AccountId: 011433970860
ContactId: 8a087307-4c92-4a5a-a5dc-ce7e63ef5c97
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 290160 ms
Total Talk Time (AGENT): 75372 ms
Total Talk Time (CUSTOMER): 167255 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/8a087307-4c92-4a5a-a5dc-ce7e63ef5c97_20250430T19:22_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi [PII]. I um am trying to figure out um.
[CUSTOMER][NEUTRAL] If had had to file a claim for a hospital visit.
[CUSTOMER][NEUTRAL] Uh, I've not filed a.
[AGENT][POSITIVE] I'd be happy to assist.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] May I have your policy number, please?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Where I, I have the card in front of me.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Is the policy number on the card?
[AGENT][NEUTRAL] Um, yes, it would say inpatient or outpatient hospital cert number.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] Um, OK, so I'm actually calling on behalf of my husband, but I have my card in my hand. Um, I'm the.
[CUSTOMER][NEUTRAL] I don't know if it will be a sequential number or not. Let me give you my number and then uh I'll give you his name.
[CUSTOMER][NEUTRAL] It's 02450151 ML 7.
[AGENT][NEUTRAL] OK, what's your name and date of birth?
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] My name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And if you can verify your email address for me.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment.
[AGENT][NEUTRAL] And you're wanting information on how to file a claim?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] For my husband [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, um,
[AGENT][NEUTRAL] So there's 3 different ways you can file the claim. You can either register with the online service center and upload your documents there, or you can fax them or just mail them in.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK, so I'm in his, I'm online in under his ID. Do I just fax the hospital bill in?
[AGENT][NEUTRAL] Um, no, we,
[CUSTOMER][NEUTRAL] I mean, I'm sorry, a scan and upload the hospital bill or I, I can't find the, I guess I'm trying to figure out where the claim form is.
[AGENT][NEUTRAL] So we don't need the hospital bill unless it has the diagnosis on it. We need the explanation of benefits from your primary insurance along with the medical documentation stating what the diagnosis for the treatment was.
[CUSTOMER][NEUTRAL] OK, you need the explanation of benefits from the primary. I can do that. And then how do I, where, where would the diagnosis come from? Like the sum summarization visit.
[AGENT][NEUTRAL] Whoever gave him the treatment.
[AGENT][NEUTRAL] So whoever gave him the treatment or wherever he was treated, they can give you the information on the diagnosis.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK, and is there an actual um.
[CUSTOMER][NEUTRAL] Is there an actual claim form or do I just send all this information?
[AGENT][NEUTRAL] Um, you can fill out the claim form if you want, but the only thing we need is those two pieces of documentation, the EOB from your primary and the diagnosis for the data service.
[CUSTOMER][NEUTRAL] OK, and can I get an idea if um it was a hospital room it was uh it was uh.
[CUSTOMER][NEUTRAL] It was an emergency room visit, but he didn't spend the night. It was a gallstone. Um, and
[CUSTOMER][NEUTRAL] So I have the explanation of benefits from the primary health provider. Um, how, how would I know? I guess what I'm trying to understand is how do I know if you're gonna cover the balance for the, the, the, basically there's a $1000 balance after the primary um.
[CUSTOMER][NEUTRAL] Covered their part. So what I'm trying to understand is how, how do you, oh I guess from the, from the explanation of benefits, you know what our balance is.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, and then when you know that and if you end up covering it, how does that work? Do you, how, how does the coverage work? Do you pay the hospital bill or do you send us the check or how does that work?
[AGENT][NEUTRAL] We pay whoever files, so if you're filing the, the check would come to you if they file we pay them.
[CUSTOMER][NEUTRAL] OK, so you need the explanation of benefits and you need the diagnosis from the emergency room.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And just those that documentation uploaded in his account.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK. I got it. Thank you.
[AGENT][NEUTRAL] OK, was there anything else I could assist with today?
[CUSTOMER][POSITIVE] No, that's good thank you for your help.
[AGENT][POSITIVE] Thank you for calling APO you have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.