AccountId: 011433970860
ContactId: 99603446-10b0-4fe7-90dc-346e0f34d420
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 426429 ms
Total Talk Time (AGENT): 246412 ms
Total Talk Time (CUSTOMER): 201257 ms
Interruptions: 3
Overall Sentiment: AGENT=2.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/99603446-10b0-4fe7-90dc-346e0f34d420_20250314T14:07_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Hi [PII]. I'm calling to see why they haven't paid um my medical bills when I went to the urgent care.
[AGENT][POSITIVE] OK, yeah, I'd love to help you take a look at that today. Do you mind if I get your name and a good call back number real quick?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And [PII]
[AGENT][NEUTRAL] Alrighty Miss [PII], so we wanna look at some claim statuses for some unpaid claims. Did I understand that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Perfect and do you have that policy number handy, ma'am?
[CUSTOMER][NEUTRAL] I don't.
[AGENT][POSITIVE] No worries, I oh.
[CUSTOMER][NEUTRAL] Oh wait what policy number my American public life?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me see, I should have it here.
[AGENT][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Because I don't have the bill with me, but they called me to, to, you know, try to get the.
[CUSTOMER][NEGATIVE] The money, you know, to collect the money. And I said that I have a secondary insurance, and for some reason they said that they deleted it. Um, I don't know why, they deleted it.
[CUSTOMER][NEUTRAL] And then for me to call and find out, so that's why I'm calling, OK.
[CUSTOMER][NEUTRAL] Let me see, American Public Life. OK, um.
[CUSTOMER][NEUTRAL] The group number?
[AGENT][NEUTRAL] I can find you with the group number if you have that or if you have the policy number, that'd be quickest but either or.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It says in hospitals benefit uh certificate that one? OK, it's 02505670 M as in Mary, L as in Larry 7.
[AGENT][NEUTRAL] Yep. That's it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Perfect. Let me take a peek and Miss [PII], would you be able to verify your date of birth for me please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Beautiful thank you and I am just gonna verify with you real quick some additional information if you could verify for me please your mailing address?
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Perfect and I'm so sorry, pardon me, um, just the, oh no, the phone number on file matches the one you gave me um I don't have an email address on file I can add one if you like, but um, yes, let's do it. OK, what is that email address my friend?
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's [PII] My last name [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] [PII]. OK, perfect. I'm just gonna make sure that's saved through. [PII] Perfect.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, [PII]
[AGENT][POSITIVE] I, oh, I'm so sorry. That is what I wrote but not what I said. I'm sorry about that.
[CUSTOMER][NEUTRAL] [PII] [PII]
[CUSTOMER][POSITIVE] It's OK. No problem. That happens.
[AGENT][NEUTRAL] And, OK, perfect. So, Ms. [PII], I am showing the last claim we received for you, we received um early.
[AGENT][NEUTRAL] Early January of this year, and it was for Baptist Health Medical Group, um, for a date of service, it looks like [PII].
[AGENT][NEUTRAL] [PII], does that seem like the right?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh what what.
[AGENT][NEUTRAL] You said it was an urgent care, right?
[CUSTOMER][NEUTRAL] Urgent care, it's [PII].
[AGENT][NEUTRAL] OK, no, so I, we have not received any claims from them. So your status with us is good and active, but they haven't sent us any claims.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You see? They were, they, she was telling me something about, they, they, I guess they tried it and they denied it, so they deleted it from the system, which I don't understand.
[AGENT][NEUTRAL] I don't either, no, um, yes, we don't have any claims on file that have been denied at all. I actually don't show that you've had a denied claim. I showed too and they've both been paid.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, good. Let me ask you another question because I went to the foot doctor like a week ago, and I gave them both insurance. I gave them um my Aetna and then the American Public Life, the secondary, right? And they still billed me and I paid $60. Do I get that refund back from you?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so you can file a claim. What I can do is I now that I have your email address I can send you an online service center guide where you can upload like your claim information and we can just reimburse you as long as benefits are payable, um, and I can go ahead and send you that information, um, for the doctor that you've already paid um I can send you the name of the claim form that makes it easier to process everything instead of trying to search for all the different documents but for the.
[CUSTOMER][NEUTRAL] If I
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Urgent care, um, I would highly recommend, and I can't like tell you what to do, but I would like recommend trying to strong arm them like hey I'm not gonna pay you anything until I see that denial claim, you know what I mean like because they can file with us you do have, now I can't promise you benefits are payable because I don't process claims, but you have a policy with us and it doesn't look like they've tried.
[CUSTOMER][NEUTRAL] Uh-huh. Yeah, yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, thank you for letting me know. I'm gonna follow up on that. And another question, and when I go see cause I have American Public Life, and I have um colonial life. So sometimes I, I, I pay every month, of course, to take it off my check. But my question is um do I get a
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] If I go to, no, I think that's through American public, I mean, that's through colonial. If I go to the OBGYN and then to get the mammogram and all that, I know they, they send me $50 for each time to uh preventive care, you know? But, but you don't, you don't do that, right? It's [PII], it's a colonial.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Not with this policy, um, some of our policies like our cancer policies and stuff like that have those sort of provisions, but this one is just the gap insurance, um, to help cover the cost of major medical.
[CUSTOMER][NEGATIVE] Oh, OK, whatever, and, um, and it doesn't cover you guys go ahead and, and take over, right?
[AGENT][POSITIVE] That's our goal. I mean, it's not perfect, but yes, you do have benefits, um, and the idea is they help pick up and pay on things applied to the co-pay, the co-insurance, and the deductible that major medical leaves behind.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Oh, OK. OK. So, um, thank you so much for your time and for your help.
[AGENT][POSITIVE] My pleasure. And um do you go by [PII] or is is [PII] better?
[CUSTOMER][NEUTRAL] [PII], that's fine.
[AGENT][NEUTRAL] [PII]'s fine. OK, Miss [PII], I am going to go ahead and send you out that email. It's gonna have the claim form which will just help you understand what sort of documents you need to gather to submit a claim and then that guide for the online service center so that way you can create an account, log in and upload your claim form, but then it'll let you like set up your direct deposit and just check up on your claims and then next time a provider tells you, hey, I submitted a claim and it was denied, you can look on there and you can be like, mm I don't see a claim you submitted, you know what I mean?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Um, all good. Yes.
[AGENT][POSITIVE] So it'll kind of give you the power.
[CUSTOMER][POSITIVE] Yes, good, thank you so much for letting me know. I appreciate it.
[AGENT][POSITIVE] OK. Hey, it's my pleasure. I'll go ahead and get this out to you. Is there anything else I can do to help you with today?
[CUSTOMER][POSITIVE] No, that's it. You've been very kind. Have a great day and have a good weekend, a great weekend.
[AGENT][POSITIVE] Hey, well, it's my pleasure. You too. Enjoy, Ms. [PII]. Thank you. Thanks for calling APL. Bye bye.
[CUSTOMER][POSITIVE] Thank you. Thank you so much. Bye-bye.