AccountId: 011433970860
ContactId: c00c86df-454b-4e7d-b5bf-18aefff1f80e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 603190 ms
Total Talk Time (AGENT): 280399 ms
Total Talk Time (CUSTOMER): 125925 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/c00c86df-454b-4e7d-b5bf-18aefff1f80e_20241230T13:07_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII] and I got a uh a paper with the explanation of benefits.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And on that it says
[CUSTOMER][NEGATIVE] It says these services were rendered after coverage was terminated. My coverage was never terminated.
[AGENT][NEUTRAL] OK, [PII], what's the, um, policy number?
[CUSTOMER][NEUTRAL] 00951081
[AGENT][NEUTRAL] What's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, give me a moment to pull up the uh information. Are you looking at an explanation of benefits?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What's the claim number on that document?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] 353-9888
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] [PII], verify your date of birth and your mailing address, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Do you have an email address on file that you can verify?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thanks, so let's look at that claim.
[CUSTOMER][NEUTRAL] Just one S.
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And is this a supplemental gap policy that you have with us?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, it shows that it's not been active since [PII].
[CUSTOMER][NEGATIVE] What are you talking about? They take it out of my check every month.
[AGENT][NEUTRAL] Now this
[CUSTOMER][NEUTRAL] Well, uh
[CUSTOMER][NEUTRAL] Yeah, I've been a policy holder since the [PII].
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] I do not show any premiums taken since um [PII].
[AGENT][NEUTRAL] Do you have a uh a copy of, of, um, you said it's been deducted from your account. Does it say American Public Life?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Yes sir.
[CUSTOMER][POSITIVE] Yes, it does.
[CUSTOMER][NEUTRAL] I've been a policy holder since [PII].
[AGENT][NEUTRAL] Who is your employer?
[CUSTOMER][NEUTRAL] Now?
[AGENT][NEUTRAL] Mm, well, let me say this, this policy that I'm looking at was effective [PII]. So who is your current um employer?
[CUSTOMER][NEUTRAL] Z
[CUSTOMER][NEUTRAL] I work for Zola now, but I don't have it taken out of them.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] OK, did you used to work for MC Assembly?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And when did you stop working there?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so that's who this policy was through MC Assembly.
[AGENT][NEUTRAL] And I don't show that you have a.
[CUSTOMER][NEUTRAL] No, this is my supplementary.
[CUSTOMER][NEUTRAL] I didn't have that from them.
[AGENT][NEUTRAL] No, MC assembly is your your former employer.
[CUSTOMER][NEUTRAL] I had a
[AGENT][NEUTRAL] And American public, OK, and you had the supplemental gap policy um through that employer.
[CUSTOMER][NEUTRAL] Yes, I know.
[AGENT][NEUTRAL] But if you're no longer
[CUSTOMER][NEUTRAL] I have the continental.
[CUSTOMER][NEUTRAL] I have the continental life insurance.
[AGENT][NEUTRAL] OK, so you're not speaking with Continental, you're speaking with American Public Life.
[AGENT][NEUTRAL] So let me look at, let me look, let me look at the claim that that that we uh process for you. Give me a second.
[CUSTOMER][NEUTRAL] Well, that's, that's who they.
[CUSTOMER][NEUTRAL] It was [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is that emergency medicine services?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me a second, let me take a look at that document.
[AGENT][NEUTRAL] I'm thinking perhaps the doctor's office may have sent it to the wrong insurance company, but let me double check.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So the policy number that's on your claim is different it's not an APL policy number, so I'm wondering if they perhaps may have submitted the claim to the wrong company for payment.
[CUSTOMER][NEUTRAL] Oh, I see.
[AGENT][NEUTRAL] Uh-huh. That's what it looks like.
[CUSTOMER][NEUTRAL] So who, so who do I call the hospital?
[AGENT][NEUTRAL] Yes, I would contact the hospital and see what uh insurance cards they may have on file and ask them where did they mail this claim. Of course we know it went to came to APL, but I'm thinking they may have sent it to the incorrect um insurance company because the.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Policy number on the claim is, is different than what you gave me, different than the 95108.
[AGENT][NEUTRAL] One.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] It's another number on the claim on their claim.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I will contact the um.
[AGENT][NEUTRAL] Hospital medicine services we received the facility claim and it looks like the ER.
[AGENT][NEUTRAL] Or the physicians, like the doctor's claim as well.
[AGENT][NEUTRAL] Uh, one was 10:15 we received another one. This was actually inpatient. It says that data service is 10-17-2024.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Were you in the hospital?
[CUSTOMER][NEUTRAL] You don't have
[CUSTOMER][NEUTRAL] Yes, they admitted me.
[AGENT][NEUTRAL] OK. Yeah, I see the one you're speaking of. I see the 10:15, 24 as well. So did you report to the emergency room and then they admitted you?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I see two claims one for 10-15 24, and then the other one is for 10-1724.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And so it looks like.
[CUSTOMER][NEUTRAL] You don't have
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] You don't have to have a phone number there, do you? that I can call?
[AGENT][NEUTRAL] Let me, let me see if they have a phone number on their claim. There is, so let me see, there's gonna be two different phone numbers because one bill is for the hospital and then the other bill is for the um.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The doctor that saw you while you were there. Uh, let me see if the numbers are the same.
[AGENT][NEUTRAL] OK, so the phone number for.
[AGENT][NEUTRAL] Hospital medicine Services of New Hampshire on the claim on their claim it says area code [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me look at the other claim and see if it has a different number on there.
[AGENT][NEUTRAL] And then the claim for the 1015 data service which I believe the ELB that you have from APL that number it's the same number um 603 well this one is 332-521-1 is that what I gave you before?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, so this is for.
[CUSTOMER][NEUTRAL] Now what
[AGENT][NEUTRAL] Yeah, this is for the emergency room physician's office.
[AGENT][NEUTRAL] The other one was for, yeah, so this one is 603.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this date of service is [PII]. The first one I gave you is for date of service [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] But it looks like they may have sent it to the wrong insurance company.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][POSITIVE] All right, thank you very much for your help.
[AGENT][POSITIVE] Oh, you're welcome. Did you have any other questions I can help out with today, [PII]?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][NEUTRAL] Uh-huh, bye-bye.
[CUSTOMER][NEUTRAL] Bye.