AccountId: 011433970860
ContactId: 68c0752c-12c4-4e78-847d-e67c018a1779
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 484519 ms
Total Talk Time (AGENT): 174364 ms
Total Talk Time (CUSTOMER): 301236 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/68c0752c-12c4-4e78-847d-e67c018a1779_20250114T20:05_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] Hi [PII], this is Mr. [PII] calling. Um, I'm getting a letter from an urgent care that I went to back on [PII] for my son [PII]. Um, let me first validate who I am. Can I give you my either my certificate number or group number? What do you need first?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Certificate number would be wonderful, and you've done this before, haven't you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How can you tell?
[CUSTOMER][POSITIVE] Uh, you guys are a pleasure to work with. You guys are fantastic, so.
[AGENT][NEUTRAL] Well
[AGENT][POSITIVE] Oh, great.
[CUSTOMER][NEUTRAL] Yes, um, I don't hear a [PII] drawl with you though, however.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm in [PII].
[CUSTOMER][NEUTRAL] Ah, there you go.
[AGENT][NEUTRAL] Can you hear that?
[CUSTOMER][NEUTRAL] You guys are all in [PII], OK.
[CUSTOMER][POSITIVE] Very good. Alright, so the uh certification number, this is the outpatient one, it's 01960211.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mary Lisa, 8.
[AGENT][NEUTRAL] Thank you, Mr. [PII]. Can you verify your first name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] The current mailing address, email, and phone number.
[CUSTOMER][NEUTRAL] [PII]. Email I think you guys have, do you have a [PII] or a Google account?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So that would be [PII] and then phone number, my cell is [PII].
[AGENT][POSITIVE] Perfect. You passed.
[CUSTOMER][NEUTRAL] Ooh, I was sweating.
[AGENT][POSITIVE] You did good. You got a 100+.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, OK, so, um, Baptist Health is calling me. I've got a letter saying we owe them a bunch of money. Uh, they're saying my visit to their facility, their, their urgent care on [PII], um, they have a, a total charge here of $1,171. They're waiting for.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A $100 balance to be paid. I said APL should be covering that, so they wanted me to check with you. Number one, do you see that on uh on for my son [PII] on [PII] for 1171171? do you see that charge coming?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We do
[AGENT][NEUTRAL] We do not have that claim on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, that's interesting. They said they sent it to APL.
[AGENT][NEGATIVE] We have not received it. I don't know where they might have sent that claim.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] But we don't have it on file.
[CUSTOMER][NEUTRAL] OK, so, and I asked the representative, you know, what do I do based on APL's response, so they said, um, basically if.
[CUSTOMER][NEUTRAL] You know you're not aware of it you don't have it. I'm to call them back and ask for a certain department I guess they'll forward it to you again. I don't know but this is.
[AGENT][NEUTRAL] Yeah and I can give you a fax number they can send it directly to our claims department. In fact, it should be on your card, but I can get that.
[CUSTOMER][NEUTRAL] Oh, let me get that.
[CUSTOMER][NEUTRAL] OK, APL fax, please go ahead.
[AGENT][NEUTRAL] Our fax number is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] and that does come straight to our claims department.
[AGENT][POSITIVE] It's the quickest way to get a claim.
[CUSTOMER][NEUTRAL] OK and
[CUSTOMER][NEUTRAL] OK, and should they put on there my certificate number or group number or name or what what's what should be on there or just a.
[AGENT][NEUTRAL] Policy number would be great, the 1960211, and I'm pretty sure that they would be aware, but we also need your primary EOB with that claim. I was checking in the notes to see if they've even called for claim status. No, I don't see that they have.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, because they did say that Aetna paid the 1st $400 and something dollars and they're looking for that co-pay, and I said, Well, APL typically takes care of my urgent care co-pays. I'm in my primary doesn't, so that's what's wonderful, wonderful about having you guys so.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I'll call them. I'll let them know the fax number. I'll repeat it now [PII] that goes directly to the claims department and you need them to include the primary EOB.
[AGENT][NEUTRAL] That is correct because your policy is secondary, so we have to have that Aetna EOB showing what they applied to deductible copay and co-insurance. They will probably send that anyway, but just as a reminder so we don't get the claim and then still have additional information needed, you might just want to mention it to them, say, hey, by the way.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Be sure to send everything.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The next item.
[AGENT][POSITIVE] Oh, we've got multiple ones. Good.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEGATIVE] No, that's it that's the only issue I have with following up with you guys you don't even know about it, so I gotta get back to them. I have another thing.
[CUSTOMER][POSITIVE] That you know, because I changed my primary from Aetna to Imagine Health.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And you're still secondary after that they don't even know. Imagine Health apparently never sent a bill to them so they're, they're at ground zero on that one.
[AGENT][NEUTRAL] Oh, so, so when, on [PII], were you with Imagine?
[CUSTOMER][NEUTRAL] No, on [PII] I was with Aetna. I had an Aetna.
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] OK, so we're sending it on this one.
[CUSTOMER][NEUTRAL] Right, and then come October I I switched to a new company, excuse me, and they have this Imagine uh health which is part of multi plan or something, um, it's a weird one, it's not Aetna, not Blue Cross Blue Shield, it's so it's a weird, a weird one, but it's been working, so that's OK.
[AGENT][NEUTRAL] Right
[AGENT][POSITIVE] Well, good.
[CUSTOMER][NEUTRAL] All right, that's it.
[AGENT][NEUTRAL] I'm glad it works that I was, this medical costs these days is just outrageous anyway.
[CUSTOMER][NEUTRAL] It really is, it's just uh it's too much so I really need to bank on, you know, the insurance as a primary and follow on you guys as a secondary, which, which I have been doing and that's why I know so much about what you're looking for. So thanks again for your patience.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yeah, I know you, oh no, thank you for for your expertise.
[CUSTOMER][POSITIVE] OK, I'll get back to, uh, Baptist Health and let them know that they use the stuff. Thank you so much.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Well, it has been my pleasure to assist you, Mr. [PII]. Thank you for calling APL and from [PII], I hope you have a wonderful day and stay warm.
[CUSTOMER][POSITIVE] Thank you, yes. Oh, we're in [PII], so we're OK.
[AGENT][POSITIVE] I know. That's where I wish I were. I that's where I wish I lived.
[CUSTOMER][NEUTRAL] 8
[CUSTOMER][NEUTRAL] Well, it is nice, but then come May, March, April, May, June, you want to be anywhere but here because it's just so darn hot. You just can't breathe. It's just.
[AGENT][NEUTRAL] Well, see, [PII], we get that hot heat and the humidity. I mean,
[CUSTOMER][NEUTRAL] Ah, I've never been to.
[AGENT][NEUTRAL] So I'm used to that.
[AGENT][POSITIVE] The, the plus side in [PII] is you get a little sea breeze. We don't get that here in [PII]. We just get hot and humid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh right, yeah, we do have a nice breeze pretty much all the time, which is, and it's so pretty looking at the palm leaves blowing it is.
[AGENT][NEGATIVE] Oh my gosh. Oh, you're making me jealous.
[CUSTOMER][POSITIVE] That's very nice.
[CUSTOMER][NEUTRAL] I'll I'll stop there.
[AGENT][POSITIVE] Well it's been such a pleasure, and if you need anything else, Mr. [PII], never hesitate to give us a call.
[CUSTOMER][POSITIVE] You as well, yeah, I, I, I, uh, me as well, rather, thanks so much. Have a great.
[AGENT][POSITIVE] Alright thank you you too bye bye.
[CUSTOMER][NEUTRAL] OK.