AccountId: 011433970860
ContactId: 5efd66b8-d721-44f9-9e68-a11f53f19f36
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 445420 ms
Total Talk Time (AGENT): 161627 ms
Total Talk Time (CUSTOMER): 145165 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/5efd66b8-d721-44f9-9e68-a11f53f19f36_20250611T12:58_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. I, um, my name is [PII]. I'm calling to check on a possible claim. I'm not certain about it.
[AGENT][NEUTRAL] OK, are you the insured or you're calling from the provider's office?
[CUSTOMER][NEUTRAL] I'm the insured.
[AGENT][NEUTRAL] Alright, Ms. [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And may I have your policy number?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Is that the one that says group number?
[AGENT][NEUTRAL] Um, no, ma'am, it's just a policy er number.
[CUSTOMER][NEUTRAL] OK. 018.
[AGENT][NEUTRAL] It should start with a 0. Yeah, there you go.
[CUSTOMER][NEUTRAL] 25837 ML 7
[AGENT][NEUTRAL] Thank you. And can you verify your date of birth and the mailing address on file?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And um Mrs. [PII], is the claim for you or your husband or dependents?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For me
[AGENT][NEUTRAL] It's for you? OK.
[AGENT][NEUTRAL] And what would, do you know what the date of service would be for the claim when you receive the services?
[CUSTOMER][NEUTRAL] I think, um.
[CUSTOMER][NEUTRAL] I think it was in [PII].
[CUSTOMER][NEUTRAL] I'm just checking to see if a claim was filed. I'm not sure.
[AGENT][NEUTRAL] OK, um, hold on one second, let me see if we, oh.
[AGENT][NEUTRAL] Oh, we've processed quite a few. Um, do you have like a bill or something that you have from there that we can probably get the date?
[CUSTOMER][NEUTRAL] No, I don't have a bill. Um, do you see anything from, uh, do you guys cover ambulance ride?
[AGENT][NEUTRAL] Well, see
[CUSTOMER][NEUTRAL] Like from hospital to to.
[AGENT][NEUTRAL] So basically it's just a
[CUSTOMER][NEUTRAL] It says it's from um.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] I'm sorry, go on. Oh, I was saying it's from, um, they say it's from a hos hospital.
[CUSTOMER][NEUTRAL] Also like
[CUSTOMER][NEUTRAL] From Mount Sinai.
[AGENT][NEUTRAL] So basically for your claims, it's just like a list of all the claims we filed with the since [PII]. So it's just the the dates and the claim number. So
[CUSTOMER][NEUTRAL] And, oh gosh.
[AGENT][NEUTRAL] Unless I go through each one, there's really no way for, you know what I mean, for me to uh.
[CUSTOMER][NEUTRAL] No, I don't have that.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] I'm not sure. Um, but you said it was from [PII]. I can go through all the ones from [PII] and see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it's uh in in [PII]. I don't just don't remember the exact date.
[AGENT][NEUTRAL] And, and it's an ambulance bill that you're looking for?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Is that covered though, in my plan?
[AGENT][NEUTRAL] Uh, well, let me, let me find the claim first, uh.
[AGENT][NEUTRAL] Since I'm looking through the list and then I'll go through that, I'll look at that one next.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And you said it's from [PII] or would it be from the ambulance company?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I think it's the ambulance.
[CUSTOMER][NEUTRAL] Um, American Medical Response, I believe the name is.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so looking through the ones from [PII], I don't see anything, but it could come over as a different provider. The best thing to do would be if you, if you can locate the name of the ambulance company, just call them and see if they have a bill for you and they'll have the the data service on there. And then with that data service, we'll be able to put that in here and see if there's a claim here on file.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. Um, can you tell me if ambulance service is covered in my plan though?
[AGENT][NEUTRAL] Yes, hold on one moment, let me look and see for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so I'm just waiting for it to come up. Hold on one moment.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] So under outpatient, yes, um, the ambulance is covered up to $500 per occurrence. Occurrence is anything of the same or related issues. So every time you, if, for example, uh, if it was something about your knee, everything for your knee is one occurrence, and then if you get something, if you go for your shoulder, it's a new body part that's a new occurrence.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] Mm I'm not sure if you can help me. I just need to find, find out. Um, I, I was at, um, uh, what is it, [PII] as a patient in [PII], in [PII], but they transferred me from their emergency room to the main hospital.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Would that be covered? The transport you mean an ambulance, would that be covered?
[AGENT][NEUTRAL] Yes, whatever the reason, the ambulance itself is covered under outpatient, up to that $500 per occurrence.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, thank you very much. You've been very helpful.
[AGENT][POSITIVE] Well, you're very welcome and thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] You too. Thanks. Bye-bye.
[AGENT][POSITIVE] Thank you, bye bye.