AccountId: 011433970860
ContactId: b7950248-1605-47e3-b6cc-4041c242ac56
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 253399 ms
Total Talk Time (AGENT): 126906 ms
Total Talk Time (CUSTOMER): 99101 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/b7950248-1605-47e3-b6cc-4041c242ac56_20250319T19:51_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, good afternoon. I had a quick question. Um, I went to the emergency room, um, due to an accident and my co-pay of $100 is that something that I could, um, claim with APL?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I can check and see. um may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Certainly. My name is [PII] Last name [PII] Phone number [PII].
[AGENT][NEUTRAL] Thank you and may I have the policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 01975687 M as in Mary L as in Larry 8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, and for security, may I have your date of birth, mailing address and email address on file?
[CUSTOMER][NEUTRAL] Date of birth [PII]. Address [PII]. And my email address, did you ask?
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, we have [PII] [PII] Is that incorrect?
[CUSTOMER][NEUTRAL] No, that's fine. They both work. They updated our emails recently.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Oh, OK. All right, thank you. OK. And let's see, so you have a secondary policy, and yes, this one does cover for the ER visits. Um, this is part of your outpatient benefits and this is not a guarantee, just a verification of coverage and that's just a disclaimer and we cover up to $500 per day.
[CUSTOMER][NEUTRAL] OK, so I paid $100 co-pay. So what kind of information do I need to, to put in a claim? I have just the receipt that I paid by my credit card.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, we cannot use the receipts. Um, let me give you the information that we're gonna need. Let me know when you're ready.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK, so the first thing we're gonna need is the claim form. Our claim form, you can find it on our website at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it's gonna be the meddling claim form.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the first page of that form, you're gonna see the instructions, but I'm gonna go ahead and give it to you as well. Um, the second document that we're gonna need is an itemized bill with the diagnosis code and this comes from the ER.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the 3rd document is gonna be the copy of the explanation of benefits from the primary insurance showing the amount they apply towards the deductible co-payment of co-insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So once we receive all three, it's got a complete claim and we'll go ahead and process for reimbursement.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I, I didn't know if there's explanation of benefits when I'm doing a copay that was kind of kind of confusing to me, but um.
[AGENT][NEUTRAL] Oh, yeah, they, they always need to uh um process a claim. It doesn't matter if you pay or not pay, uh, they have to process through your primary insurance and then once you receive that information, um, you can go ahead and send us a copy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I, I guess I'll give them a call and see if I can get that sent to me then.
[AGENT][POSITIVE] OK, yes, sure. Mhm. No problem.
[CUSTOMER][POSITIVE] So, OK. Thank you so much. I appreciate your help.
[AGENT][NEUTRAL] You're welcome. Is there anything else I may help you with today, Ms. [PII]?
[CUSTOMER][POSITIVE] No, that'll do it thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling ATL. Have a good day.
[CUSTOMER][NEUTRAL] You too now bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye, Miss.