AccountId: 011433970860
ContactId: 6fabe3d6-0168-4fb1-9e0b-93afd4b342d2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 538950 ms
Total Talk Time (AGENT): 226050 ms
Total Talk Time (CUSTOMER): 128373 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/6fabe3d6-0168-4fb1-9e0b-93afd4b342d2_20250611T14:15_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEGATIVE] Hey [PII], my name is [PII]. I'm calling because I received a bill from when I was in the hospital 2 years ago, and I'm just receiving the bill now, and they're letting me know that, um, you know, the services I had with APL you guys did not pay.
[AGENT][NEUTRAL] OK, let me take a look and see if we received the uh claim. Uh, could I get your policy number?
[CUSTOMER][NEUTRAL] Um, would that be the certificate number?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] 0229
[CUSTOMER][NEUTRAL] 7981
[CUSTOMER][NEUTRAL] M as in Mary, L as in love, and the number 8.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And could I get a good call back number for you please?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And if you could verify your um.
[AGENT][NEUTRAL] Your full name and date of birth, please.
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying the account and you said you received a bill for a hospital stay 2 years ago. What is the date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] To [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I do show the claim received.
[AGENT][NEUTRAL] So it looks like they they sent the claim twice, both times, well, we requested your primary explanation of benefits. They're only submitting the claim and not the explanation of benefits for us to, you know, for us to see what it is you owe.
[CUSTOMER][NEGATIVE] OK, because I have here, I don't know if this helps, but they billed total $23,983.80 and my primary insurance paid $23,633.80. That leaves behind the $350 that I am being billed for.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, so if you have a copy of your explanation of benefits um that you received from um your primary, basically it says this is not a bill, we received your claim and given that information, it it has to be the explanation of benefits. I believe that's what you're saying you have. Uh, you can submit.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Oh, it's not. It's just the bill, the bill from the hospital.
[CUSTOMER][NEUTRAL] It's just about, yeah.
[AGENT][NEUTRAL] OK. Uh, so you should be able to go uh to your portal, like an online portal or call your primary and request that they send you a copy of it. They can probably email it to you and then you can upload it to the online service center and we can reprocess the claim, or, you know, you can contact the hospital and let them know, hey, they have um they need the explanation of benefits from my primary.
[AGENT][NEUTRAL] But if you have that information, you can submit it.
[CUSTOMER][NEUTRAL] OK, do you know?
[CUSTOMER][NEUTRAL] Do you know who my primary is? Does that show in the system? I don't even remember what insurance I had at the time.
[AGENT][NEUTRAL] OK, let me check and see.
[AGENT][NEUTRAL] So it looks like you guys had Aetna. That's who we show in the system.
[CUSTOMER][NEUTRAL] OK, do you have any information like a policy number or anything like that? Because maybe I could just log in directly.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] We wouldn't uh we don't have, let me see if I can find something that was submitted.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Let me check one of your other claims that was paid.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, and uh.
[AGENT][NEUTRAL] A
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] See if they put anything on the claim.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, I see, you know, it looks like they only put our, I guess when they submit to us they only put our information on the current claim. Let me look at this, the explanation of benefits on this particular, let's see.
[AGENT][NEUTRAL] Mhm
[AGENT][NEGATIVE] I do not show.
[AGENT][NEUTRAL] A policy number.
[CUSTOMER][NEUTRAL] That's OK. I'll try to set up an account. Is there an email where, where I can go ahead and send you guys the EOB once I get it?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, so, uh, the
[AGENT][NEUTRAL] Email you want to or the so you'll need to set um well let's see your policy you no longer have a policy with us, right?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] OK, yeah, you know, so, um.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] The EOB can be mailed uh emailed to let me find it. I'm sorry.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] 01 moment, let me get that email address. I definitely, OK, what is that it?
[AGENT][POSITIVE] Hold one moment for me, sorry about that.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Where is the email address claims.
[AGENT][POSITIVE] Oh my gosh.
[AGENT][NEUTRAL] I know big as I say broker.
[AGENT][NEUTRAL] They claim
[AGENT][NEUTRAL] OK, thank you for holding I apologize for the wait. Uh, the email address that you can submit it would be [PII].
[AGENT][NEUTRAL] At
[CUSTOMER][NEUTRAL] With an [PII]?
[AGENT][NEUTRAL] Um, with an [PII], mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so that's [PII].
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] OK. All right, so I'm gonna check.
[AGENT][NEUTRAL] And is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Um, no, I'm just trying, I'm going to try to, um, get this EOB sent over and then, um, you guys will reopen the claim at that point and process it.
[AGENT][NEUTRAL] Yes, so we'll process it and make payment to the hospital.
[CUSTOMER][POSITIVE] Understood. Thank you so much for your help.
[AGENT][NEUTRAL] You're welcome. Is there anything else?
[CUSTOMER][POSITIVE] Um, no, that's pretty much it. Thank you so much.
[AGENT][POSITIVE] OK. You have a wonderful day, [PII].
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][POSITIVE] Thank you for calling APL bye bye.