c6-62b71e0f5f94
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 241199 ms
Total Talk Time (AGENT): 83257 ms
Total Talk Time (CUSTOMER): 108798 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/4bcad306-3219-4a94-87c6-62b71e0f5f94_20250312T17:33_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Yes, hi, [PII], how are you?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][POSITIVE] I'm good. Thank you for asking. My name is [PII].
[CUSTOMER][NEGATIVE] And I'm calling because I submit a claim for my daughters, but I, I, it looks like processed, but I don't understand if I missed something. I, I don't get it. Can you help me?
[AGENT][POSITIVE] I'd be happy to assist with the claim today, Ms. [PII], if I can get a good call back number for you.
[AGENT][NEUTRAL] May I have a good call back number for you?
[CUSTOMER][NEUTRAL] The good, sorry?
[AGENT][NEUTRAL] Number telephone number.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 598
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is your policy number?
[CUSTOMER][NEUTRAL] Um, OK, this is the one that's the group number or?
[CUSTOMER][NEUTRAL] OK, one second, I can see. OK, the policy number is 255.
[CUSTOMER][NEUTRAL] 2779.
[AGENT][NEUTRAL] Um, that's not a valid policy number.
[CUSTOMER][NEUTRAL] OK, tell me where can I find the because this is the one on the website. Tell me where can I find it on the card.
[AGENT][NEUTRAL] It would say inpatient or outpatient hospital, um.
[CUSTOMER][NEUTRAL] OK, it's 02.
[CUSTOMER][NEUTRAL] 55
[CUSTOMER][NEUTRAL] 277
[CUSTOMER][NEUTRAL] 9
[CUSTOMER][NEUTRAL] ML 7.
[AGENT][NEUTRAL] And what is your date of birth and email address?
[CUSTOMER][NEUTRAL] [PII]. And my email is [PII].
[AGENT][NEUTRAL] And what is the name and date of birth of the dependent?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Her date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that information. So I'm showing that we um asked for the we need the explanation of benefits from your primary insurance in order to finish processing the claim.
[CUSTOMER][NEUTRAL] Like what? Like, tell me exactly, sorry, because I don't know what what that means. Like you need like the estimates to send.
[AGENT][NEUTRAL] Anytime
[AGENT][NEUTRAL] Anytime, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] To send it to me before I pay that?
[CUSTOMER][NEUTRAL] No, because what I have, the, when, when we went to the surgery, I have like the estimates. They give me like the paper, the estimate, how's the insurance cover and how much I paid. This is the one you want?
[AGENT][NEUTRAL] No, ma'am, I need the explanation. I'm sorry, go ahead.
[CUSTOMER][POSITIVE] Like to go.
[CUSTOMER][POSITIVE] No, no, no, this is what I'm telling you. This is what I have. Tell me what do you need so I can get it for you.
[AGENT][NEUTRAL] We need the explanation of benefits from your primary insurance. The explanation of benefits is that notification that you get from your insurance every time they process a claim. It'll normally say on it, this is not a bill, and then it'll list the claim that they received and how they processed it and if they applied anything to deductible, co-pay or co-insurance and then it'll normally say patient responsibility, that's the form that we need from your primary insurance in order to finish processing your claim.
[CUSTOMER][NEUTRAL] OK. Uh, so do I have to call them and ask them for, or I can get it from the website?
[AGENT][NEUTRAL] You should be able to get it from your website with your major medical company, but if you're having trouble figuring out how to do it, you can just call them.
[CUSTOMER][NEUTRAL] OK. So, and after what I have to do, go in the, the, the um the APL website and upload file?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK. Thank you so much. I really appreciate it. Thank you.
[AGENT][NEUTRAL] Was there anything else I can assist with today?
[CUSTOMER][POSITIVE] No, thank you so much. Thank you. Bye bye.
[AGENT][POSITIVE] Thank you for calling APO. Have a good day.
[CUSTOMER][POSITIVE] Thank you bye bye.