AccountId: 011433970860
ContactId: 6445ab08-9617-4ded-831f-d40272dc7685
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 448739 ms
Total Talk Time (AGENT): 208959 ms
Total Talk Time (CUSTOMER): 215939 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/6445ab08-9617-4ded-831f-d40272dc7685_20250218T18:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, this is [PII]. Um, I have a question about a claim that my, um, OBGYN did for my first ultrasound that I did here in in [PII].
[AGENT][NEUTRAL] OK, I could take a look at that claim for you. uh, what was your last name, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you and then can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, 25 41 62 4.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, I'm just gonna verify some information really quick, [PII], can I get your date of birth please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Suite 316.
[CUSTOMER][NEUTRAL] [PII] and um the zip code is [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that. OK, let's take a look here.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Uh, when was this, um, what the date of service do you remember when this was?
[CUSTOMER][NEUTRAL] Um, I know that they claimed because the thing is they didn't use the gap insurance, so I had to pay 300, almost 300.
[CUSTOMER][NEUTRAL] Um, for the ultrasound, but the date, the claim in [PII].
[AGENT][NEUTRAL] OK, is that that was the date of service or that's when they filed the claim?
[CUSTOMER][NEUTRAL] That's when they filed the, the, the claim.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The date of service was in, in, in October.
[AGENT][NEUTRAL] OK, let's take a look.
[CUSTOMER][NEUTRAL] I cannot recall exactly the date, but it was in the first ultrasound that I had.
[AGENT][NEUTRAL] OK, so it was for you. I'm let's see, so I see.
[AGENT][NEUTRAL] A few claims on file, none from [PII]. I see one that we received [PII], the [PII], and then [PII], um, of this month.
[AGENT][NEUTRAL] So I'm wondering if that might be it.
[CUSTOMER][NEUTRAL] Let's
[AGENT][NEUTRAL] It looks like all of the data service.
[CUSTOMER][NEUTRAL] Uh, it's the first one, the first claim, because that's the first claim that was made.
[CUSTOMER][NEUTRAL] The one in um [PII].
[AGENT][NEUTRAL] OK, I see one that's the date of service as [PII].
[CUSTOMER][NEUTRAL] Yes, but it concerns some.
[AGENT][NEUTRAL] You said this was
[AGENT][NEUTRAL] Uh-huh, go ahead.
[CUSTOMER][NEUTRAL] Yes, but that's the day they, that's the day they claimed.
[CUSTOMER][NEUTRAL] The ultrasound.
[AGENT][NEUTRAL] OK, let me take a look here.
[CUSTOMER][NEUTRAL] The date of service was back in October last year.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEGATIVE] So for the first one I've got this is [PII] it looks like there were a couple of items and we did pay that full benefit so I don't believe this is the right one.
[CUSTOMER][NEUTRAL] OK. Um,
[AGENT][NEUTRAL] I've got another one for [PII]. This is what was just submitted, um, eight days ago, so just [PII] of this year.
[CUSTOMER][NEUTRAL] Yeah, that's the, that's, yeah, that's another office, that's the Miami Field Services. But it, it was just this one time that um they didn't go through my gap insurance, so I had to pay direct to get the service, I had to pay 300.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um,
[AGENT][NEUTRAL] I'm not seeing anything with that exact amount um.
[CUSTOMER][NEUTRAL] I don't know if they did it.
[AGENT][NEUTRAL] Again, I just have 3 claims on file for you, [PII]. The first one we did pay that full benefit amount uh for the other two it's stating that we're missing the primary EOB. What I would have you do is reach out to them, um, and have them call us so that we can go over all of this with you, of course verifying that we did receive the correct information, um, and then of course we can let them know that we need that primary EOB in order to process these claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. Um, OK, because the only thing that I have is the receipt right now.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But if I get the, because I'm right now I don't really trust them I mean anymore with this paperwork, um, if I get the EOB can there's an email that I can send it to you or I or just upload it here on the portal?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You can absolutely upload it onto that portal, yes, um, and they they should have wherever you went for treatment they will have that primary EOB so you could just simply ask them for it if you'd rather just do it yourself.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And do you know if APL covers the ultrasound?
[AGENT][POSITIVE] This policy absolutely should. This is your secondary medical, let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And as long as your primary medical did uh contribute, correct?
[CUSTOMER][NEUTRAL] Yes, OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yeah, that's really the biggest thing with this policy. Mhm.
[CUSTOMER][NEUTRAL] OK. I'm gonna go look for it and I'm, I'm gonna look for it and upload it.
[CUSTOMER][NEUTRAL] And lastly, I just gave birth. I just gave birth last Thursday.
[AGENT][POSITIVE] OK, sounds good.
[AGENT][POSITIVE] Oh goodness
[CUSTOMER][NEUTRAL] So, uh
[CUSTOMER][NEUTRAL] That's another, another bill that will be coming, but um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Then I will
[CUSTOMER][NEUTRAL] I hope they do the the right paperwork and file it to to the APL also.
[AGENT][NEUTRAL] Yeah, did you give the hospital um this information and they just didn't take it?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They didn't take the, they didn't take the APL the day we went to the hospital, no?
[AGENT][NEUTRAL] Uh, OK, OK, I just have to ask, it's always, of course, a lot easier if they would file the claim for you. OK, OK, so yeah.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] No, they just, my, yeah, they just took my first.
[CUSTOMER][NEUTRAL] Yes, I will. When I receive the bill, when I receive the bill, then um I will contact you again to go through the claim.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Sounds good and we will absolutely help you out with that. Well, congratulations. I hope you're feeling OK. I know how rough that is.
[CUSTOMER][POSITIVE] Yes, thank you.
[AGENT][NEUTRAL] Was there anything else I can help you with, [PII]?
[CUSTOMER][NEUTRAL] No, that's, that's it. I'm gonna go look for the UB to send to you.
[AGENT][POSITIVE] OK, sounds good well thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] All right. Thank you. Have a great day.
[AGENT][POSITIVE] Thank you bye bye.
[CUSTOMER][NEUTRAL] It's not all.
[CUSTOMER][NEUTRAL] Oh, no, no, this is.
[CUSTOMER][NEUTRAL] Sorry, are you still there?
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, do we have to also upload the information of my, of my baby?
[AGENT][NEUTRAL] Um, are you to add them or for the um claims?
[CUSTOMER][NEUTRAL] You have to add them.
[CUSTOMER][NEUTRAL] To add him to the APL too.
[AGENT][NEUTRAL] To add them to the policy that would be through your employer.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Yes, so, um, I would get that information to your employers so that you can get the baby added um you should be able to right away that's, you know, most of them have that allowance for, um, significant life events so.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. OK. I'm gonna do that. Thank you.
[AGENT][NEUTRAL] OK, do you have any other questions for me? Of course.
[CUSTOMER][POSITIVE] No, that's all. Thank you.
[AGENT][POSITIVE] Alrighty, yes ma'am, thanks for calling APL have a great rest of your day.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][POSITIVE] Thank you. Bye bye.