AccountId: 011433970860
ContactId: d72318b9-969b-4a4a-9342-fab2b56fdfce
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 336350 ms
Total Talk Time (AGENT): 168499 ms
Total Talk Time (CUSTOMER): 161212 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/d72318b9-969b-4a4a-9342-fab2b56fdfce_20250304T17:37_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm so sorry. I didn't catch your name. What did you say it was?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. Hi [PII]. My name is [PII]. I'm calling from AquaSure Insurance. We have, um, one of our groups on your gap plan. The group number is 19145. It's for Ferretti Group of America, and I just had one of their employees call me and I feel super bad for this poor gentleman. He thought he cut his finger badly. He thought he went to an urgent care, but he now owes $3500 between.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It must have been an out it was an outpatient hospital ER and not an urgent care. Um, he's very distraught that he owes 3500 for 5 stitches in his finger, and yeah, he does have your plan. Um, so I wanted to find out like how much it will cover and what he needs to do to file a claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, um, now he can, uh, create an online account, um, at [PII] and um he can file his claim online or um if he presented his uh Medlink card at the time of service, the provider normally.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know, submit some uh some providers just don't. It's not it's not required if they don't, but, um, he can certainly, um, file the claim online or um I can send you a claim form and he can mail it or fax, I believe fax it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you send me the claim form and I'll give him the options. He seems pretty computer savvy because he said he had um an online account with Cigna, so he probably has one with you. I don't think he submitted the card at the time of service because he thought he was at an urgent care, um, so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Two other questions I have then is um how much does it pay and so he has a bill for $3,034 from the hospital and then he has another invoice from the ER physician for around $500. Now does it pay the ER physician too or just the hospital?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I, I, I couldn't say for sure without, um,
[AGENT][NEUTRAL] You know, I, I, I'm not aware, you know what their policy pays. What I can do is I can get you over to our claims team and they can take a look at his policy and give you that, you know, kind of give you an idea of what would be paid, what benefits are payable, so, um, if you're interested in that.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Oh, that would be great.
[AGENT][NEUTRAL] Uh, but [PII], what's your email address so that I can send that claim form and then I can also send you, uh, like how to maneuver through our online service center, um, like if he does create an account and submit that claim online.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, thank you. Yes, that would be wonderful. I'll just, can I just forward it what you're gonna send me over to him? There there perfect. OK, so my email is [PII].
[AGENT][POSITIVE] Oh, most definitely, most definitely.
[AGENT][POSITIVE] For sure. Perfect. What I'll do is I'm gonna get you over to our claims team, um, and then in the meantime I'm gonna go ahead and send you that email. Uh, do you by chance have the insured's name so that I can give them a head start on looking up his information?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, that would be great. His name is [PII]. I do not have any ID for him. I might actually, hang on.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I've got it, his.
[CUSTOMER][NEUTRAL] I forget, are they navigate? Oh great, OK.
[AGENT][NEUTRAL] His plan number is 248-6566 so uh I'm gonna put you on a brief hold while I get you over to our claims team and they're gonna be able to talk to you about benefits.
[CUSTOMER][NEUTRAL] 248
[CUSTOMER][POSITIVE] OK, thanks so much.
[AGENT][POSITIVE] Oh, no problem. I hope you have a great day. Hold on for me.
[CUSTOMER][NEGATIVE] You too. You are on hold.
[CUSTOMER][NEUTRAL] Sing.
[CUSTOMER][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[AGENT][NEUTRAL] Hi [PII], this is [PII] and Burr Resources. How are you today?
[CUSTOMER][POSITIVE] I'm good, [PII] how are you?
[AGENT][NEUTRAL] I'm pretty good. I have got a broker's office online. Her name is [PII], and she's calling about a possible claim for one of their insureds. Um, she just has some questions on what's, you know, a pay, you know, what if, what benefits are payable. sorry, couldn't get that spit out fast enough. Um, and the policy that she's calling about is 248-6566 for [PII]. Would you be able to talk to [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm. [PII] don't have any claims on file.
[AGENT][NEUTRAL] Right, I said it's a possible claim. She just has some benefit questions before he files the claim.
[CUSTOMER][NEUTRAL] OK, so let me verify if we have permission to speak with.
[CUSTOMER][NEUTRAL] Bear with me, [PII].
[CUSTOMER][NEUTRAL] And you said her name was [PII]?
[AGENT][NEUTRAL] Yes, [PII], she is with Acerer. She's with the broker's office.
[CUSTOMER][NEUTRAL] OK. You can send her over. Did she verify his date of birth and everything?
[AGENT][NEUTRAL] Uh, she had his name and policy, so I've got that much.
[CUSTOMER][NEUTRAL] Alright, so you can send over.
[AGENT][POSITIVE] Thank you. You have a great day.
[CUSTOMER][POSITIVE] Thanks, you do the same.