AccountId: 011433970860
ContactId: 5bd0b635-292b-48a5-848b-d5f0e4d861aa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 383660 ms
Total Talk Time (AGENT): 172753 ms
Total Talk Time (CUSTOMER): 161948 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/5bd0b635-292b-48a5-848b-d5f0e4d861aa_20250220T21:31_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] Yeah, so I was just at the, uh, doctor, dermatologist, and this was the 2nd time I was there, and I know I have the gap coverage with UnitedHealthcare. I know APL doesn't cover the copay on the gap coverage, but I had two procedures and they said that APL says I'm not a client of theirs.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It says insured is not found in BIC membership file.
[AGENT][NEUTRAL] Well, I'll be
[AGENT][NEUTRAL] OK. Well, let's take a look at that. So you don't have an APL policy?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I do. I don't know why they, when the doctor filed the claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They got they got back a letter.
[CUSTOMER][NEUTRAL] Uh, they showed it to me that says in yeah, insured not found in DIC membership file, so we're unable to process the claim.
[AGENT][NEUTRAL] Unable to locate you?
[AGENT][NEUTRAL] Do you have an APL ID card?
[CUSTOMER][NEUTRAL] Uh, yes, so it's group number 19098.
[AGENT][NEUTRAL] And what is that policy certificate number or policy ID number?
[CUSTOMER][NEUTRAL] Uh, in the, uh, the outpatient or the in hospitals?
[AGENT][NEUTRAL] Outpatient, please, sir.
[CUSTOMER][NEUTRAL] There too.
[CUSTOMER][NEUTRAL] 0202.
[CUSTOMER][NEUTRAL] 77
[CUSTOMER][NEUTRAL] 52
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] And what is your name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh [PII]
[CUSTOMER][NEUTRAL] Is the first name. Last name is [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And birthday is [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] Now
[CUSTOMER][NEUTRAL] Unless I got a new card, but I don't remember getting a new card or anything.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, you do have another policy that is active and what is, let's just verify your information and I can email you a copy of your new card or and that would be the only thing because your policy is active.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK great.
[AGENT][NEUTRAL] I mean, you've had continuous coverage.
[CUSTOMER][NEGATIVE] OK, yeah, I don't know why I never got the new card then. I don't know why, yeah, maybe that's the reason, so I guess that's the reason it was, it was denied, OK.
[AGENT][NEUTRAL] Well, we, we're gonna
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's a possibility. And so what what I need to do is just to verify your current mailing address if you don't mind.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mailing address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it's uh [PII].
[AGENT][NEUTRAL] All right, thank you. And what is your uh callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And bear with me just one second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] I'm just trying to get everything pulled up so I can get you taken care of. And I can also give you your policy number if you would like.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] Your current policy number is 248.
[AGENT][NEUTRAL] 15. Take your time.
[CUSTOMER][NEUTRAL] Give me one sec, hold on.
[AGENT][NEUTRAL] Just tell me when you're ready. It is 2.
[CUSTOMER][NEUTRAL] OK, what is it?
[CUSTOMER][NEUTRAL] Uh, right.
[AGENT][NEUTRAL] 248
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 15. Mhm.
[CUSTOMER][NEUTRAL] 248
[CUSTOMER][NEUTRAL] 15
[AGENT][NEUTRAL] 53.
[CUSTOMER][NEUTRAL] 532481553.
[AGENT][POSITIVE] That's right.
[CUSTOMER][POSITIVE] OK great OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] What is your, would you like for me to add an email? I can email you a copy.
[CUSTOMER][NEUTRAL] Sure it's uh [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, give me just one second.
[AGENT][NEUTRAL] Let me make sure this.
[AGENT][NEUTRAL] Group offers.
[AGENT][POSITIVE] Well, I'm gonna email to you. That won't matter, so I'll be happy to email that to your email.
[AGENT][NEUTRAL] And on this email, there's gonna be our online service center.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You can create a login and password. You can view your policy benefits, you can print additional cards, you can check claim status, and what I would suggest, Mr. [PII], is to contact that office and make sure they have your updated policy information and they can even.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah they had the old one they must have had the old one because I gave them the old card. I didn't know there was a new uh number or a new card or anything, so I guess that's what happened so I should tell them to reapply.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, reapply again then right with this, uh, number for the one from both procedures, OK, from the one in November and then the one from today, OK.
[AGENT][POSITIVE] That's correct.
[AGENT][POSITIVE] That's right.
[AGENT][POSITIVE] And they can even fax it to us, you know, that way if they're older claims we can get them sooner than mailing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And, um,
[CUSTOMER][POSITIVE] OK great.
[AGENT][NEUTRAL] The fax number should be on your card actually.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] But even your card that you have now.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] It's the same fax number, they can fax it to us and we can get that taken care of for you and I'm sorry about that. I'm sorr[PII] you didn't get your new card.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's OK, it's OK, yeah, it was, it was two visits that they said I had a balance and then they told me today.
[CUSTOMER][NEUTRAL] You know it wasn't covered that I wasn't and then they told me to call to see if there what the issue was, so I guess that was the issue that.
[CUSTOMER][NEUTRAL] It was a different car. It was a new car, but thank you.
[AGENT][POSITIVE] Right. Well, it's been a pleasure to assist you. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Uh, no, that was it, thank you.
[AGENT][POSITIVE] Oh, Mr. [PII], thank you for calling APL. I hope you have a wonderful afternoon.
[CUSTOMER][POSITIVE] You too thanks bye.
[AGENT][POSITIVE] Thank you. Bye bye.