AccountId: 011433970860
ContactId: ea6d7ed6-6d6d-4f9c-b453-6e237ffe3276
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 650659 ms
Total Talk Time (AGENT): 323422 ms
Total Talk Time (CUSTOMER): 246761 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/ea6d7ed6-6d6d-4f9c-b453-6e237ffe3276_20250115T16:09_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hi this is [PII]. Can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], how are you? My name's [PII]. Um, I'm calling. I have, uh, APL, um, and I was, um, wondering, I had a few questions about, um, a claim that was sent to you guys back in November, I believe.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I want to see how like what's the what's pending for that or where it's at.
[AGENT][NEUTRAL] Yeah, I can help you look at that Ms. [PII]. Do you mind if I get your policy number?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes, it's 15494.
[AGENT][NEUTRAL] 15494
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Unfortunately, I'm not showing an active policy under that number.
[CUSTOMER][NEUTRAL] OK, uh, what's the actual policy number like exactly because there's the group number?
[AGENT][NEUTRAL] Oh, OK, um.
[CUSTOMER][NEUTRAL] And there's a
[AGENT][NEUTRAL] You might say certificate or member ID.
[CUSTOMER][NEUTRAL] Oh, OK, there's an in hospital and outpatient one, so I'll give you whichever, right? OK, um.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah, the, the numbers are the same before the letters.
[CUSTOMER][NEUTRAL] Oh OK, yeah, 01936591.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then there's one that's ML 7.
[AGENT][POSITIVE] Perfect. Let me try pulling it up that way for you, my friend.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And would you be able to verify for me, pretty please, your last name and your date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and then first name [PII]. Date of birth [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And [PII].
[AGENT][NEUTRAL] And I do just need to uh verify additional information with you if you could verify for me your mailing address.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And then just two more things. One is that email address and one's the phone number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] My email address, I don't know if you guys have my, my personal or my work one. my first, my personal one is [PII] like my name and then [PII].
[AGENT][NEUTRAL] I'm pretty sure it's your personal.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Wonderful and then just have a phone number on file, my friend.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect, is that a good number to call you back if we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, that's my, yeah, that's my personal cell phone.
[AGENT][POSITIVE] Perfect. And then I do see that the last claim we received it was on behalf of yourself, correct?
[CUSTOMER][NEUTRAL] So for pediatrics.
[AGENT][NEUTRAL] Um, was it for one of your dependents, my friend?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, I'm so sorry. And which dependent did we want to look at?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's uh [PII] for my [PII].
[AGENT][NEUTRAL] For [PII].
[AGENT][NEUTRAL] All right. Um, so the only claim on file I actually see for [PII] was from Baptist Hospital in August. I'm not showing anything else on file for her.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Alright, because there's actually like a few claims that need to be submitted one one's gonna be submitted. It's from like envision. It's from a different.
[CUSTOMER][NEUTRAL] We're a different company, um, and then I got it from pediatrics, um, and they were supposed to be sending a plane back in like November actually.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, OK, and hold on, actually, this looks like [PII]'s on here twice, so let me take a peek at that second, and I don't know why it looks like maybe it was just an error. Um, OK, so I actually have one from [PII]'s. It was from [PII], and then another one from [PII]'s from October, so both of them.
[CUSTOMER][NEUTRAL] I don't know if it's under me. Would it be under me maybe?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] But it's still not the envision one.
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] Oh well they want from pediatrics too.
[CUSTOMER][NEUTRAL] It's called, you know.
[CUSTOMER][NEUTRAL] There's one that should be from pediatrics Medical Group.
[AGENT][NEUTRAL] Mm. Not on file with us. I'm sorry.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Weird because they're one game.
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] Would I have to call them?
[AGENT][NEUTRAL] Yeah, I would ask them to submit a claim with us because we don't have any of their claims on file, um, and.
[CUSTOMER][NEUTRAL] Would it be for me, though, would it be under under [PII]? Would it be a claim under for my name?
[AGENT][NEUTRAL] It's gonna be whoever had the um.
[AGENT][NEUTRAL] The work done so.
[CUSTOMER][NEUTRAL] Um, because this might
[CUSTOMER][NEUTRAL] Can you check if it's, I mean, because you have to bring the different profiles like it's mine and for my daughter as well.
[CUSTOMER][NEUTRAL] Could you check if it's under my name?
[AGENT][NEUTRAL] Yeah, were you the one who had the, was it like were you the patient like at the time that had the medical services?
[CUSTOMER][NEUTRAL] The claim?
[CUSTOMER][NEUTRAL] Yeah, I mean here doesn't give me like an actual date of when this when this uh.
[CUSTOMER][NEUTRAL] The short with me.
[AGENT][NEUTRAL] OK, yeah, if you were the one who received the services, it would be under your name.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm so sorry. I thought you said it was your daughter who had the service.
[CUSTOMER][NEUTRAL] Well, there's a few things that I wanted to check with you, um, with you guys.
[CUSTOMER][NEUTRAL] One's for me and then there's like 2 for her.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, absolutely, and then what is the company we want to look at um for for yours?
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yeah, it's, it would be this one, the pediatrics, it's with an X at the end, Medical group.
[AGENT][NEUTRAL] I don't have any claims on file from a pediatrics medical group.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEGATIVE] So weird.
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right and then.
[CUSTOMER][NEUTRAL] Another question that I have, well, there's another one that's gonna be under my name as well, and it's gonna be through Envision, but that I think was done like it was done like this morning, so they're not gonna yet.
[AGENT][NEUTRAL] OK, yeah. The last thing I have from you was back in October and it was from Kendall Anesthesia.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then I have a question because um.
[CUSTOMER][NEUTRAL] My daughter's getting something done with a company called Cranial Technologies and um the gap is not going through like for some reason the gap is not gonna work under that, but they told me to make to put a claim and call my gap insurance so would that be with you?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, absolutely you can place a claim with us on your own if you'd like um you're just going to, and I can email you the, the claim form so you have it, um, but you would just, uh, fill out the claim form and it's gonna have like directions for everything we need on our side, um, but you're gonna need an itemized bill that has the diagnosis code and the procedure codes as well as the.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] I'm sorry I'm getting that email put together for you real quick, um.
[AGENT][NEUTRAL] And then yeah you can submit the claim that way if you have used our online portal you can submit it through our online portal alternatively you can.
[AGENT][NEUTRAL] Um, fax it or mail it to us.
[CUSTOMER][NEUTRAL] OK, I'll do it through the online portal.
[AGENT][POSITIVE] Perfect. I'm gonna include a user guide on the online portal for you then um that way you can if you have any questions it will tell you step by step, um, all the functionality in there and then how to set it up.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And just attaching those files and I'll be able to have that sent to you my friend.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, as far as the claims go, if you submit the claim, what we do is we'll pay you, and if the provider submits the claim, we pay the provider. So you'll, um, you can also write up. I cannot talk. I'm so sorry. You can also set up um like direct deposit for claim payments.
[AGENT][NEUTRAL] Um, in that online portal as well so that way if you have benefits payable you don't have to wait for a check and wonder if it's coming in the mail, um, you can just have it set up to go directly to your direct deposit, but that's gonna also be in that user guide for you, OK?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Oh, OK, OK, perfect.
[AGENT][POSITIVE] All right. I have APL is the first part of that, so if you just need to search for APL in your inbox, you can, and I do have that coming your way right now. And then what else can I do for you today, my friend?
[CUSTOMER][POSITIVE] Perfect, perfect.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, that's all just, I really wanted to see if you guys, if you had that claim from pediatrics, but I guess, I guess not. I'm gonna have to give them a call.
[AGENT][NEUTRAL] Absolutely and worst case scenario, I don't recommend it. I really recommend like pushing the provider to submit the claim with us because they have all the paperwork right there in handy and usually when you're requesting it, it takes forever to get it um and to get the right things, um, but if you have to, you're always welcome to submit a claim with us as well.
[CUSTOMER][NEUTRAL] I don't know what's going on.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh OK, so it's best for the provider to do it, OK.
[AGENT][POSITIVE] I think it's easier. Some providers just won't. They like they won't file secondary insurances at all, um, and there's not much you can do, but if you can, if you can have them do it, I highly recommend it. They pay someone to do it, they know what they're looking for, um, and it's so much easier as on, on you, on, you know what I mean?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and I'm, I'm trying to make sure your life's easy. So I would recommend having them do it if you can, but if you really can't and they won't do it, don't lose out on the benefits, just submit a claim with us.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][POSITIVE] OK perfect perfect we'll do I'll call them again to see if they can just admit it themselves. Thank you for that advice.
[AGENT][POSITIVE] Perfect.
[AGENT][POSITIVE] Yes, it's my pleasure you have such a wonderful day and I wish you the best of luck with all of this.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Thank you so much. You too. Have a good one. bye-bye.
[AGENT][POSITIVE] My pleasure you too bye bye.