AccountId: 011433970860
ContactId: 5e32ad80-f838-4c4c-a2c2-2bb8a7787b1f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 309470 ms
Total Talk Time (AGENT): 169410 ms
Total Talk Time (CUSTOMER): 149570 ms
Interruptions: 4
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/5e32ad80-f838-4c4c-a2c2-2bb8a7787b1f_20241231T19:31_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII]. My name is [PII]. I have your gap insurance through my employer.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I had an incident back in May and I got a letter yesterday saying that they've been trying to get payment for the gap insurance and that you need some additional information and so I'm trying to figure out what it is. So what information do you need from me?
[AGENT][NEUTRAL] Um, let me first start with your name and a callback number.
[CUSTOMER][NEUTRAL] OK. My name is [PII] My last name is [PII]
[CUSTOMER][NEUTRAL] And it's [PII].
[AGENT][NEUTRAL] Thank you. And what is your policy number with us?
[CUSTOMER][NEUTRAL] Uh, let's see, um.
[CUSTOMER][NEUTRAL] Let's see insurer coverage individual. I have a group number. Oh, an outpatient here is it's certification number, right?
[AGENT][NEUTRAL] The outpatient certificate number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, 01866.
[CUSTOMER][NEUTRAL] 994.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] OK, if you could verify your uh date of birth and your mailing address, please.
[CUSTOMER][NEUTRAL] And my date of birth is [PII] and my mailing address is [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying your account and you said it is for services rendered back in [PII] and we're requesting additional information.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I do show an emergency room visit on [PII]. Uh, we have requested your primary explanation of benefits. So, uh, we're able to see your patient responsibility.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the amount we need to pay.
[CUSTOMER][NEUTRAL] Requested the, the, I'm sorry, requested the primary.
[AGENT][NEUTRAL] Uh-huh. Explanation. The primary insurance carriers explanation of benefits.
[CUSTOMER][NEUTRAL] So what's the rest of it?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Explanation of benefits. So I call my primary insurance and have them send that to you?
[AGENT][NEUTRAL] No, actually, the provider is supposed to send that, so we sent the request to uh the facility, the hospital, letting them know that they need to send that information to us. If you have it, you can send it yourself and then we can process the claim and pay the hospital. So, uh, the explanation of benefits is um when you go to the doctor and
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, you get the, you get it in the mail from your insurance company that says this is not a bill, we received the claim for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, this is what we pay, this is what you owe, uh, that is the statement that we need.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'm gonna look through my stuff and see if I have it. But in the meantime, I will call them and tell them they know exactly what that is, explanation of benefits, I'm sure. And they're waiting, and you're waiting for it from the hospital.
[AGENT][NEUTRAL] Right, they do.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Right? OK. And they, and they know they have all the information about your office on how to send that to you. So do I need to give them anything else? OK.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, because they sent the claim.
[AGENT][NEUTRAL] Uh, no, that is, that is it, um.
[AGENT][POSITIVE] They did send the claim, so they definitely, um, you know, know where to send it. Um, if anything, you can let them know it can be faxed, which is quicker to get to us, and I can provide you the fax number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that would be great. I think I have it on the card. Is it the [PII]?
[CUSTOMER][NEUTRAL] [PII]. I'm sorry, I don't see well. Uh, [PII], that 1 [PII], is that what it says? OK, I got it right here.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, [PII]. Yes, ma'am. That is the correct, uh, fax number if they want to fax it over.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'll call them right now and let them know that's what you need from them. Thank you.
[AGENT][POSITIVE] OK. OK. You're welcome. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Have they, have they, have, is it noted that they've called you and asked what you needed at all or no?
[AGENT][NEUTRAL] Let me look at the notes and see if we've received any.
[CUSTOMER][NEUTRAL] Do they
[AGENT][NEUTRAL] No, I don't show any calls uh coming through, um, about, um, yeah.
[CUSTOMER][NEUTRAL] No contact. OK.
[AGENT][NEUTRAL] I don't show anything coming through, but again, as I stated, if you can get a hold of the explanation of benefits, um, if you're not able to get through to them, you can get that um statement from your insurance carrier.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And, um, you know, send it yourself, um, you know, if you're having a hard time getting that from the, getting the hospital to do it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I'll figure it out, but I'll get it done one way or the other. Maybe not today, but probably by Thursday. You have a great New Year. Thank you.
[AGENT][POSITIVE] Oh, OK. You have a wonderful new year yourself. Thank you for calling APL.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] OK, bye-bye.