AccountId: 011433970860
ContactId: a404193c-87e1-401f-bee2-fab807b13fef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 391470 ms
Total Talk Time (AGENT): 213673 ms
Total Talk Time (CUSTOMER): 103150 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/a404193c-87e1-401f-bee2-fab807b13fef_20250507T13:41_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] Oh, yes. I was called. I just visited my hand out again today.
[CUSTOMER][NEGATIVE] And when I, when I went the first time, I gave her my insurance and she said she turned it in, but she said y'all, y'all emailed her back or something.
[CUSTOMER][NEUTRAL] And told her that I wouldn't recognize in the system, y'all the system or something.
[AGENT][NEUTRAL] Hm, OK, well, I can definitely look into it for you, um, and see what's going on with the system or what happened. Um, may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh [PII].
[CUSTOMER][NEUTRAL] And the and the phone number is [PII].
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] Thank you for that. And I can look your um
[AGENT][NEUTRAL] Your policy with your social or if you have an ID card with the policy number, I can use that too.
[CUSTOMER][NEUTRAL] Uh, uh, my social is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] I'm just waiting for the policies to populate here. Here we go.
[AGENT][NEUTRAL] All right, and I have you here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Uh, the email is [PII], and my birthday is [PII].
[AGENT][POSITIVE] Thank you. And your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So yeah, I'm not sure, well, they definitely didn't call us. There's no notes here, um, except for one injury, but I I don't know if maybe they called your primary insurance. I'm not sure who they called, but you have a policy here. Um, it's been active since [PII], and with your social it came right up, um, but I can give you your policy number too if you need it.
[CUSTOMER][NEUTRAL] Uh, give me a minute. Let, let me see, is it, is everything right?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, what's the what's the policy number?
[AGENT][NEUTRAL] It's 259.
[AGENT][NEUTRAL] 5671.
[CUSTOMER][NEUTRAL] OK, uh,
[CUSTOMER][NEUTRAL] And you, uh, so is my medical insurance through y'all too?
[AGENT][NEUTRAL] So, um, yes and no. So your major medical is through Blue Cross Blue Shield. So this policy is through your job. So you have Blue Cross Blue Shield first and then your APL policy is second. So we're together, but we're separate, if that makes sense, like they'll they'll
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So when you, when they tried to send the claim in from when he went, they said that basically he was denied like he didn't have insurance at all. So does it have to go through Blue Cross Blue Shield first?
[AGENT][NEUTRAL] Yes. So anytime, basically I just tell my customers, anytime you, you give your primary, just go ahead and give our card to. If your primary doesn't like apply benefits, then we can't because we're second to them, but if they do, then we can, um.
[CUSTOMER][NEUTRAL] what
[AGENT][NEUTRAL] Your primary has its own benefits and secondary too, so like, for example, if you go to the doctor's office, it may be covered under your primary, but your secondary may only cover the treatment in the office. So it, it depends. I was just looking at this one claim that came in, which was denied because office visits aren't covered.
[AGENT][NEUTRAL] Well, part of it was denied because office visits weren't covered. The other part was denied asking for billing. So once we receive the billing from Carolina Han Center, we can continue processing.
[CUSTOMER][NEUTRAL] So that's why
[CUSTOMER][NEGATIVE] So that's what happened. You only turned that insurance card in. You didn't turn your main, my my next question is, I never got my Blue Cross Blue Shield insurance cards.
[CUSTOMER][NEUTRAL] How do I go about getting them?
[AGENT][NEUTRAL] Well, so you'll have to go through your HR because we're not, we're not really affiliated with Blue Cross, we just, we're second to them because they're major. So your um HR department has all of your elections, they'll be able to reach out or let you know who to reach out to Blue Cross to get your cards. It's a different company, so I don't know how they work with that part.
[CUSTOMER][NEUTRAL] OK, you gotta call [PII]. OK, alright, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] But yeah, if you want to give, because I see this claim, we only have one claim for you and it is from the Carolina Hand Center. If you want to give them the policy number I just gave you and our phone number, so that way they can call us to verify your benefits, but
[AGENT][NEGATIVE] Yeah, I'm not sure who they call uh before, but they definitely haven't talked to us.
[CUSTOMER][POSITIVE] OK, we'll do that. OK, thank you. I will do that.
[AGENT][NEUTRAL] You're welcome. So, um, when you call them, also let them know that and and they receive this in the mail as well, so they do know because we send out like an explanation of benefits. We're just waiting for them to send the itemized billing so that we can continue processing the claim that they did file. So as soon as we get that we can keep, you know, processing for a decision.
[CUSTOMER][POSITIVE] OK. OK, alright, thank you.
[AGENT][POSITIVE] You're very welcome. Well, was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh no ma'am, that's all.
[AGENT][POSITIVE] Alright, well, thanks so much for calling APL. I hope you all have a great day.
[CUSTOMER][POSITIVE] All right thank you bye bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.