AccountId: 011433970860
ContactId: cdc851d8-3adb-473a-976f-b08a5dc35b16
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 414750 ms
Total Talk Time (AGENT): 152291 ms
Total Talk Time (CUSTOMER): 233081 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/cdc851d8-3adb-473a-976f-b08a5dc35b16_20250107T19:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, this is [PII].
[CUSTOMER][NEUTRAL] And I had just got off the phone with one of your co-workers, and they told me to call back because I'm having
[CUSTOMER][NEUTRAL] Trouble down here, UNC Health, they're saying that
[CUSTOMER][NEUTRAL] This is they can't find this insurance in their system. So they told me to call you guys to see about what providers do y'all have far as emergency room and and visits and stuff because I'm at UNC Hospital.
[AGENT][NEUTRAL] OK, let me get your policy pulled up, Mr. [PII], and in case this call is disconnected, may I have your callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I have your policy number, please?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh let me get it back out of my wallet. It is.
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 567382
[AGENT][NEUTRAL] Thank you. And that was 02567382?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And can you please verify your mailing address?
[CUSTOMER][NEUTRAL] [PII]. Hello.
[AGENT][NEUTRAL] Can you also verify your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And for our records, can you verify your email address?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. I show you have a limited hospital indemnity plan. This coverage is not a major medical coverage, so you can choose any provider.
[CUSTOMER][NEGATIVE] OK, and see when they try to put this insurance in their system, nothing is coming up.
[CUSTOMER][POSITIVE] So I didn't been to the emergency room once, and I already got a bill for that and now they recommend to come see a hand specialist. So therefore, I'm fixing to get another bill. So we we it's not pulling up in their system.
[AGENT][NEUTRAL] OK, I'm not sure why it's not come up in their system. You gave them your policy number with us and all that information?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Yes, ma'am, and basically what they told me to do is they're not going to charge me today. They're gonna send me a bill and they told me to just forward it to you guys.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, that you can file a claim with us directly or they can file the claim with us as long as you're presenting them with our information, they should be able to file the claim on your behalf as well. But yeah, they can file the claim or either you can file the claim, either or.
[CUSTOMER][NEUTRAL] So then that way y'all can kind of.
[CUSTOMER][NEUTRAL] Yeah, well, I can be, yeah.
[CUSTOMER][NEGATIVE] Because I have my insurance card here, American Public Life, TRC staff and my name and everything on it and they done typed all this information in, but when they do, this insurance company is not showing in their system.
[AGENT][NEUTRAL] OK. Did you let them know this is not a major medical coverage?
[AGENT][NEUTRAL] So it will not come up as major medical. This is a limited hospital indemnity plan. It's not the same as major medical. So I don't know if they're keying in in their major medical system or, or not.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And see, it's got limited, it's got limited benefit medical plan on the card.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You can have them reach out to us directly.
[CUSTOMER][NEUTRAL] So I, I, I did not, I did not.
[AGENT][NEUTRAL] And we can let them know what coverage you currently have and the benefits under your coverage.
[CUSTOMER][NEUTRAL] Yeah, well, the, the hospital talked to your co-worker, but they couldn't resolve it. The issue, she, she, they was on the phone with each other.
[CUSTOMER][NEGATIVE] I mean, I'm, I'm at the doctor now because I have a [PII] appointment, and so I'm here at the doctor. So they didn't like I said, when I called your coworker about 10 minutes ago, and they, they talked on the phone and, and everything, but they could never find this insurance. I mean, I, I don't know what's going on, you know, I'm, I'm not an insurance person or a doctor, so I don't know what's going on with this. I know I'm being charged.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Every week for insurance, but it just seems to be I don't know why they can't find it in there. I don't, I don't know what's going on.
[AGENT][NEUTRAL] And you're there for an office visit?
[CUSTOMER][NEUTRAL] I'm here to get my hand checked out. Yes, ma'am, to see a hand specialist.
[AGENT][NEUTRAL] OK. So you do have coverage for services in the, in the physician's office, but yes, you can file the claim with us.
[AGENT][NEUTRAL] Directly.
[CUSTOMER][NEGATIVE] OK, but like I said, they, I guess once I get the bill, then I can file it because basically that's what I guess her manager or overseer told me, he came from out back and told me that it ain't that it's not covered, it's just ain't showing in their system. So he said the best way to do that was when I got the bill, just send it to you guys and you guys can reach out and figure it out on that end. I mean, I don't, I'm just going by what they told me.
[AGENT][NEUTRAL] OK. So yes, you can file the claim, but, but if you decide to file the claim, then we will need that the itemized billing and which includes the diagnosis code for what you are seen and treated for, and you can file that claim. You can file the claim on our online service center or you can mail it in or fax it in to us and, and then reimbursement will be payable to you directly if you file the claim.
[CUSTOMER][NEUTRAL] OK, and what's y'all's address right here, uh, submit claims to [PII], what's that [PII]?
[AGENT][NEUTRAL] Yes, that will be the claimant's mailing address, the [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, so y'all located in [PII].
[AGENT][NEUTRAL] That will be the claim's mailing address.
[CUSTOMER][NEUTRAL] OK, and where is this issue was located out of?
[AGENT][NEUTRAL] American public life.
[CUSTOMER][NEUTRAL] Is it in [PII]?
[AGENT][NEUTRAL] American public life is out of [PII].
[CUSTOMER][NEUTRAL] Yeah, is it in [PII]?
[CUSTOMER][NEUTRAL] [PII]. OK. All right. Well, I guess we'll figure it out once I get the bill. So I mean, that's that's all. I don't know what's going on. Like I said, and, and it's UNC Health is who I'm with, so you can document that in the notes and maybe one of you guys can reach out to them and let them know this is what they need to do, but I, I don't, my hands are tied. I don't know what to tell them what to do.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with today, Mr. [PII]?
[CUSTOMER][NEUTRAL] No, ma'am, so that's not something that you guys would do.
[AGENT][NEUTRAL] They will have to contact us. We wouldn't have your information to um provide to them. They'll have to contact us directly, the provider.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So y'all don't have my policy and and benefits and stuff. Is that what you? OK.
[AGENT][NEUTRAL] Yeah, we have your policy information, but I don't know, I don't, we would have the um number for the facility that you're currently at.
[CUSTOMER][NEUTRAL] They need is, is they.
[AGENT][NEUTRAL] We would need their contact information.
[CUSTOMER][NEUTRAL] I'm at UNC Health.
[CUSTOMER][POSITIVE] Oh, I can get it for you and well I, I'll give you all of the information y'all need and then when I call back.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, if you can provide them with that information, we can call and talk to them directly.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] OK, well, thanks for calling APL. You have a good day.