AccountId: 011433970860
ContactId: 82fb6386-cdda-43dd-809b-c0dbbc08041f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 281190 ms
Total Talk Time (AGENT): 119334 ms
Total Talk Time (CUSTOMER): 141028 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/82fb6386-cdda-43dd-809b-c0dbbc08041f_20250127T14:25_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling with MSG, um, services. We are one of the, um, your brokers, and I have a question, I have a question, um, regarding a group that is no longer, um, with you guys. Uh, one of the group members, she just recently received an invoice from her OBGYN.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, dated back from [PII]. That, and that's when, that was when she was with um APL.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And they had Humana. So I was just wondering if
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] If we could still um resubmit that um or submit that information for reimbursement or anything.
[AGENT][NEUTRAL] Yeah, as long as the policy, what's what's the group number? Do you have a group number?
[CUSTOMER][NEUTRAL] Um, I do not. I could give you her social.
[AGENT][NEUTRAL] What's the name of it? What's the name of the employer?
[CUSTOMER][NEUTRAL] Um, na, naval and Panti.
[AGENT][NEUTRAL] Can you spell that for me?
[CUSTOMER][NEUTRAL] Sure. Give me 1 2nd.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Is N like Nancy, A like Apple, V like Victor L like Lily I like India?
[CUSTOMER][NEUTRAL] M like Mary. P like [PII]. I like India. A like Apple. [PII].
[CUSTOMER][POSITIVE] I [PII].
[AGENT][NEUTRAL] OK, I see that. No, [PII], OK, I found it. Sorry. I was just to make sure the right deal. Let me pull this up real quick.
[CUSTOMER][NEUTRAL] And then USA Inc.
[AGENT][NEUTRAL] So, OK, and what is the name of the the person that you're calling in regards to?
[CUSTOMER][NEUTRAL] Her name is [PII].
[AGENT][NEUTRAL] OK, let me pull up here real quick.
[AGENT][NEUTRAL] What's your last name?
[CUSTOMER][NEUTRAL] Uh, give me one second. Uh, I'm gonna spell it out for you because it's kind of, uh, it's [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] I found her. She's the only [PII] She's the only [PII] I yielding. OK, yeah, so her coverage is effective [PII]. So if she has any claims during that time period, she can still file those.
[CUSTOMER][NEUTRAL] OK, OK, and what would she need? because I only see that she's sending me over, um, what is it she's sending me over and is the.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Invoice for her OBGYN.
[AGENT][NEUTRAL] OK, so what we'll need is the itemized bill from the OBGYN that has the diagnosis and the data service on it, and then we'll need a copy of her primary health insurance at that time, explanation of benefits showing how much they paid on the claim since the policy reimburses for co-insurance and deductibles and things like that, we'll have to have that primary insurance payment showing how they process the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, all right, so she will have to, OK, perfect. I will go ahead and and reach out to her and let her know then.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, was there anything else?
[CUSTOMER][NEUTRAL] No, that will be, and where did you send it to?
[AGENT][NEUTRAL] Um, since she can't upload it since her policy is terminated, you can, she can, the claim can be faxed or mailed to us. Let me get our mailing address and our fax. The fax number is [PII], it is [PII].
[CUSTOMER][NEUTRAL] OK, can I have the fax?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if it's faxed, make sure that you put the policy, she puts the policy number, whoever's gonna fax her her policy number is the 2158345 needs to be on there.
[CUSTOMER][NEUTRAL] What's the policy number again?
[AGENT][NEUTRAL] It's 215-8345.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, so she just need the EOB and the and the um invoice from the doctor, correct?
[AGENT][NEUTRAL] Yeah, yeah, as long as just make sure the diagnosis is on there, um, and the procedure code so we know. It can't be like a balance due statement. It's gonna have to have, you know, the codes on there, the procedure code and the diagnosis code.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um, yes, I think it has. It has OBGYN, uh, OK, yoga ID.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Of the office outpatient visit for [PII]. OK. OK. I will go ahead and um
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And let her know then.
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] All right. All right, thank you.
[AGENT][POSITIVE] Thanks for calling APL you have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you bye bye.