AccountId: 011433970860
ContactId: 819f06a6-6fc0-40c8-8f74-30b613161746
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 294040 ms
Total Talk Time (AGENT): 131998 ms
Total Talk Time (CUSTOMER): 155392 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/819f06a6-6fc0-40c8-8f74-30b613161746_20250407T20:35_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, yeah, I'm calling to see how this, uh, APL works because, uh, we were at the hospital, um.
[CUSTOMER][NEUTRAL] A couple weeks ago with our son and we gave him this insurance information but I don't know if they took it um because we have like a a bill, OK.
[AGENT][NEUTRAL] OK, I can check the claim.
[AGENT][NEUTRAL] OK, I'm sorry. Um, may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII] and it's uh my phone number [PII]. Go on.
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The policy number?
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yeah, it, it would be on the card, right?
[AGENT][NEUTRAL] Uh-huh, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Insured, I see insured coverage group number uh plan.
[AGENT][NEUTRAL] Maybe in the bottom where it says in the hospital outpatient cert.
[CUSTOMER][NEUTRAL] I said
[CUSTOMER][NEUTRAL] Oh yeah, and and hospital benefit certification number is that it?
[AGENT][NEUTRAL] Mhm, yeah, that's it.
[CUSTOMER][NEUTRAL] 02457349 M as in Mary L 7
[AGENT][NEUTRAL] All right, thank you. And may I have your date of birth and mailing address for verification?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. And um who's the patient?
[CUSTOMER][NEUTRAL] It would be uh [PII]
[CUSTOMER][NEUTRAL] What?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] What's his date of birth?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, there is no claims on file for Co and.
[CUSTOMER][NEUTRAL] So
[AGENT][POSITIVE] You have not received any claims at all.
[CUSTOMER][NEUTRAL] Um, OK, how do I.
[CUSTOMER][NEUTRAL] If I received it, but how do I like um submit that to you guys?
[AGENT][NEUTRAL] OK, you have two options and um there's an easy one and a hard one. the easy one will be to call them back, let them know that they have not submitted the claim to your secondary policy and see if they can submit the claim directly to us. That will be the easiest way. Um, now, you can also submit the claim yourself. Um, if you're gonna submit the claim, we're gonna need um a couple of documents, including the claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So the first document we're gonna need is the claim form and that you can find through our website at [PII].
[CUSTOMER][NEUTRAL] And you know what I have.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's gonna be the mailing claim form.
[AGENT][NEUTRAL] The second document we're gonna need is an itemized bill with the diagnosis codes and procedure codes, and that comes from the provider of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the third document is the explanation of benefits from the primary insurance showing the amount applied towards the deductible co-payment and co-insurance.
[CUSTOMER][NEUTRAL] OK, the explanation of benefits, the claim form, itemized bill, and the EC.
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK, and then the first option would be to just call them and tell them, give them the information.
[AGENT][NEUTRAL] Yes, call them, let them know that you have a secondary supplemental plan to the major medical and that you would like for them to submit the claim directly to us.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Secondary supplemental plan, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK perfect alright.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][POSITIVE] Um, and then how does it, uh, and this actually, no, we're good, we're good, OK, you've been great help, so thank you.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Do you have any other questions? Any other questions I can answer for you?
[CUSTOMER][NEUTRAL] Uh, no, we're all, uh, just wanna confirm we're all added, um, my two sons Cohen, Caden, me, [PII], and under my husband like.
[AGENT][NEUTRAL] Yeah, yeah, it's a family plan. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK awesome.
[AGENT][NEUTRAL] No. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Nope, that would be it.
[AGENT][POSITIVE] Alright, well thank you for calling ATL. Have a good day.
[CUSTOMER][NEUTRAL] OK, you too, bye.
[AGENT][POSITIVE] Thank you. Bye-bye.