AccountId: 011433970860
ContactId: 92533fa4-cddf-41f8-b44e-500973ae2f70
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 334429 ms
Total Talk Time (AGENT): 141269 ms
Total Talk Time (CUSTOMER): 154122 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/92533fa4-cddf-41f8-b44e-500973ae2f70_20250613T19:32_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. Um, I had a quick question for you guys. Um, I'm not exactly sure what we can do here, if anything, um, but within the last year, I have been to the emergency room twice for, um,
[CUSTOMER][NEGATIVE] Uh, allergic reactions. And long story short, I've got a $1200 bill from the hospital twice. I, I didn't know if that's something that's covered under my policy or not.
[AGENT][NEUTRAL] OK, uh, do you have your policy number?
[CUSTOMER][NEUTRAL] Yes ma'am, I got a POL number or an ID number.
[AGENT][NEUTRAL] Uh, policy number, it should start with 01 or 02.
[CUSTOMER][NEUTRAL] 02452076
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes ma'am, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you so much, give me one moment please, let's see.
[AGENT][NEUTRAL] OK, and Mr. [PII], verify your date of birth, mailing address and email address.
[CUSTOMER][NEUTRAL] [PII], [PII]. So you're gonna be [PII] or [PII]. Um, and what was the last thing?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Email address.
[CUSTOMER][NEUTRAL] Should be [PII].
[AGENT][NEUTRAL] OK, yes sir, I see, and you say you had ER services performed?
[CUSTOMER][NEUTRAL] Yes ma'am, it was just uh.
[CUSTOMER][NEUTRAL] Uh, allergic reaction using EpiPen went to the hospital just to be safe, kept me for 3 hours, sent me home.
[AGENT][NEUTRAL] OK. Well, under your policy, uh, this is a secondary plan. What it does, it helps with your primary insurance deductible, co-pay or co-insurance for services outpatient or in hospitals and ER is outpatient.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And not a guarantee of payment, just a verification of coverage. You have an outpatient benefit max up to 2600 per calendar year.
[AGENT][NEUTRAL] So, um,
[AGENT][NEUTRAL] You can either give the provider your information with us as secondary or you can file a claims yourself.
[CUSTOMER][NEUTRAL] OK, so essentially just call the hospital and tell them I got a secondary insurance here it's APL. Here's my information and then they'll take it from there I guess.
[AGENT][NEUTRAL] Uh, yes, sir. Typically, uh, what they would do is just give us a call, verify benefits, and we can confirm that you do have a policy with us and where to submit claims.
[CUSTOMER][NEUTRAL] OK, all right, um, now I'm just I'm gonna ask just because, so I have paid one of these bills already just because, I mean it was old and I wasn't thinking. I just went ahead and paid it and forgot about it. Um, is there anything to do about that one or is that just kind of a, kind of a wash at this point?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] It was for another ER visit?
[CUSTOMER][NEUTRAL] Yes ma'am, I'd have to look up the dates, but it's.
[CUSTOMER][NEUTRAL] I it's probably within the last year as well. The most recent one was back here, back here in April, middle of April this year.
[AGENT][NEUTRAL] OK. Um, well, your policy was effective [PII], just to let you know, but you can submit the claim. Um, what we will need is the itemized bill showing the diagnosis and procedure codes.
[AGENT][NEUTRAL] And your primary insurance explanation of benefits or EOB for that data service.
[CUSTOMER][NEGATIVE] OK, I might have to call you guys another time and do that. I don't know where any of this in I know where it is, but it's gonna take me forever to actually locate a specific one. I don't wanna keep you on the phone here too long.
[AGENT][POSITIVE] No, you're fine. And just to let you know there is no time limit either, so you don't have to rush to submit the claim. There's no time limit.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][POSITIVE] OK, perfect. OK, here's this thing fromla. Oh, I don't need this. It's on it.
[CUSTOMER][NEUTRAL] OK, well, I'm good, good news on the no time, uh, timeline thing or whatever. Anyway, all right, I guess I'm gonna go ahead and call the hospital and tell them, uh, tell them what I got and
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] See if uh see what we can do.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And just make sure you tell them it's a secondary policy. Don't tell them it's a gap plan. Um, I know some our insurers have told their providers a gap plan and some providers won't accept it because some gap policies don't pay the providers, so they don't submit claims. But just remember to just tell them it's secondary. I just wanted to.
[AGENT][NEUTRAL] Warn you about that.
[CUSTOMER][POSITIVE] Perfect, I appreciate that information. um, what was your name again? I'm sorry.
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][POSITIVE] OK. All right, [PII], thank you so much. I appreciate it. Uh, you have a great weekend.
[AGENT][POSITIVE] You're welcome. You too and thank you so much for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye.