AccountId: 011433970860
ContactId: d10601a0-e5db-4cca-ac1d-f06da5dda0e3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 446540 ms
Total Talk Time (AGENT): 133576 ms
Total Talk Time (CUSTOMER): 203962 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/d10601a0-e5db-4cca-ac1d-f06da5dda0e3_20250428T20:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, I'm sorry you broke up. What was your name?
[AGENT][NEUTRAL] My name is [PII]. Um, it's spelled [PII] Last initial is [PII].
[CUSTOMER][NEUTRAL] If
[CUSTOMER][NEUTRAL] That's fine. That's fine. I don't need that. I just wanted to know how to address you. [PII] how are you? Uh, I'm an attorney. I'm representing a client, and, uh, she was, she, uh, sustained an injury and as a result she used her APL card and I'm trying to get the lien, uh, any lien amount if there is any.
[CUSTOMER][NEUTRAL] On the payouts for her, who can I speak to about getting that?
[AGENT][NEUTRAL] OK. Well, first, um, I'll need your name again and a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] OK my name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And that's [PII].
[CUSTOMER][NEUTRAL] My callback number? I'll give you my cell [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And now I need the policy number, please.
[CUSTOMER][NEUTRAL] Um, there's the payer ID or there is benefits certain number for in hospital or outpatient, which one would it be?
[AGENT][NEUTRAL] The outpatient cert number?
[CUSTOMER][NEUTRAL] The outpatient, OK, 02.
[CUSTOMER][NEUTRAL] 53.
[CUSTOMER][NEUTRAL] 805.
[CUSTOMER][NEUTRAL] 0
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] OK. Thank you. Now please verify her name and date of birth.
[CUSTOMER][NEUTRAL] It's [PII] and her date of birth, you're gonna have to give me one second. I have to pull that up.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Let me see if I have it on the dashboard.
[CUSTOMER][NEUTRAL] No, hold on.
[CUSTOMER][NEUTRAL] Hold on, let me just call her that that'll probably be faster.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh no, she didn't answer. Hold up. Oh, I think I have it here.
[CUSTOMER][NEUTRAL] Her date of birth is [PII].
[AGENT][NEUTRAL] OK. Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, I'm showing the effective date on this policy was [PII]. The policy is still active and actually this is a policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] See um for secondary gap insurance. What we do is cover the co-pay, the co-insurance, and the deductible after the primary insurance processes, um, medical claims for covered services. So what type of service is this for?
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] This was, uh, she used her APL card after she used her main uh medical insurance. Uh, my guess is to cover the copay, but I would, what, what she needs is the payout like anything you guys paid out and liens if if you have any liens on what you paid out.
[AGENT][NEUTRAL] OK, for claims, um, what date of service?
[AGENT][NEUTRAL] Are we looking at?
[CUSTOMER][NEUTRAL] Um, the injury happened on [PII].
[AGENT][NEUTRAL] OK. Yes, sir. I do show a claim for an ER visit. Um, and under this policy for outpatient services, we cover up to $250 per day. So I'm showing that this claim for the ER visit, um, it paid out for $250. It probably covered the co-pay.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, is there any other, is there any other payments that you made regarding that claim or just that?
[AGENT][NEUTRAL] It's just this one, this is the only one we have on file.
[CUSTOMER][NEUTRAL] OK, she also went to a specialist on February, let me see here.
[CUSTOMER][NEUTRAL] [PII], do you have anything on that day?
[AGENT][NEUTRAL] No, sir, we don't.
[CUSTOMER][NEUTRAL] No? OK, so is there any way I can get um just a summary of that?
[AGENT][NEUTRAL] Um, the explanation of benefits, I can fax it to you.
[CUSTOMER][NEUTRAL] Sure, can you email it instead or it has to be fax?
[AGENT][NEUTRAL] It has to be faxed.
[CUSTOMER][NEUTRAL] OK, that's fine. I'll take the fax. I just gotta remember what my fax number is now. Give me one second.
[AGENT][NEUTRAL] OK. Sure.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK, our fax number is [PII].
[CUSTOMER][NEUTRAL] 403.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And would I attention that to you?
[CUSTOMER][NEUTRAL] Do you have a um.
[CUSTOMER][NEUTRAL] Say that again.
[AGENT][NEUTRAL] Would I attention it to you, the facts?
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, to me that's fine.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the other thing was uh the liens if any.
[AGENT][NEUTRAL] Um, no, sir. I'm not showing any.
[CUSTOMER][NEUTRAL] Uh can you fax that to me as well?
[AGENT][NEUTRAL] But no lans?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, we wouldn't have a record of that. All we have is this explanation of benefits for the ER visit on [PII].
[CUSTOMER][NEUTRAL] OK, do you have a uh subrogation unit or recovery unit or anything like that?
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, yeah, this is just a medical policy for secondary gap insurance for medical claims only.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I get it. I just wanna I just wanna make sure that because if there's if there's a, if I make a recovery, I wanna make sure if you have a lien that you get the money you get, you get what I'm saying?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] Yeah, I don't wanna, I don't wanna, let's say the case settles tomorrow or today. I don't want to um take the money and not and not pay what's owed you, you, you get what I mean?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah, and all we have is this explanation of benefits. So you should receive it in about 10 minutes. I'm faxing it now.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you Evi, right? [PII]?
[AGENT][POSITIVE] Yes, sir. Yes, that's correct. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] No, that's it thank you you've been very helpful.
[AGENT][POSITIVE] OK. I thank you again, [PII] for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Mm, thank you.