AccountId: 011433970860
ContactId: 7dfd095c-4b92-466d-a037-25f5cd68f615
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 647460 ms
Total Talk Time (AGENT): 323913 ms
Total Talk Time (CUSTOMER): 248431 ms
Interruptions: 4
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/7dfd095c-4b92-466d-a037-25f5cd68f615_20250509T17:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], how are you?
[AGENT][POSITIVE] I'm doing well. How are you doing today, ma'am?
[CUSTOMER][POSITIVE] I'm pretty good. I'm really hoping you can help me, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know what you need from me. Um, my, my uh husband has a secondary plan through you with this company.
[CUSTOMER][NEUTRAL] And he went for an MRI last night.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEGATIVE] And they told him that you guys denied covering his co-pay, which is supposed to be covered. Um, and then when I called them today to question them about it and say, you know, I think you probably billed it wrong. We've never had this problem before. Um, the young lady told me that I needed to call you guys and get a reference number and call her back.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] I, I don't know. I don't know why they can't do it properly. I'm aggravated with them. I'm sorry.
[AGENT][NEUTRAL] Oh wow, OK.
[AGENT][NEUTRAL] Yes, ma'am, I understand. OK. May I please, um, get your name and your callback number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And my number is [PII] and I'm on the plan as well.
[AGENT][NEUTRAL] OK, Ms. [PII].
[CUSTOMER][NEUTRAL] It's just through his job.
[AGENT][NEUTRAL] Yes, ma'am, I understand. OK. And um what is the policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Um, would that be the outpatient benefit cert number?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Or the group one, OK. 01826150 M like Mary, L like love 8.
[AGENT][POSITIVE] OK, thank you so much. And let me pull this up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And you said
[AGENT][NEUTRAL] Well first let me verify your date of birth. What is your date of birth please?
[CUSTOMER][NEUTRAL] Mine's [PII] and his is 3372.
[AGENT][NEUTRAL] Thank you ma'am and then I'll also need the address, phone number and email address that we have on the policy for you.
[CUSTOMER][NEUTRAL] Uh, OK, it should be [PII].
[CUSTOMER][NEUTRAL] And then the phone number is [PII].
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And then the email is gonna be billed by Dom and I don't know if it's [PII] Yahoo or [PII]. He has both. I'm sorry, but it's one of them, but it's billed by Dom.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes, ma'am, that's.
[AGENT][NEUTRAL] I've got the yes ma'am I've got that verified um OK so.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] You went to the emergency room or you went and had an MRI last night?
[CUSTOMER][NEGATIVE] No, he didn't have it done. No, he didn't get it done because they said they wouldn't do it without the whatever his co-pay is $350 which we don't have.
[AGENT][NEUTRAL] OK, let's look and see.
[CUSTOMER][NEGATIVE] They normally when, like when I had mine done, they, they didn't bill me. They, they, they got it from you guys. They billed you guys when I had mine done.
[AGENT][NEUTRAL] OK, looking at this policy.
[CUSTOMER][NEUTRAL] Or however it works. I don't know.
[AGENT][NEUTRAL] And I can't, I can't give um information for your husband without his consent, but I can give you general information about the policy so and that's for both of you so looking in my notes we did not have anybody called to verify benefits with us yesterday.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. That's what I figured. That little girl didn't sound like she knew what she was talking about.
[AGENT][NEUTRAL] Right, so if they had called, we would have been able to tell them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] And this is just to verify your benefits. It's not a guarantee of payment. This is a, you're correct, it is a supplemental insurance policy that does help with deductible, co-pay and co-insurance.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, you have an inpatient calendar year benefit amount of $3500 to go towards that. And then you have an outpatient per calendar day benefit of $750 to go towards that. Um, now, if they had called to verify the benefits, we would have told them that over the telephone, you know, that, that it does help and it is um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm, yep.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Build secondary to the primary, so all they need to do is take your information they can call us and verify benefits they can send in a claim and I can give you the payer ID number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you're ready. It's [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And when they send in the claim, they just need to send the explanation of benefits from the primary insurance with the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To show you know what was paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And they can call the same number you called to verify benefits.
[CUSTOMER][POSITIVE] OK, excellent. Thank you so much.
[AGENT][NEUTRAL] Well, you're welcome, Ms. [PII]. I'm sorry you're having a hard time.
[CUSTOMER][NEUTRAL] I have one last
[CUSTOMER][NEUTRAL] It's OK. I do have one last question. How long, um, how long after a procedure do we have to file a claim? My husband had a ang angiogram or something at a hospital last year, and he just completely forgot about running it through you guys and I'm like, you ding dong.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] There's
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so the policy effective date is [PII].
[CUSTOMER][NEUTRAL] That's.
[AGENT][NEUTRAL] And it's current and active. So we don't have a timely filing limit as long as you're covered on the data service, you can file at any time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so how would we go about doing that?
[AGENT][NEUTRAL] Uh, are you guys signed up for the online service center?
[CUSTOMER][NEUTRAL] I don't know. He had this before, so I, I'm not sure.
[AGENT][NEUTRAL] Let me check real quick.
[CUSTOMER][NEUTRAL] If we're not, we should be.
[AGENT][POSITIVE] Yes, ma'am. That's the easiest way.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And if this uh facility that you're going to for the MRI does not want to help you as far as filing the claim for you, you can always file yourself through the online service center and it does look like he has, it does look like he has signed up for it in the past and I can't give the information.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] OK. Oh good. OK.
[AGENT][NEUTRAL] Um, without his consent for the username because he's the account holder, but if you go in there and you click on your policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I was gonna say, do you have a minute? I can get him on the phone.
[AGENT][POSITIVE] Oh yes, absolutely.
[CUSTOMER][NEUTRAL] Because he won't remember. Yeah, let me conference him in because he isn't gonna remember. Alright, hold on one second.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, [PII]
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, I have my husband on the line. Hello?
[AGENT][POSITIVE] Hi, Mr. Mr. [PII]. This is [PII]. I'm with APL. I am trying to help Miss [PII] with your policy and try to help her with some claims. Um, I'm doing well today, sir, ready for the weekend.
[CUSTOMER][NEUTRAL] How you doing?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Yes, us too.
[AGENT][NEUTRAL] Yes, sir. I just need to verify a little information with you so I can help her further. Um, can you please give me your date of birth, sir?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you very much. I appreciate you verifying that. And then I know Ms. [PII] has already given this information, but I'm gonna need it from you also. Can you give me your address, phone number, and email address that's on the policy?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What do you need again? You need my address? What else?
[AGENT][NEUTRAL] Your phone number that's on the policy and your email address that's on the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, email address is [PII] and the phone number is [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you sir. Now she is needing your username for the online service center because she is wanting to file a claim for you for some services last year. Do you remember your username?
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, might be [PII].
[AGENT][NEUTRAL] No sir, um, do you need to know your username?
[CUSTOMER][NEUTRAL] I knew, I knew he didn't remember.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, your username is [PII].
[CUSTOMER][NEUTRAL] OK. Got it.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Now you may need to go in there and reset your password if you don't remember it.
[CUSTOMER][NEUTRAL] No I I might, I might have the password on file somewhere. What is the website?
[AGENT][POSITIVE] OK awesome.
[AGENT][NEUTRAL] The, the website that you're gonna go to is secured, [PII]
[CUSTOMER][NEUTRAL] I might
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you so much, Mr. [PII]. I appreciate you verifying and giving me consent to speak to Ms. [PII] about your policy.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] I hope you guys have a wonderful weekend. If you could, you want to stay on the phone, you can, but if you don't want to, you don't have to, sir.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Alrighty thank you. Thanks love bye. All right bye.
[AGENT][POSITIVE] You're welcome, sir.