AccountId: 011433970860
ContactId: 72c78291-edfa-4383-8a02-092590436a4d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 316339 ms
Total Talk Time (AGENT): 118154 ms
Total Talk Time (CUSTOMER): 141520 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/72c78291-edfa-4383-8a02-092590436a4d_20250422T17:14_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I, I, uh, my wife recently had some claims processed through our main insurance provider, and I was wondering how it worked with you guys, whether we need to send you the claims or the provider does, or, or just how it all works.
[AGENT][NEUTRAL] OK, do you have a phone number I can get in case we get disconnected I can call you back.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] And do you have your policy number?
[CUSTOMER][NEUTRAL] Uh yes.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Is that the inhospital benefit certification number?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, so that's 02605470 ML 7.
[AGENT][NEUTRAL] Thank you, hold on one moment please.
[AGENT][NEUTRAL] And what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And can I verify your date of birth?
[CUSTOMER][NEUTRAL] Sure [PII].
[AGENT][NEUTRAL] And can I verify your address and email address, please?
[CUSTOMER][NEUTRAL] Yes, [PII] and then the email is [PII].
[AGENT][POSITIVE] Thank you, Mr. [PII].
[AGENT][NEUTRAL] And you wanted to know how to file some claims?
[CUSTOMER][NEUTRAL] Yeah, well, I mean just basically what it says like we just had some claims processed through our main insurance provider and I didn't know if they sent it to you and I'm just supposed to wait or um if if I'm supposed to send you the claim or basically who who pays the, the bill and and how does that part work?
[AGENT][NEUTRAL] OK, I can help you with that. You can either give them your card and have them file the claim for you and then if they don't file the claim for you, you can always file it yourself.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And then when I log into the website would it show me claims that are in process?
[AGENT][NEUTRAL] Right, yes, so once we get claims in it'll show you what what we have in and what's being processed.
[CUSTOMER][NEUTRAL] OK, so if I don't see anything there right now then that means that uh.
[AGENT][NEUTRAL] No claims have been filed.
[CUSTOMER][NEUTRAL] OK, and is there any way for me to know how much would get reimbursed?
[AGENT][NEUTRAL] Uh, what was it outpatient inpatient doctor's office?
[CUSTOMER][NEUTRAL] Yeah, it was a delivery for childbirth.
[AGENT][NEUTRAL] So it was inpatient.
[CUSTOMER][NEUTRAL] Hospital.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, any benefits given over the phones, not a guarantee of payment. The policy was effective [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For inpatient, it coordinates with the primary insurance. So whatever your primary applies to your deductible, co-pay or co-insurance only for inpatient, we'll pay up to 3000.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK, so it's um anything that is that gets applied to deductible, co-pay, or co-insurance.
[AGENT][NEUTRAL] Co-pay. Yes, sir.
[CUSTOMER][NEUTRAL] That's it, nothing else.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so like something that has to do with prescription, for example, would not be covered?
[AGENT][NEUTRAL] No, prescriptions are not covered.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, and then so any bills that I get then I should pay them and then send you guys the receipt or do I send you the bill or or how does it work?
[AGENT][NEUTRAL] Um, if they want to file it for you now, we can't pay by receipts. We're gonna need itemized bills.
[AGENT][NEUTRAL] That has procedure codes.
[AGENT][NEUTRAL] Charges
[AGENT][NEUTRAL] And diagnosis codes on it?
[AGENT][NEUTRAL] And also your explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so then.
[CUSTOMER][NEUTRAL] OK, so the EOB and itemized uh charge code basically from whoever's billing me?
[AGENT][NEUTRAL] Right, and I'll have to have the procedure code, diagnosis code, and the charges.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] OK, and then do I send receipt as well or no?
[AGENT][NEUTRAL] You don't have to, no.
[CUSTOMER][NEUTRAL] OK, so then if I send you those two documents, does the money you guys send the money to the to the provider or to me?
[AGENT][NEUTRAL] If you file it, we'll pay you. If they file it, we pay them.
[CUSTOMER][NEUTRAL] Got it, got it, but since they didn't file it, then it has to be me.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, alright, I can work with that thank you very much.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, no, that's all.
[AGENT][POSITIVE] Thank you, Mr. [PII], for calling APO. You have a good day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] OK.