AccountId: 011433970860
ContactId: a6df65d4-2728-499e-8b6a-7987895f248a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 395579 ms
Total Talk Time (AGENT): 244156 ms
Total Talk Time (CUSTOMER): 129298 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/a6df65d4-2728-499e-8b6a-7987895f248a_20250102T13:48_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] This is [PII], hello.
[CUSTOMER][NEUTRAL] Yeah, hi, um,
[CUSTOMER][NEUTRAL] Yes, hello. I could not, um.
[CUSTOMER][NEUTRAL] I just called a I got a bill that should have probably been picked up by you guys and I was wondering if you could investigate it and.
[CUSTOMER][NEUTRAL] Let me know what the status is.
[AGENT][NEUTRAL] OK, so you're wanting to check this to see if we have received a claim for yourself, is that correct?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] Yes, this is [PII].
[CUSTOMER][NEUTRAL] And my outpatient benefit cert number, or do you want my payer ID?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] First off, I want your callback number.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] OK, thank you. And now your policy number?
[AGENT][NEUTRAL] But did you say you had an outpatient?
[CUSTOMER][NEUTRAL] With my what
[AGENT][NEUTRAL] Number?
[CUSTOMER][NEUTRAL] I have an outpatient and inpatient, a group number a payer ID which one you want?
[AGENT][NEUTRAL] And then then, OK. So whichever of
[AGENT][NEUTRAL] If you will notice on your
[CUSTOMER][NEUTRAL] It would be appropriate for the outpatient benefit.
[AGENT][NEUTRAL] Yes, ma'am. And just for your knowledge, if you'll look at those numbers, the very first part of both of those numbers is identical prior to the ML so that is actually the policy number.
[CUSTOMER][NEUTRAL] Certain number.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I noticed.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Oh, OK, very good.
[AGENT][POSITIVE] Just that first part. Mhm. So either one. You're welcome.
[CUSTOMER][POSITIVE] All right thank you.
[CUSTOMER][NEUTRAL] 02404350
[AGENT][NEUTRAL] OK, thank you. So give me a moment, Miss [PII], to get your information pulled up. And once I do, I will have to verify several things with you first for security and also any information that is provided will be a verification of benefits and not a guarantee of payment. So first off, if you will please verify your date of birth.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And your home mailing address?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. The phone number on file for you is the same as the one that you gave me. So that is your best contact number, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, thank you. And lastly, your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] I'm so sorry. Could you please repeat that one more time, please?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, thank you very much for verifying all of your information. So what is the data service, Ms. [PII], that you're wanting to check to see if we received a claim for?
[CUSTOMER][NEUTRAL] Um, I wanted to see if, um, 10:16.
[CUSTOMER][NEUTRAL] 24.
[CUSTOMER][NEUTRAL] Um, there was an office visit at a doctor's, first name [PII].
[CUSTOMER][NEUTRAL] And they said that they submitted it to APL, but
[CUSTOMER][NEGATIVE] You guys didn't pay it.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so let's see, let me look at this claim. We do have one claim on file for you for that data service.
[AGENT][NEUTRAL] With and is the provider with the Brown Health Medical Group. Is that correct?
[CUSTOMER][POSITIVE] Correct. Correct.
[AGENT][NEUTRAL] OK, so on this, yes, ma'am, we did receive it and it was denied because office visits are not covered under this supplemental policy.
[CUSTOMER][NEUTRAL] Oh, OK, I didn't know that for some reason I thought.
[CUSTOMER][NEUTRAL] Just the copays were, but maybe not.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] It does help, this policy is designed to help you with co-pays, deductibles and co-insurance amounts of covered services. However, office visits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Themselves are not covered. Now, if you were to have some type of treatment rendered to you in the office, then we could review the treatment portion of it. For example, I mean, I don't know, you've cut your finger and you went to the doctor and, you know, they charged you an office visit, but they also did an X-ray or performed some type of treatment on that finger. We could review that portion of it.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now in looking at your profile I can't tell that you've ever set this up. Are you familiar with our portal, Ms. [PII], the online service center? OK, and have you set up your profile there?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Probably not.
[AGENT][POSITIVE] OK. If you think that is some, it's not required that you do that, but that does give you access to everything online, like your ID cards, policy information, that lists out all your benefits. You can also see claims that we have received and your explanation of benefits. So I have a user guide that I would be more than happy to email to you in a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Sure. Why don't you do that? That sounds good.
[AGENT][NEUTRAL] That gives you, OK, because it explains how to set it up and then it also explains the different things that you can do in there because should you ever have to file a claim with us yourself, you can actually upload your information into the portal for our review.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And if you need any assistance in setting it up, you can call us back and we'll be happy to help you with that.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] The email that you will receive from me, Ms. [PII], is gonna come from [PII] and I will put APL in your subject line so that that's easy to recognize.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sounds great.
[AGENT][NEUTRAL] OK. Well, is there anything else that I can help you with this morning?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, you've been most helpful.
[AGENT][POSITIVE] Oh, well, it was my pleasure and so thank you again for calling APL. I hope you have a great day and a very happy [PII].
[CUSTOMER][POSITIVE] Well, thank you. You too. God bless. Bye now.
[AGENT][POSITIVE] Yes, ma'am, and God bless you as well. Bye-bye.
[CUSTOMER][POSITIVE] Thank you, bye now.