AccountId: 011433970860
ContactId: 97a5a361-6395-4eaf-833b-8f73bdefcb02
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 992789 ms
Total Talk Time (AGENT): 163560 ms
Total Talk Time (CUSTOMER): 437262 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/97a5a361-6395-4eaf-833b-8f73bdefcb02_20250402T21:22_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, uh, my name is [PII]. I'm actually calling for my wife who's here, uh, [PII]. She had a claim that I just talked to somebody there and they said no they didn't see a claim and I just talked to the hospital and they said, well, uh, they sent it out right after the the service which was I think [PII] on [PII] they sent another out to you.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] On [PII] they send another one you got no reply on [PII] no reply, uh, yet, uh, the person I talked to said they hadn't received anything, uh, for the initial service in the emergency room.
[AGENT][NEUTRAL] OK. Do you have the policy number?
[CUSTOMER][NEUTRAL] I do. It is 025.
[CUSTOMER][NEUTRAL] 63037.
[AGENT][NEUTRAL] And what is the address on the policy?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. You said your name was [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Um, who is the provider?
[CUSTOMER][NEUTRAL] Um, the, you mean the primary provider?
[AGENT][NEUTRAL] Who provided the services?
[CUSTOMER][NEUTRAL] Oh, I'm sorry, Carl Hospital in [PII].
[AGENT][NEUTRAL] Yeah, the date of service?
[CUSTOMER][NEUTRAL] I think she said it was [PII] or [PII]. I'm sorry.
[CUSTOMER][NEUTRAL] Of last year.
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] Yeah I'm double checking as well. I don't, I don't have that data service on file.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Not at that was not for that claim.
[CUSTOMER][NEUTRAL] So they gave me a fax number they said if you wanted to uh contact them they could give you all the information.
[AGENT][NEUTRAL] Yeah, did you get, uh, so they need to send the explanation, the primary explanation of benefits from whoever the primary insurance is and then along with the claim.
[CUSTOMER][NEUTRAL] Well they they've sent it 5 times.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] And you and you don't have it so, so they said you could request it from them by faxing.
[CUSTOMER][NEUTRAL] To the to a number and they will send it again.
[CUSTOMER][NEUTRAL] By fax
[AGENT][NEUTRAL] OK, um, we don't typically do that. Do you have like a representative that can call in for the hospital, or because I mean we do have a claim on file from Earl, but not for that date or Carl, what the, I'm sorry.
[CUSTOMER][NEUTRAL] Right, because that that was for the afterwards after she had to have uh occupational therapy afterwards but she had to go in the emergency room for the initial claim.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] Yeah, I mean, because did did you provide the card on file to the hos I mean clearly they've been able.
[CUSTOMER][NEUTRAL] They said they submitted it.
[AGENT][NEUTRAL] Yeah, cause we, I mean we've received.
[CUSTOMER][NEUTRAL] Yeah, they, they said they submitted it.
[AGENT][NEUTRAL] We have received a claim from them before, so they.
[AGENT][NEUTRAL] Whoever submitted that one had the right information so I don't, I don't know what information they have so.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, I don't know on that date if we gave them a number, uh, you know, a card at that point, but then, uh, I just called them and they said, oh yeah, we've been billing that starting from [PII] on.
[CUSTOMER][NEUTRAL] So I don't know.
[AGENT][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Can I try to get them on the phone and you guys can talk together?
[AGENT][POSITIVE] Yeah, absolutely.
[CUSTOMER][NEUTRAL] OK, let's try that so hold on just a second.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right thanks.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, let's see what we got. Are you still there from I'm still with you go ahead mhm.
[AGENT][NEUTRAL] OK, I'm on the line too. This is [PII] from APL.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, OK, I just wanna make sure we didn't lose you there, OK. And and the first name of the first name of your wife again is [PII] one moment.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think they probably got it spelled in all capitals one moment.
[CUSTOMER][NEUTRAL] OK, [PII] right.
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] What 46-59. That's her birth. No, that's the date of birth, right? Mhm, yeah. Oh, I thought you said I'll say, well, I got the wrong person again. Um, gotta bring it in on backside. I probably there's no you if it don't let me bring it in. There's no balance. One moment.
[CUSTOMER][NEUTRAL] Yeah, because I think I already paid it, but I wanna make sure.
[CUSTOMER][NEUTRAL] The insurance company can reimburse me or whatever but.
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] I think it was on [PII].
[CUSTOMER][NEUTRAL] OK, I'm just gonna read this real quick.
[CUSTOMER][NEUTRAL] OK, good. OK, all right, so what's going on today? Who do we have on with us? OK, I have a representative from American Public Life ATM.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, hi, this is [PII]. I'm with American uh APL so they've got a gap policy, um, a secondary policy which we need we don't have this claim on file, um, and if you can submit the UB on that along with the primary explanation of benefits, uh, we, we have received a claim from you before because I've got one on file for data service [PII], but that's the only one I have on file.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And um I can provide our payer ID, our fax number or our claims mailing address, but at this point I would think if you could possibly fax it or submit it electronically, that would work best.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, this is for the [PII].
[AGENT][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, alright, and you said the name of the insurance is American?
[CUSTOMER][NEUTRAL] Let me see, I have it right here. One moment, let me just bring it up.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you so much. I have it here, [PII].
[CUSTOMER][NEUTRAL] Bring up this sign here. I don't know what they got going on, but it's a whole lot.
[CUSTOMER][NEUTRAL] One minute, not you guys. I'm just speaking, speaking of the crew.
[CUSTOMER][POSITIVE] OK, so I'm gonna go in and get this one.
[CUSTOMER][NEUTRAL] OK, so what I, I, I'm gonna let you know what I have and you can tell me if it's different. American Public Life.
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And then I have a fax of uh fax number of [PII].
[AGENT][POSITIVE] Yes, that's right.
[CUSTOMER][NEUTRAL] OK, give me one moment to get back to the other side.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Back to that [PII] I just wanna take a look and see how many people.
[CUSTOMER][NEUTRAL] Got to see that claim.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I do so I went to Aetna and then Medicare.
[CUSTOMER][NEUTRAL] Um, I don't see a post, uh, well, I mean, I'm sorry, it's the that's the Edna, um, yeah, commercial. It was you don't have Medicare Part A and B anymore? No, I, that's where Aetna came in because our group plan, we got a group plan, uh, with over 50 employees and didn't have to be on Medicare anymore.
[CUSTOMER][NEUTRAL] OK, so let me, uh, when did the Medicare end? That's what we need to start [PII]. OK, let me go back to the coverage, straighten that out first.
[CUSTOMER][NEUTRAL] Probably what it is, there's too many things going on here.
[CUSTOMER][NEUTRAL] OK, so we got that and you said it ended [PII]. Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Aetna started [PII] as did uh AP American Public Life.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, so, um.
[CUSTOMER][NEUTRAL] Medicare ended [PII]. Correct.
[CUSTOMER][POSITIVE] OK, of 24. Correct.
[CUSTOMER][NEUTRAL] Alright, let me get that in there one moment.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, so we got that.
[CUSTOMER][NEUTRAL] And then we have the Aetna which began on [PII], and the American life also begin [PII]? OK. Aetna is a high deductible plan and they're a gap plan.
[CUSTOMER][NEUTRAL] Got you OK so.
[CUSTOMER][NEUTRAL] OK, so what I'm gonna do is I'll go ahead and have them, um, review this again back to American Public Life. Uh, please allow 30 business days and then I'm quite sure when everything's done American Public Life, you guys will reach out to your client.
[AGENT][NEUTRAL] OK, yeah, and then.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I just note that if there's no assignment of benefits we would pay the insured, but if there's assignment of benefits we're we're going to send the payment to you if eligible so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's fine.
[CUSTOMER][POSITIVE] Because there's other things still outstanding there so.
[AGENT][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] Yeah, I think it's they have it they have it at 200, well, you know, it's just, yeah they have it at 239 outstanding, um.
[CUSTOMER][NEUTRAL] Yeah, it looked like it went and then someone pushed it back so I'll go ahead and ask them to review this to make sure that it did go to, uh, what we verified with American Public Life, um, and then, uh, one second here, can I get your name, ma'am, please?
[AGENT][NEUTRAL] Uh, my name is [PII]. And what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] [PII]. OK, thank you so much.
[CUSTOMER][NEUTRAL] Alright, is there a reference number for this call from you? I don't have one, but if you do, I.
[AGENT][NEUTRAL] No, we just use it be my name and then first letter of my last name which is [PII] and then today's date.
[AGENT][NEUTRAL] So [PII] yeah.
[CUSTOMER][NEUTRAL] Day's date OK same here.
[CUSTOMER][POSITIVE] OK all right thank you so much, and we will uh get right on this. OK, thanks both of you appreciate it. All right, no problem.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Any additional questions or concerns?
[CUSTOMER][NEUTRAL] You have a question, [PII]?
[AGENT][NEUTRAL] I don't have anything. Do you have anything for me, [PII]?
[CUSTOMER][POSITIVE] No, I, I'm, I'm good.
[AGENT][NEUTRAL] OK, all right, well.
[CUSTOMER][POSITIVE] Yeah alright thanks guys.
[AGENT][POSITIVE] Thank you. Have a good evening.
[CUSTOMER][NEUTRAL] Alright you too bye bye bye.
[AGENT][NEUTRAL] Bye.