AccountId: 011433970860
ContactId: a5159f40-6f97-47eb-a31c-13d1a52ec4c3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 331329 ms
Total Talk Time (AGENT): 179663 ms
Total Talk Time (CUSTOMER): 82508 ms
Interruptions: 0
Overall Sentiment: AGENT=2.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/a5159f40-6f97-47eb-a31c-13d1a52ec4c3_20250402T13:59_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, good, good morning. Uh, this is [PII]. I was calling about a claim that was submitted from an outpatient clinic back in February, and I'm trying to because they just sent me a bill to say, um, it wasn't paid.
[CUSTOMER][NEUTRAL] So I'm trying to find out why it wasn't paying.
[AGENT][NEUTRAL] OK, Mr. [PII].
[AGENT][NEUTRAL] OK, Mr. [PII], so you received a notification from your provider that a claim was denied by APL and you're wanting to check on that. Is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes, I can help you with that and what is a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 254-463-2
[AGENT][POSITIVE] Thank you and your policy number please.
[CUSTOMER][NEUTRAL] My policy number.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Oh no, let me find it.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Which one what's the number, the hospital or the outpatient?
[AGENT][NEUTRAL] If you will notice, Ms. [PII], on both of those numbers, the very first part of both numbers prior to the letters ML are identical. So that's your actual policy number, so you can just give me that first part of that number.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, 017.
[CUSTOMER][NEUTRAL] 919-62
[AGENT][POSITIVE] OK, thank you. So if you'll give me just a couple of moments please to get your information pulled up.
[AGENT][NEUTRAL] And Mr. [PII], I will need to verify several things with you first for security and also Mr. [PII], any information that's provided today would be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And also your home mailing address.
[CUSTOMER][NEUTRAL] It's [PII], that's [PII].
[AGENT][NEUTRAL] Thank you and the phone number that we have on file for you is the same as the one that you gave to me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Thank you and lastly your email address please.
[CUSTOMER][NEUTRAL] Which one?
[AGENT][NEUTRAL] Your email?
[CUSTOMER][NEUTRAL] Oh, it's [PII].
[AGENT][NEUTRAL] OK, thank you very much. And what is the date of service, Mr. [PII], that you're calling about?
[CUSTOMER][NEUTRAL] It was uh [PII], uh, it was Western Outpatient clinic.
[AGENT][NEUTRAL] OK, just one moment then.
[AGENT][NEUTRAL] OK, so Mr. [PII], you did say that your date of service was for [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, now we do not have a claim on file here at APL for that data service for you.
[CUSTOMER][NEGATIVE] So they never submit a claim to y'all.
[AGENT][NEUTRAL] And you
[AGENT][NEUTRAL] And you, so you said it was for Western outpatient, is that correct?
[CUSTOMER][POSITIVE] Yes, yes ma'am.
[AGENT][NEUTRAL] OK, yes, so we, we do not have a claim on file for you at all for that data service.
[CUSTOMER][NEUTRAL] OK, let me call them and find out cause they've been calling and I gave them the information and I don't know what's going on, but they just sent me a letter yesterday about this.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Um, so yes, sir, I would definitely follow up with them. They may have filed it with your primary insurance and then just not filed it yet with your secondary with us. But as of now, no, we do not have a claim for you. Now, I do have one question for you, miss.
[CUSTOMER][NEUTRAL] OK, let me call them and find out. OK, go ahead.
[AGENT][NEUTRAL] OK, and 11 more question for you, Mr. [PII], have you ever set up your profile in our portal called the online service center?
[AGENT][NEUTRAL] Where you can have access to your ID cards, policy information, and claims information online.
[CUSTOMER][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, well I'm going to email you the user guide that will explain how to set up that profile and then it also gives you information on the different things that you can do within the portal. The email that I will send to you is going to come from [PII].
[AGENT][NEUTRAL] And I will put APL in your subject line so that that's easy for you to recognize.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK then thank you.
[AGENT][POSITIVE] OK, well, you're certainly very welcome. So is there anything else at the moment that I can help you with?
[CUSTOMER][NEUTRAL] No, that was it.
[AGENT][POSITIVE] OK, well thank you again, Mr. [PII] for calling APO and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Yes, sir. You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] OK bye bye.