AccountId: 011433970860
ContactId: 9aab4688-78df-438c-99de-97fbe37baf25
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 720320 ms
Total Talk Time (AGENT): 345362 ms
Total Talk Time (CUSTOMER): 279980 ms
Interruptions: 6
Overall Sentiment: AGENT=1.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/9aab4688-78df-438c-99de-97fbe37baf25_20250221T15:34_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, hi, [PII]. I am calling regarding, um, some
[CUSTOMER][NEGATIVE] My, um, newborn being added to our APL and in charges that doesn't seem like they were covered.
[AGENT][POSITIVE] It would be my pleasure to assist you. Do you have your APL policy number?
[CUSTOMER][NEUTRAL] I do, I do, it's 02292679.
[AGENT][NEUTRAL] That number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. And what is your name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] [PII] and it's [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the current mailing address?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] Alright thank you.
[AGENT][POSITIVE] And a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Have I spoken with you before? Sure seems familiar. OK, good.
[CUSTOMER][NEUTRAL] Yes, I called about some other things and.
[AGENT][NEUTRAL] I thought I remembered you. I just wanted to make sure.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Well, it's nice to talk to you again.
[AGENT][NEUTRAL] OK, so.
[CUSTOMER][POSITIVE] OK, yes, you too.
[AGENT][NEUTRAL] Is this for [PII]?
[CUSTOMER][POSITIVE] This is growing, yes.
[AGENT][NEUTRAL] OK, so he is added on the policy.
[CUSTOMER][NEUTRAL] Was he added for in November or in January?
[AGENT][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] It was supposed to be added in November.
[AGENT][NEUTRAL] Let me see if I can.
[AGENT][NEUTRAL] See what day he was added.
[AGENT][NEUTRAL] I'm sorry, it's taking a minute.
[CUSTOMER][POSITIVE] You're totally fine.
[AGENT][NEUTRAL] I'm gonna have to check further on that to see when he was added.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you, do you mind holding just a quick moment?
[CUSTOMER][POSITIVE] Yeah, no, that's no problem.
[AGENT][NEUTRAL] All right, thank you, [PII]. One moment please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII].
[AGENT][POSITIVE] Hey. Happy Friday.
[CUSTOMER][POSITIVE] Happy Friday, [PII].
[AGENT][NEUTRAL] Oh. Hey, I just have a question. I was wondering if you could check something for me. It's on policy 2292679.
[CUSTOMER][NEUTRAL] OK, what you got.
[CUSTOMER][NEUTRAL] All right, let me pull up a screen here.
[AGENT][NEUTRAL] Pull up a screen.
[CUSTOMER][NEUTRAL] Oh the scoring girl.
[CUSTOMER][NEUTRAL] 2292679. OK.
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So this is on [PII].
[AGENT][NEUTRAL] Part 4. This is a newborn, and she said that he was supposed to be his affected date should have been November.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is [PII], [PII].
[AGENT][NEUTRAL] How can you tell for the newborn?
[CUSTOMER][NEUTRAL] Look, OK, go to [PII].
[AGENT][NEUTRAL] Oh, right there. Well it's date of birth, yeah.
[CUSTOMER][NEUTRAL] And and there's a.
[CUSTOMER][NEUTRAL] Well, next to it it's effective date.
[AGENT][POSITIVE] Got you.
[AGENT][POSITIVE] But OK, that's what I needed to know.
[AGENT][NEUTRAL] I was trying to look in the notes and I couldn't figure out the, you know, just said.
[CUSTOMER][NEUTRAL] Um, girl.
[AGENT][POSITIVE] Corrected effective date.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] On [PII] and I'm like.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Well, how do you
[CUSTOMER][NEGATIVE] Can't do it.
[AGENT][NEUTRAL] You know sometimes you just skim over these screens and there's just so much information.
[CUSTOMER][NEGATIVE] Just a butt load of information. I know, and oh my [PII], I can be looking right at it and not see it.
[AGENT][NEUTRAL] Me too.
[CUSTOMER][NEGATIVE] I am not kidding, [PII]. It is horrible.
[AGENT][POSITIVE] I'm right there with you, girls. I think it's our generation, I mean, well, OK, forgive me, but our age. That's right.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] We don't blame it on that anyway, aren't we?
[AGENT][NEUTRAL] We've seen so much in our life, we just kind of skim over things.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hey girl, girl, ain't it the truth. Ain't it the truth. Lord, have [PII]. Yeah, no, it's [PII].
[AGENT][NEUTRAL] OK, so I can go back to.
[AGENT][POSITIVE] Good. All right. I'll get back to Ms. [PII]. Thank you. I just wanted to verify that. Appreciate you, [PII]. Have a great weekend. Bye-bye.
[CUSTOMER][POSITIVE] You're welcome there anytime. Bye dear. You too, honey. Bye.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Ms. [PII], thank you for your patience. [PII]'s effective date is his date of birth, [PII]. Mhm.
[CUSTOMER][NEUTRAL] Yes. Mhm.
[CUSTOMER][POSITIVE] His date of birth, perfect.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Where
[CUSTOMER][NEUTRAL] Um, his ster like his, uh, no, his, um,
[CUSTOMER][NEUTRAL] Circumcision, is that not something that would be covered?
[AGENT][NEUTRAL] I'm sorry, I got tick that you call this sterilization.
[CUSTOMER][NEUTRAL] Through GPL
[CUSTOMER][NEUTRAL] I know. Well, my husband had a vasectomy and so I was gonna ask you about that too. So there's a lot.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] You got a lot going on, don't you?
[CUSTOMER][POSITIVE] Yeah we do, we do.
[AGENT][POSITIVE] That's not a problem. I'll be happy to help you with that. Now, let me check, do y'all have that you have an active online portal, correct?
[CUSTOMER][NEUTRAL] Um, I beli I don't know if I have access to it. I know my husband does.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So anytime you're wondering if something is covered or not, just, just for future reference, you can call us too. But there's a section called exclusions under what is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you would check that, um,
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] List of exclusions, for example, uh, sterilization and reversal of sterilization is under the list of exclusions, meaning it is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that's no problem. Yeah. Mhm.
[AGENT][NEUTRAL] So it sterilization would not be a covered benefit.
[CUSTOMER][NEUTRAL] OK, that's fine.
[AGENT][POSITIVE] Just kind of make, trying to make it a little easier sometimes.
[CUSTOMER][POSITIVE] Yes, that, that's, that's good to know.
[AGENT][POSITIVE] If you're like me, if I just know where to find something, I don't mind getting it myself.
[CUSTOMER][POSITIVE] Yes, yes, I'm, I'm like that too.
[AGENT][NEUTRAL] And let's see, I.
[CUSTOMER][NEUTRAL] Um, but for, for Owen, do you know?
[AGENT][NEUTRAL] Now I know the policy pays towards sickness or injury, and I don't believe that circumcision is going to be considered under the sickness.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Benefit. Mhm.
[CUSTOMER][NEUTRAL] Under one of those? OK, OK, that's good to know alright.
[AGENT][NEUTRAL] Now, I would, I would have them submitted.
[AGENT][NEUTRAL] You know, I don't see circumcision actually listed under.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The list of exclusions.
[CUSTOMER][NEUTRAL] Yeah, I was under surgery male genital system is what the service was the bill from the hospital.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And I was looking under the list of exclusions. I don't see circumcision actually listed as an exclusion mhm and that's why I'm saying I would definitely.
[CUSTOMER][NEUTRAL] As an exclusion.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Have them submit it.
[AGENT][POSITIVE] Um, yeah, absolutely.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Cause if it's payable, we'll get that payable. And I was just checking [PII]'s claims. Now the providers have sent in claims but no um
[CUSTOMER][NEUTRAL] I will do that.
[AGENT][NEUTRAL] Explanation of benefits with the claims.
[CUSTOMER][NEUTRAL] For for like the hospital stay and.
[AGENT][NEUTRAL] I can look and see what that is for.
[CUSTOMER][NEUTRAL] For the birth
[CUSTOMER][NEUTRAL] OK, I know there's there's something from I've already spoken with her.
[CUSTOMER][NEUTRAL] Insurance, our primary and they had to resend out the the.
[AGENT][NEUTRAL] And this actually look like, looks like and me the hospitalist.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So the phys so the physicians have sent in claims. We don't have a facility claim yet from the hospital.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I haven't received any sort of bill for a hospitalist. I know that his circumcision was through um the gynecologist, so it should be like a physician.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Do you know how much that bill was?
[CUSTOMER][NEUTRAL] It currently is 12,480. It was the total was 160, but primary covered 135.
[AGENT][NEUTRAL] OK, yeah, I, I don't see that claim on file yet either.
[CUSTOMER][NEUTRAL] 20.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And then just like.
[AGENT][NEUTRAL] These are all from [PII], 16 and [PII], 8, [PII] and 18.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So just have the hospital resubmit.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK, I can do that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And they can fax it to us, but be sure to tell them that we're secondary and ask them to please include the primary EOB from your primary insurance. I'm not sure why the hospitalists did not send the EOB with their claim.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But once we get those back.
[AGENT][NEUTRAL] You know we can continue processing for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah I think I just heard from.
[CUSTOMER][NEUTRAL] Our primary and she said they had to resubmit everything and it could take 3 to 4 weeks, um.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well, there's no time frame on our policy as far as getting the claims in to be able to process them.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] Have, uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then for like well checkups those copays don't get um paid right?
[AGENT][NEUTRAL] That's correct, because the policy only pays for a sickness or injury diagnosis.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. All right. Just
[CUSTOMER][POSITIVE] That's awesome. Um, alrighty, I think [PII], do you have any other questions you think of?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I will check for the exclusions next time online.
[AGENT][POSITIVE] Oh, yeah, and, and, of course, as always, you can give us a call. We're here to help you any way we can.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Right, well, I appreciate it so much.
[AGENT][POSITIVE] Well, it has been my pleasure. Oh, and when you go, if you go online to check those benefits, you just click on the policy number itself and it'll download your policy documents.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK, OK, perfect.
[AGENT][POSITIVE] Ms. [PII], it's such a pleasure to assist you today and talk to you again. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Um, not that I can think of.
[AGENT][POSITIVE] All right, well call us if you can think of anything else. We're here and I hope you and your family have a lovely weekend.
[CUSTOMER][POSITIVE] Thank you. You too. Goodbye.
[AGENT][POSITIVE] Thank you, Ms [PII]. Bye-bye.