AccountId: 011433970860
ContactId: bcd50a3d-7b7c-4b3f-be45-54a6b9e4b649
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 536559 ms
Total Talk Time (AGENT): 132437 ms
Total Talk Time (CUSTOMER): 251901 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/bcd50a3d-7b7c-4b3f-be45-54a6b9e4b649_20250514T14:51_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, [PII], this is [PII]. Um, I was calling just because I, um, recently submitted some claims and I got a notification that they were processed and I just wanted, um, assistance understanding them if that's possible, please.
[AGENT][NEUTRAL] OK, you have your policy number, [PII]?
[CUSTOMER][NEUTRAL] Yeah, 258-512-6.
[AGENT][NEUTRAL] OK, thank you. And can you verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And then do you have a good callback number in case we are disconnected?
[CUSTOMER][NEUTRAL] Um, yes, it's [PII].
[AGENT][NEUTRAL] And then just need 2 more pieces of information, your address and your email address.
[CUSTOMER][NEUTRAL] My address is um.
[CUSTOMER][NEUTRAL] Mhm. Uh, what, which one did I want to give you? Uh, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And your email?
[CUSTOMER][NEUTRAL] Email is um
[CUSTOMER][NEUTRAL] Uh, which one? I'm trying to think which one you have.
[AGENT][NEUTRAL] It looks like a [PII].
[CUSTOMER][NEUTRAL] Oh, it's [PII], yes, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and which claim are we checking on? Do you have the claim number or the date of service?
[CUSTOMER][NEUTRAL] Um, OK, the claim number for one of them is 360.
[CUSTOMER][NEUTRAL] 0037
[AGENT][NEUTRAL] OK, it looks like um we processed that and made a payment of 1,105.
[CUSTOMER][NEUTRAL] OK, so that one was paid?
[AGENT][NEUTRAL] Uh, yes, pay that on.
[AGENT][NEUTRAL] Uh, looks like we made a payment and sent that on [PII], uh, check.
[CUSTOMER][NEUTRAL] OK, got you, and then that check's going to the provider, right?
[AGENT][NEUTRAL] Uh, no, that's going to you.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] So if you still have a balance with them, you, you would want to cash that and then pay them.
[CUSTOMER][NEUTRAL] OK, um, I should get it. That's why I was like kind of hesitant about the address. I'm moving on the [PII], but I should, I mean, I'm gonna forward everything, but I should get it before the [PII], right?
[AGENT][POSITIVE] Oh yeah, absolutely. Yeah, you should get it in the next few working days.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, and then the, the next claim I have is, so just so you understand, I think I called like last week, maybe on the [PII] or the [PII], and then I was talking about this bill and then they told me they didn't have enough information so then when I got more information I submitted another claim number but if I submitted two claim numbers for the same treatment, one's just gonna get bounced back and say like already paid, right?
[AGENT][NEUTRAL] Yes, we would deny it as a duplicate, yep.
[CUSTOMER][NEUTRAL] OK, all right. I didn't mean to do that, but unfortunately that doesn't happen, um, so.
[AGENT][NEUTRAL] Oh, that's OK.
[CUSTOMER][NEUTRAL] OK, perfect. So 5:12 you issued that check and the other claim number is 3600.
[CUSTOMER][NEUTRAL] 042.
[AGENT][NEUTRAL] OK, it looks like we did pay the provider on that one. We paid them $55.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And that went out on [PII], so they'll be getting that shortly.
[CUSTOMER][POSITIVE] To to [PII] now that's right.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] That's for [PII] now you send it to?
[AGENT][POSITIVE] Uh, let's see. Yes, that's right.
[CUSTOMER][NEUTRAL] 513 to end now. OK. Then the other claim is
[CUSTOMER][NEUTRAL] Number is 360-0740.
[AGENT][NEUTRAL] Uh, that one we paid you, um, that went out, uh, yesterday, and that was a payment of 11429.
[CUSTOMER][NEUTRAL] OK, 1 1429.
[CUSTOMER][NEUTRAL] OK, and then.
[CUSTOMER][NEUTRAL] And that went out yesterday 5:13 to me.
[CUSTOMER][NEUTRAL] Request
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] 360075-5
[AGENT][NEUTRAL] Looks like that one went out yesterday to you for 150.
[CUSTOMER][NEUTRAL] What's the last one?
[CUSTOMER][NEUTRAL] OK, so I didn't understand this because I think that this might have been like the one that I resubmitted so like uh.
[CUSTOMER][NEUTRAL] Initially
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Initially I think it's the same bill from the claim number ending in 360037, that one for $1,105 but I think when I resubmitted it, it was determined that you underpaid or something because it didn't include the deductible of the $150.
[CUSTOMER][NEUTRAL] Is that what happened? I was trying to understand.
[AGENT][NEUTRAL] Yeah, let me see.
[AGENT][NEUTRAL] Yes, the original one didn't include that. So that's why we're paying out this one.
[CUSTOMER][NEUTRAL] OK, so 150 to me for the hospital.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and then I just should pay the providers direct like when I get the bills from the providers I just use this money to pay them. That's what how this goes.
[AGENT][NEUTRAL] Yeah, I mean, this, yeah, this is a secondary policy to pick up that, whatever your primary didn't pay, so.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All [PII], well, I appreciate it. Thank you so much.
[AGENT][NEUTRAL] Anything else I can help with today, [PII]?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][NEUTRAL] OK, well, thank you for calling AT.
[CUSTOMER][NEUTRAL] Oh, actually, you know what, you know what? There is one more thing. I don't know how much, like how much is this plan cover, the plan that I have with APL like cover? Is it 2000, like I, I don't know this is.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh, let me
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Um, anything I quote is not a guarantee of payment. It's a basic outline of your policy. Uh, so it looks like for outpatient benefits, let's see what we got.
[AGENT][NEUTRAL] Yes, it's 2000.
[CUSTOMER][NEUTRAL] 2000. OK, so does it show how much I've met out of that?
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] With these newest payments.
[AGENT][NEUTRAL] Uh let me see what that is.
[AGENT][NEUTRAL] OK, so right now we are sitting at
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Uh, we're at 1,42429.
[CUSTOMER][NEUTRAL] 104.
[CUSTOMER][NEUTRAL] 24, 1,424 and how many cents?
[AGENT][NEUTRAL] 29 cents.
[CUSTOMER][NEUTRAL] 29?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, that's how much has been paid out of the 2000, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] So the 2000 is all of the benefits I have, right? From APL?
[AGENT][POSITIVE] Yes, in a calendar year. It'll start over next year, yep.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, alrighty perfect.
[CUSTOMER][POSITIVE] Thank you so much I really appreciate it.
[AGENT][POSITIVE] All right, thank you for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You as well. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.