AccountId: 011433970860
ContactId: e9de135c-7bf9-41a9-8c8c-14cfb25e24f5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 647460 ms
Total Talk Time (AGENT): 261901 ms
Total Talk Time (CUSTOMER): 321844 ms
Interruptions: 10
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/e9de135c-7bf9-41a9-8c8c-14cfb25e24f5_20250429T17:21_UTC.wav
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[CUSTOMER][NEUTRAL] You went the
[AGENT][POSITIVE] Hello, thanks for calling Shilo. This is, thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, how are you?
[AGENT][POSITIVE] I'm great, thanks for asking. How are you?
[CUSTOMER][NEGATIVE] I'm well, thank you. I have uh um gap insurance American Public Life, and I did pay $1000 for the procedure and my understanding that I, I can't get that money back. My boss is telling me like I can call and submit a claim, so I'm not sure how this works. This is my first time, uh, claiming, uh, something.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Can I have a callback number for you and your name and the policy number?
[CUSTOMER][NEUTRAL] [PII]. My name is [PII], and I have a group number. Is that uh what do you need?
[AGENT][NEUTRAL] It should say policy or certain number.
[CUSTOMER][NEUTRAL] No, it says group number and then I have in hospital benefits certificate.
[AGENT][NEUTRAL] Inpatient, outpatient er number, that's the number that's the policy number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. 01887403 M as in Mary, L as in Larry 7.
[AGENT][NEUTRAL] So I didn't hear what you said after the 40.
[CUSTOMER][NEUTRAL] 4033.
[CUSTOMER][NEUTRAL] M as in Mary. L as in Larry. 7.
[AGENT][NEUTRAL] Thank you. Could you verify your mailing address and your date of birth?
[CUSTOMER][NEUTRAL] [PII] and my date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] You said, what was your first, what is your full name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII] and [PII], what is the email address that we don't have one for you. Would you like to put an email address on file?
[CUSTOMER][NEUTRAL] Um, yeah, you can put [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So I have [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] All right, thank you. And what is a good call back number for you?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 232
[CUSTOMER][NEUTRAL] 0708.
[AGENT][POSITIVE] Thank you so for.
[AGENT][NEUTRAL] And you're calling in regards to a claim. Do you have that date of service that you're calling about to make sure that the provider did not submit the claim on your behalf?
[CUSTOMER][NEUTRAL] F
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Thank you. OK, so that you don't have, they haven't submitted it for you. So are you familiar?
[CUSTOMER][NEUTRAL] No, because I paid $1000.
[AGENT][NEUTRAL] Are you familiar with the online account, the AM public online account?
[CUSTOMER][NEGATIVE] No, this is my first time using it. I've never like uh.
[CUSTOMER][NEUTRAL] I thought that whatever the hospital doesn't pay gap pays automatically. I just found out like I've paid so many times but I didn't know that I have to call.
[AGENT][NEUTRAL] You have multiple claims on file.
[CUSTOMER][NEUTRAL] Yeah, but probably that's like the, the provider, they, uh, they didn't make me pay anything with here, uh, with Cleveland Clinic. They asked me to pay the $1000 so I guess they want me to claim it from, yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] OK, so what you would need is your.
[CUSTOMER][NEGATIVE] So no, I'm not.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] In order to submit a claim for us to process it and make a payment, you would need your itemized bill from the provider's office and your explanation of benefits from your primary insurance company.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For their date of service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And when I say an itemized bill, you would need the itemized bill listing the diagnosis codes.
[CUSTOMER][NEUTRAL] Let me write it down.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then you said oh I need the explanation of benefits.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes, from your primary insurance company.
[CUSTOMER][NEUTRAL] OK, and then do I mail it to you guys or?
[AGENT][NEUTRAL] Um, you can mail it to us or you can send it to us by fax or you can upload it. You can create an online account and upload it to your online account, whichever.
[AGENT][NEUTRAL] Per you prefer?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Do you need the fax number or do you have that information?
[CUSTOMER][NEUTRAL] And what it
[CUSTOMER][NEGATIVE] No, I don't like how do I like what is the website where I need to create an an account?
[AGENT][NEUTRAL] So the website is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I'll I'll look into it then.
[AGENT][NEUTRAL] Would you like that fax number?
[CUSTOMER][NEUTRAL] Uh, mm, yes, sure.
[AGENT][NEUTRAL] So the fax number would be [PII].
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] that's [PII] attention claims department.
[CUSTOMER][NEUTRAL] The gas will take care of all the.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] Alright, sounds good thank you.
[CUSTOMER][POSITIVE] No, thank you very much. You've been great.
[AGENT][NEUTRAL] And if you have any other claims for the year of [PII]?
[AGENT][NEUTRAL] Um, you may want to submit them because I don't we have some claims, but all of them is from [PII].
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] We, what about the
[CUSTOMER][NEUTRAL] What about the emergency room $250 deductible? Is that also covered by uh.
[CUSTOMER][NEUTRAL] Like the gap.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] For
[AGENT][NEUTRAL] So you have outpatient benefits of $1000 per calendar year and ER visits falls under your outpatient benefits and this is not a guarantee of benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] 15
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me make sure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so I think this $1000 that I paid will be enough because for that one procedure I paid $1000 in cash, yeah.
[AGENT][NEUTRAL] Yes I am.
[AGENT][NEUTRAL] And then I'm not sure like [PII], but I'm maybe butchering the name [PII], what, what's the member's name? I think this is one of your dependents.
[CUSTOMER][NEUTRAL] [PII] Mhm.
[AGENT][NEUTRAL] But it has [PII] in the front of it.
[CUSTOMER][NEUTRAL] No, there's not, uh, he's not on my policy anymore. I have only 4 [PII], and [PII]
[CUSTOMER][NEUTRAL] [PII] is not anymore. He's been taken off a while back.
[AGENT][NEUTRAL] Oh, well, I wanna know why he's still on there showing that he's active.
[CUSTOMER][NEGATIVE] No, he's not. He shouldn't be, he's not on my health.
[AGENT][NEUTRAL] So would you like to speak to someone in customer service so that they can be removed, so he could be removed?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] I'll have my boss fix it in the system like I'll but yeah he's not covered.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] All right then, is there any?
[CUSTOMER][NEGATIVE] Oh yeah you can you can put you can put me through the customer service, yeah, let me, let me remove him.
[AGENT][NEUTRAL] Alrighty, so hold one moment, OK? Let me see if I can get someone to assist you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hey, [PII], how are you doing?
[CUSTOMER][POSITIVE] I'm good how are you? Who have I got?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Oh hi, Ms. [PII] I'm good. um, how are you, dear?
[AGENT][POSITIVE] I'm good, Ms. [PII], thank you for asking, Ms. [PII].
[CUSTOMER][POSITIVE] Good dear what you got sorry.
[AGENT][NEUTRAL] I have a um insured on the phone. Her name is [PII]. She's calling about uh the well she was calling about her claims verify how to submit a claim, but then when I asked her about a member that's listed on the policy because she, I noticed that there was no claim submitted for the member, she said that this member was supposed to been removed be removed from the policy because the member is.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Actually, I don't know, I'm gonna let you look at the policy because it looks like several of them should be removed. 1887403 because of their age. It's 1887403.
[CUSTOMER][NEUTRAL] OK, what's that number dear?
[CUSTOMER][NEUTRAL] Alright, and then
[CUSTOMER][NEUTRAL] You would think our system would automatically kick them off, wouldn't you, but I guess I don't know if it knows how to or not. I'll be honest with you, I really don't know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So she said she wanted to speak to someone about it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But if you can.
[CUSTOMER][NEUTRAL] [PII]. OK. And then there's [PII].
[CUSTOMER][NEUTRAL] Oh man.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So [PII] and [PII] are the only ones who should be on there still, OK, yeah, it's not gonna change her premium in any, but yeah, I'll, I'll send an email to have them reviewed something about [PII] at one time remember was [PII], I think, and for I don't even know. I, I don't even know used to be up to the age of [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] For [PII] I will have somebody review it and see what's going on with that and we'll go from there.
[AGENT][NEUTRAL] All right. Well, thank you, Ms. [PII]. Mm, she hung up. Look like she hung up.
[CUSTOMER][POSITIVE] You'll just put her on through. Thank you, dear. Have a good day. OK.
[CUSTOMER][NEUTRAL] Alright, well, I will, I will send an email to [PII] and uh I mean I'll, I am [PII] to look at the look at it when she gets a chance or email or whatever.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] All right, thank you, Ms. [PII]. Have a good day.
[CUSTOMER][POSITIVE] [PII], [PII] over here. OK, thank you, dear. You too, bye.
[AGENT][POSITIVE] Thanks. Goodbye.