AccountId: 011433970860
ContactId: e5a6220f-866e-41db-a25a-6bf08364eebd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 464679 ms
Total Talk Time (AGENT): 249485 ms
Total Talk Time (CUSTOMER): 130775 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/e5a6220f-866e-41db-a25a-6bf08364eebd_20250311T19:09_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Um, I was in the hospital, um, last year, and I received a statement from the hospital for payment. I called them and I tried to give them APL information, um, but they said you guys need to contact them.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I cannot give them the information, yeah.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Oh man, I'm sorry, that's again. Alright, well, um, let's get your policy pulled up. We don't typically reach out to providers. Um, however, if you need to, um, we can, you can absolutely file the claims yourself. So let's first just double check to see if we did receive anything from them just for good measure. Uh, what was your name? I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII] and the last name is [PII]. That's [PII]
[AGENT][NEUTRAL] OK, thank you and then [PII], can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] OK, and then do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, I do. It's 2,454,910.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, got it thank you one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right. And I'm just gonna verify some information really quick. Can I get your date of birth, please?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. Um, I was gonna ask for the email address we have. It does look like it's uh [PII]. I don't know if you would know what that is.
[AGENT][NEUTRAL] Looks like it might be through his employer.
[CUSTOMER][NEUTRAL] Yeah, that's, um, I can give you, it's [PII] [PII].
[AGENT][NEUTRAL] OK, we've got a different one. We've got one [PII] [PII], but that's OK. um, OK, so this claim was this for you or was this for him?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's for me.
[AGENT][NEUTRAL] It is OK um do you have that date of service?
[CUSTOMER][NEUTRAL] Um, yeah, let me just look at the statement here. It's, uh, oh, no, that's the statement date.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, hold on, let me see if they put it on another page here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I believe.
[CUSTOMER][NEUTRAL] It was [PII] of last year.
[AGENT][NEUTRAL] [PII]. OK, thank you. One moment, let's see, just to check if we received that.
[AGENT][NEUTRAL] Well, I've got a few, um, [PII] and [PII], um, do you happen to have that amount, the charged amount?
[CUSTOMER][NEUTRAL] The charged amount I believe was $12,540.48.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it was Welling Wellington Regional Medical Centre.
[AGENT][NEUTRAL] OK, all right, bear with me just a moment because I do see quite a few claims now I don't know if that's before or after your major medical paid. I'm guessing that's before, so I'm not sure if that's the amount they would have sent us so just bear with me a moment, let me see if I see any just from that provider.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Bear with me just a moment, I appreciate your patience.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so no we have not received anything from them all right, so again we don't reach out to providers um I'm sorry they're being difficult, but um if they're willing to, which they should, um, you can absolutely file this claim yourself um well let me know when you're ready and I'll tell you the information that we need that you can get from them.
[CUSTOMER][NEUTRAL] Um, hold on, I just had surgery on my right wrist, so I'm a little.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Oh gosh, I'm sorry and I'm gonna have to make you right I'm sorry.
[CUSTOMER][NEUTRAL] It's OK. Hold on. No, it's fine. Hold on.
[AGENT][NEUTRAL] Sure, you're fine.
[CUSTOMER][NEUTRAL] OK, what do you need?
[AGENT][NEUTRAL] So we need the item statement.
[CUSTOMER][NEUTRAL] Item statements.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] The I my statement that shows diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then we need the explanation of benefits from your primary insurance.
[AGENT][NEUTRAL] And you the provider, I'm sorry.
[CUSTOMER][POSITIVE] Oh my gosh, this is
[CUSTOMER][NEUTRAL] This is, this is a lot.
[AGENT][NEUTRAL] It is very confusing um that's why of course it's so much easier generally when they can do it for you um but they will have all of this information so if you just ask for that um and they can send it to you um do you have access to a desktop or a laptop computer, [PII]?
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] OK, so the reason I ask generally the quickest and easiest way to get claim information to us is going to be through our online portal and um I can give you that web address if you like or I can email it to you.
[CUSTOMER][NEUTRAL] Oh, if you can email it, it would be easier for me, please.
[AGENT][NEUTRAL] Sure, yes, um, so I'll include that link and then I'll go ahead and include that information that we need as well, uh, just so you've got it all in one place um I will say when you go to create an account, the information you enter does have to match what we have in our system um so it does have to be that email which let me verify what that was again.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It does look like that's through [PII]'s employer, so [PII], yes, and then there will be a spot where it asks for um a member ID or a social security number, uh, and you're going to enter it would be his social security number.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Work, yes, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. All right, got it.
[AGENT][NEUTRAL] Alright, I know that was information overload. I apologize you have to deal with this. um, did you have any questions for me right now?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, I do not. Thank you very much.
[AGENT][NEUTRAL] OK, sure, now, um, did you want the email that I send this link to um was there a different email you wanted me to send that to?
[CUSTOMER][NEUTRAL] No, that's fine. I'll get off his work email.
[AGENT][NEUTRAL] OK, OK, I'll go ahead and just send it there then right and if you have any other questions or need any assistance, don't hesitate to give us a call back. It is very confusing.
[CUSTOMER][POSITIVE] All right. Thank you very much. I appreciate that.
[AGENT][POSITIVE] You are very welcome, of course I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You too. Thank you. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.