AccountId: 011433970860
ContactId: a9034edd-9d77-4cb6-beec-66e8b9874257
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 722799 ms
Total Talk Time (AGENT): 201813 ms
Total Talk Time (CUSTOMER): 209014 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/a9034edd-9d77-4cb6-beec-66e8b9874257_20250318T17:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. Can I help you?
[CUSTOMER][POSITIVE] Hi, good afternoon, [PII]. How are you doing?
[AGENT][POSITIVE] I'm doing well how are you doing today?
[CUSTOMER][NEUTRAL] Very well, thank you. Um, I was calling because I wanted to find out some information. I have a, a bill that was sent to me by, um, a hospital. Now my regular insurance paid for it, and I also have APR of my secondary insurance. I wanted to understand what happened.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, that they're saying that they can't pay it out.
[AGENT][NEUTRAL] OK, alright, I can check on the claim for you. Can you please give me your name and the number?
[CUSTOMER][NEUTRAL] Yes, uh, my name is [PII]. Oh, but it doesn't matter that it's under my son's name.
[CUSTOMER][NEUTRAL] The, the claim?
[AGENT][POSITIVE] Right. I can, I can look under your son's name and see how the claim processed. Absolutely.
[AGENT][NEUTRAL] OK, Ms. [PII], what is your policy?
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Um, my, uh, group number is 21265, or do you need the certificate number?
[AGENT][NEUTRAL] The certificate number, please.
[CUSTOMER][NEUTRAL] OK, it's 01719341 M.
[CUSTOMER][NEUTRAL] L 7.
[AGENT][NEUTRAL] OK, let me look this up real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And um [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you ma'am and then what your address phone number and email address that we have on the policy?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and the phone number should on the policy, could it be mine or my husband's cause he's the policy owner.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, so his?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] OK, thank you. And then also the, uh, do you know his email address?
[CUSTOMER][NEUTRAL] It should be [PII].
[AGENT][POSITIVE] OK, thank you I appreciate.
[CUSTOMER][NEUTRAL] Because I'm not sure if they used his word is that one OK.
[AGENT][NEUTRAL] Yes ma'am
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And dependent is the claim for.
[CUSTOMER][NEUTRAL] [PII] she.
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] All right, let me see if anything's been sent on him.
[CUSTOMER][NEUTRAL] Oh yes, I, I, I have the claim number.
[AGENT][NEUTRAL] OK, what's the claim number?
[CUSTOMER][NEUTRAL] Hold on, give me 1 2nd.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Sorry. Um, let me see, I have it here.
[CUSTOMER][NEUTRAL] Because I sometimes say.
[CUSTOMER][NEUTRAL] Or maybe I don't have the claim number. I just have the information.
[AGENT][NEUTRAL] OK, do you have the date of service?
[CUSTOMER][NEUTRAL] Yes, it's um [PII].
[AGENT][NEUTRAL] OK, and do you know how much uh the charge amount was?
[CUSTOMER][NEUTRAL] Oh, here we go, reference is it reference number? oh claim number here we go. 3507014.
[AGENT][POSITIVE] OK, that is a big help. Let me look that up real quick.
[CUSTOMER][NEUTRAL] Yeah, sorry, I know I had to add this uh the.
[AGENT][NEUTRAL] No, that's OK.
[AGENT][NEUTRAL] We're gonna pull that up and see what's going on.
[AGENT][NEUTRAL] OK, and it was for Memorial Hospital, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, let me look.
[AGENT][NEUTRAL] OK, so on this claim,
[AGENT][NEUTRAL] It has a note that the insured's primary insurance provided full benefits. There are no benefits payable.
[CUSTOMER][NEUTRAL] OK, I, OK, so they, my insurance paid the, but you know there's a co-pay.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so usually what my insurance pays the full amount and APO pays my co-pay.
[AGENT][NEUTRAL] OK, but on this, uh-huh, go ahead.
[CUSTOMER][NEUTRAL] Now
[CUSTOMER][NEGATIVE] Oh no, because I when I called the people for memorial, they said that um that they didn't tell me that. They told me that um that my, I had reached where I couldn't, I, that they wouldn't be able to pay out anymore.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, on this, on this claim number, the insured, your primary insurance, your major medical paid for everything, so there was no benefits for us to pay.
[CUSTOMER][NEGATIVE] Right, so then, but there, but there is cause they're charging me.
[CUSTOMER][NEUTRAL] So does that mean that they have to.
[CUSTOMER][NEUTRAL] That they have to resend it? Do I have to file a claim for it? Like, what, what do I do? Because obviously there's a co-pay, usually you guys, well, APL covers the
[CUSTOMER][NEUTRAL] The difference.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, what I'm going to, right, what I'm going to do is I'm going to, um,
[CUSTOMER][NEUTRAL] I'm confused, that's.
[AGENT][NEUTRAL] Send in a request for a claims examiner to call you and advise you on what you should do to get your copay.
[CUSTOMER][NEUTRAL] Yeah, I mean, if I have to pay for it, because on their end, on their, their, the, the hospital side, they're saying that you guys sent a letter saying that no, this, this um patient, like, they already reached their claim limit.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEGATIVE] But you, but then on here, for, for you guys, your explanation you're just saying that no, the insurance paid the full amount, but I'm getting a bill.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Right, OK, so I understand where the confusion's coming in. um, what I'm going to do, like I said, is I'm gonna get a claims examiner to call you and tell you how the claim was processed and.
[AGENT][NEUTRAL] You know if there's anything that you do as far as filing the claim yourself or not, you can ask them those questions uh what is a this number.
[CUSTOMER][NEUTRAL] Mhm. Or they'll refile the claim?
[AGENT][NEUTRAL] Right. I'm gonna let them uh go over it with you so that they can advise you on what to do if there's anything that can be done, OK? um for your co-pay. Now, the phone number that you gave me.
[AGENT][NEUTRAL] Is your husband. So what's a good callback number for yourself?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I get that request in for them to call you back and then I'll be right back.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] OK, thanks.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 29
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much, Ms. [PII] for holding for me. I've got that request and for somebody to give you a call back. You should be getting a call back from a claims examiner within 24 hours.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK sounds good thank you very much.
[AGENT][POSITIVE] You're very welcome. Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] Oh, that's all. Thanks, you've been a lot of help.
[AGENT][POSITIVE] OK, well, you're, you're very welcome. I hope you have a wonderful day and thanks for calling APL.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye-bye, Ms.