AccountId: 011433970860
ContactId: 88e8f7f9-ecd4-4358-bf8d-228d5798ee66
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 501170 ms
Total Talk Time (AGENT): 136644 ms
Total Talk Time (CUSTOMER): 200740 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/88e8f7f9-ecd4-4358-bf8d-228d5798ee66_20250219T18:52_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm with Corolla and Virginia, and I have a question for you on a claim that we, we filed, but they messed up on the filing order. They sent it to you first and then it got denied and then it got corrected, sent to [PII]. Then [PII] automatically sent it to you guys and then y'all denied it, saying it was a duplicate claim.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But in fact it really wasn't because it was the first time you've got it after it was filed correctly.
[CUSTOMER][NEUTRAL] I don't know where to proceed with that.
[AGENT][POSITIVE] OK, well, I can definitely assist you um with the claim. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, my name's [PII] callback number [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure it is.
[CUSTOMER][NEGATIVE] I mean I gotta get on another screen.
[CUSTOMER][NEUTRAL] His subscriber is 10070098 C as in Cat, [PII] as [PII] [PII].
[AGENT][NEUTRAL] OK, what's their secondary, uh, their APL policy number?
[CUSTOMER][NEUTRAL] They're what?
[AGENT][NEUTRAL] That sounds more like a primary. Um, what's their APL policy number? It should start with a 01 or 02. They have an ML 7 or 8 at the end.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] I don't see that.
[AGENT][NEUTRAL] Do you have the card there?
[CUSTOMER][NEUTRAL] Uh, I was looking at our insurance screen.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So I didn't have it hold on. I got to.
[CUSTOMER][NEUTRAL] You got to put in this
[CUSTOMER][NEUTRAL] I got a security override on it.
[CUSTOMER][NEUTRAL] Work here that's when people
[CUSTOMER][NEUTRAL] OK, I'm trying to find the card.
[CUSTOMER][NEUTRAL] Alright, they didn't get it. They didn't get it the last time. Let me see I have an old image of it.
[AGENT][POSITIVE] Sure, take your time.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Are you asking for their Aetna card or their?
[AGENT][NEUTRAL] No, for the American public life.
[CUSTOMER][NEUTRAL] American family.
[CUSTOMER][NEUTRAL] American Public Life one OK.
[CUSTOMER][NEUTRAL] Insurance card, no card, no card, no card.
[CUSTOMER][NEGATIVE] Looks like the only card they've ever taken an image of.
[CUSTOMER][NEUTRAL] Is the Aetna card. Can I give you his social?
[AGENT][NEUTRAL] Yes, the social would be fine.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Exit out that system.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] I got a social of [PII].
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] And can you verify them, uh, well, you already gave the date of birth. Hold on one second.
[AGENT][NEUTRAL] Alright, and thank you so much for verifying his information. Let me see if there's another policy. OK.
[AGENT][NEUTRAL] Alright, so I do see the policy here. So the policy number is 2,545,300. Let me go to the claims.
[AGENT][NEUTRAL] And all
[CUSTOMER][NEUTRAL] Wait a minute, 254, I didn't catch it. 254.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am, 5300.
[CUSTOMER][NEUTRAL] OK, and that's American Public subscriber?
[AGENT][NEUTRAL] Mhm. That's American Public Life's policy number. And what's the name of your provider's office?
[CUSTOMER][NEUTRAL] Alright, let me get on the, I gotta get on the invoice for that because.
[CUSTOMER][NEUTRAL] I handle everybody's let's see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, the provider [PII] and the facility was Velocity Care Electric road runner.
[AGENT][NEUTRAL] OK, what's the date of service?
[CUSTOMER][NEUTRAL] It was [PII].
[AGENT][NEUTRAL] OK, hold on, and it was for [PII] or one of the dependents?
[CUSTOMER][NEUTRAL] Actually.
[AGENT][NEUTRAL] Oh, actually, no, this is just him.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I thought there was more on here. Hold on one second, [PII].
[CUSTOMER][NEUTRAL] Oh wait a minute. I don't somebody else's, I think it keeps pulling up.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] It's the right thing.
[AGENT][NEUTRAL] I'm not sure because I'm not showing a claim on file for [PII] for [PII].
[CUSTOMER][NEUTRAL] I must add something else I've been in the system, so I apologize for that. Let me dig through here.
[AGENT][POSITIVE] Oh, no, you're fine. Take your time.
[CUSTOMER][NEUTRAL] He's got tons of stuff. [PII], he's got a ton of claims.
[CUSTOMER][NEUTRAL] OK, it was [PII].
[CUSTOMER][NEUTRAL] Provider was Carillion Healthcare and it was.
[CUSTOMER][NEUTRAL] The total bill charge was 346.
[CUSTOMER][NEUTRAL] Somebody emailed me to call and I just found these attachments.
[CUSTOMER][NEUTRAL] They did put transaction numbers so I don't know what that is.
[AGENT][NEUTRAL] OK, here we go. No, it's OK. I found um a claim here. Let me, I'm just waiting for it to come up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so the original claim was denied because office visits are not covered by the policy and then we received the claim again.
[AGENT][NEUTRAL] Where's the corrected claim.
[AGENT][NEGATIVE] We received the corrected claim in November, but it was denied as a duplicate. So it was denied because office visits are not covered by their secondary policy.
[CUSTOMER][NEGATIVE] So it would still be denied.
[AGENT][NEUTRAL] Right, because
[CUSTOMER][NEUTRAL] So it wasn't, yeah, OK.
[CUSTOMER][NEGATIVE] I got you so it would have been denied either way because it's not something that's covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Excellent. OK, what, what, what was your name again? [PII]?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And do we have a call reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, and the first initial to my last name is [PII].
[CUSTOMER][POSITIVE] All righty. I thank you very much. I appreciate it. One more thing off my list today.
[AGENT][NEUTRAL] Alrighty, well, was there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, I'm sorry to be so confusing.
[AGENT][NEUTRAL] Oh, you are not confusing at all.
[CUSTOMER][POSITIVE] All right. Have a good evening.
[AGENT][POSITIVE] You also, thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] All right, bye bye.