AccountId: 011433970860
ContactId: c3416cd7-30bb-46d3-8730-c38a0a0e979b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 430959 ms
Total Talk Time (AGENT): 219909 ms
Total Talk Time (CUSTOMER): 153832 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/c3416cd7-30bb-46d3-8730-c38a0a0e979b_20250415T15:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEGATIVE] Hi, yes, I'm just calling to um see about my claim that I had made. I see it went on my, um, the website on my um signed in and I just don't understand it. It says um.
[CUSTOMER][NEUTRAL] You know, uh, a date completed um for my claim, but I didn't see the money come back to me. I don't know if that's through you guys or through um something else so if you could help me with that, that'd be great.
[AGENT][NEUTRAL] Yeah, absolutely. What is your policy number or the claim number?
[CUSTOMER][NEUTRAL] My policy number.
[CUSTOMER][NEUTRAL] OK, let me just see if it's on here, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And let me just, I might have to open up my card um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEUTRAL] Oh, my policy number is 2,521,520.
[AGENT][POSITIVE] Alright, thank you so much let me pull this up here.
[AGENT][NEUTRAL] And then if I could verify your first and last name.
[CUSTOMER][NEUTRAL] My first name is [PII], my last name is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And then I'll need to verify your date of birth and address, please.
[CUSTOMER][NEUTRAL] My date of birth is [PII] and my address is [PII].
[AGENT][POSITIVE] Thank you so much. And then lastly, can you just verify the email that we should have on here?
[CUSTOMER][NEUTRAL] Um, it would be maybe it's my work email, so maybe it's a [PII] or [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just wanna make sure that's still a good one. OK, so let me look at your recent claims here.
[AGENT][NEUTRAL] OK, so are we checking on the last one that was submitted around the [PII] of this month. Does that sound right?
[CUSTOMER][NEUTRAL] The $500.01.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so, uh, the claim was received and it looks like processed and paid, so the money was paid to the provider for whatever the uh billed amount due was.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, well that doesn't make any sense because I paid my copay to, I went to the ER and I didn't have my card, so I paid out of pocket $500 so.
[CUSTOMER][NEUTRAL] Uh, is it, so I paid them already, so that they're getting a 2nd $500 to the hospital?
[AGENT][NEUTRAL] Did you submit the claim or did they submit the claim?
[CUSTOMER][NEUTRAL] I mean, it's, I, I had called, so I think it was through me, um.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Do I call the hospital?
[AGENT][NEUTRAL] Let me look and see.
[AGENT][NEUTRAL] Because if you submit the claim with your receipt EOB and all that showing the amount paid, then it would have been issued to you, but if they're submitting the claim, like they're stating that they didn't.
[AGENT][NEUTRAL] Let me see here.
[CUSTOMER][NEGATIVE] That would be so weird because I'd be like as if I paid them and you guys paid them.
[AGENT][NEUTRAL] Yeah, looks like Memorial Regional Hospital was the one that.
[AGENT][NEUTRAL] I submitting it, um.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So I would definitely contact the provider uh regarding the claim and um you know see what they uh you are gonna do if you had already um paid at the time of service, the copay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, then that's
[CUSTOMER][NEUTRAL] OK, alright, so I have to call Memorial Regional.
[AGENT][NEUTRAL] Yeah, because that's something that would need to be reimbursed, um.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] To you because that's the, that's the purpose of the secondary insurance is to cover, you know, that, so hopefully you don't have to come out of pocket, um, in like an emergency or medical situation. So, yeah, so definitely contact them and then just personal recommendation, take it or leave it in the future. I would never pay before all my insurance is billed. Um, my personal experience, I've had
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, but I.
[AGENT][NEGATIVE] Like I just refuse. Like I've had I've had major surgery and I've had the lady come in and say, oh, I need your co-pay, and I'm like, no, no, no, no. Once all my insurance has been billed, I'll be happy to take a look at it, but you're not getting anything from me now.
[CUSTOMER][NEUTRAL] Yeah, no, I, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, no, I know. It was like, I know. I was desperate. I wanted to be seen and it was.
[AGENT][NEUTRAL] I hear you. No, I hear you. I get it. I just
[CUSTOMER][NEUTRAL] I know, I know, and I, yeah.
[AGENT][NEUTRAL] Cause like, yeah, you don't want the headache of.
[CUSTOMER][POSITIVE] No, you guys have been lovely dealing with APL. It's now calling Memorial where I'm like.
[CUSTOMER][NEUTRAL] OK, OK, but uh.
[AGENT][NEUTRAL] So this was pro give me just a second while this is processed. OK, this was processed on 49.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Of 25. So that means if it was processed on 49 of 25, that was a
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That was a Wednesday and so tomorrow it would be a week that that was processed and should have been sent out and so let's see uh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, it was, it was being mailed from [PII] to [PII], so I feel like at this point they should maybe have something, you know, um, they should have received it, so.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, OK, I'll call them and see what's going on with that.
[AGENT][POSITIVE] All right, [PII], sounds good. I'm sorry about that. Is there anything else I can check on?
[CUSTOMER][POSITIVE] Thank you for your, no, listen, it's not your fault. You're, you're, you've been lovely. Thank you.
[AGENT][POSITIVE] You're very welcome. I hope you have a good day.
[CUSTOMER][POSITIVE] Thank you alright bye bye.
[AGENT][NEUTRAL] I