AccountId: 011433970860
ContactId: 4e3e236b-741b-4b9a-8481-ac2181a00e19
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 317630 ms
Total Talk Time (AGENT): 174189 ms
Total Talk Time (CUSTOMER): 127987 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/4e3e236b-741b-4b9a-8481-ac2181a00e19_20250226T19:31_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] OK.
[CUSTOMER][NEUTRAL] Hi there. I'm calling. I am a new member and um I have been giving my um information to my family's doctor and they can't verify it, so I, I wanted to connect with somebody.
[AGENT][POSITIVE] Well, I'll be happy to assist you with that. Do you have your policy number available?
[CUSTOMER][NEUTRAL] I do, yeah, it is uh 025.
[CUSTOMER][NEUTRAL] 81,980.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is your name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] My name is [PII], and my birth date is [PII].
[AGENT][NEUTRAL] All right, thank you. Ms. [PII], do you mind verifying your current mailing address and phone number?
[CUSTOMER][NEUTRAL] Sure, [PII]. My cell is [PII].
[AGENT][NEUTRAL] Thank you and we do have an [PII]&T.net email. Do you mind verifying that as well while I've got you on the line?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][POSITIVE] And it would be my pleasure to assist you, Ms. [PII]. They're stating that they can't verify the policy.
[CUSTOMER][NEUTRAL] Yes, both places that I have called say that they can't verify um.
[CUSTOMER][NEUTRAL] That so I guess they they said that they couldn't verify it and um that they were gonna put it included but they weren't sure that it would go through and.
[CUSTOMER][NEGATIVE] You know, get charged or whatever, so it worries me, um, that I'm not sure what that meant.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] I, I'm, I'm not either. That's why I was like this is it.
[AGENT][NEUTRAL] So your policy is active. The effective date was [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And as you know this is a secondary policy to your primary insurance, so I'm not sure why they're saying they couldn't verify. I did check the notes they have no one has called to verify or get benefits on your plan.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, all right, so I'll just wait. May I ask, um, do you, I was seen at urgent care, I think in January, um, have, have they, and I gave them the information. Have, have anything come through from them as, uh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I, sure. I do have a no, you're fine.
[CUSTOMER][NEUTRAL] Sorry
[AGENT][NEUTRAL] I do have a claim from [PII].
[AGENT][NEGATIVE] Urgent care for [PII]. They sent the claim in, but they did not include a copy of your primary insurance showing what was applied to your deductible or co-pay or co-insurance. Now that was processed on.
[CUSTOMER][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] they may not have received the explanation of benefits yet but we're requesting that that primary.
[AGENT][NEUTRAL] Explanation of benefits be sent in so we can continue processing the claim.
[AGENT][NEUTRAL] And normally the providers will send that in once they receive that um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] They might have not have received it I.
[AGENT][NEUTRAL] You haven't received a copy of it yet, have you?
[CUSTOMER][NEUTRAL] Of the what? I'm sorry?
[AGENT][NEUTRAL] So we're gonna we're mailing you the same explanation of benefits that we've sent to that provider stating that we needed explanation of benefits from your primary.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that's, that's why I'm saying they may not have received it yet.
[CUSTOMER][NEUTRAL] Oh, I see. OK, and that's fine and um I, I just, so they're, they're in charge of that. I don't, they're the ones that have to send that information, not me, correct?
[AGENT][NEUTRAL] Well they should now if you have a copy of that primary EOB or explanation of benefits and you want to upload it on the portal, I see you have an active online account you can provide that and we can continue processing the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'm pretty, um, I'll have to check and see what they sent me. I know they sent me a bill, which is why I then connected with them and so I'll, I'll have to check to see if there's an if that is an explanation of benefits or if it was just a bill.
[AGENT][NEUTRAL] From the uh [PII] [PII]'s is probably just a bill. That explanation of benefits would come from your primary insurance.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh yes, that thing we get like on a monthly basis, OK.
[AGENT][POSITIVE] Exactly showing the claims that have been processed.
[CUSTOMER][NEUTRAL] Yes, yes, yes, oh, OK, um, I guess, yeah, I'd have to look back on that and see. I could probably find that online, OK.
[AGENT][NEUTRAL] Mhm. Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, and um now the provider probably will send the client that EOB in.
[AGENT][NEGATIVE] I just don't know how much time, you know, will lapse, but they should not be sending you a bill if they filed insurance.
[CUSTOMER][POSITIVE] All right sounds good well thank you so much I appreciate your help.
[AGENT][POSITIVE] Oh, it's been such a pleasure to assist you. Anything else I can help you with, Ms. [PII]?
[CUSTOMER][POSITIVE] No, I'm all set. Thank you.
[AGENT][POSITIVE] And thank you for calling APL. Call us again if we can be of further assistance. Hope you have a wonderful day.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][POSITIVE] Thank you bye bye.