AccountId: 011433970860
ContactId: f26da382-4516-41a2-99c2-4b1ef04f6ff1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 264640 ms
Total Talk Time (AGENT): 90684 ms
Total Talk Time (CUSTOMER): 162466 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/f26da382-4516-41a2-99c2-4b1ef04f6ff1_20250131T14:53_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling PL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, hi, so, my name is [PII]. Um, can I give you either the policy number or claim number for you to review with me?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Sure, let me have the policy number.
[CUSTOMER][NEUTRAL] OK, 01769883.
[AGENT][POSITIVE] Thank you and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, yeah, because my connection here is not too good. [PII].
[AGENT][POSITIVE] Perfect, thank you.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK. And may I have your date of birth, mailing address and email address for verification?
[CUSTOMER][NEUTRAL] OK, date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And my email is [PII].
[AGENT][NEUTRAL] OK, and what's the mailing address?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, Miss [PII], and how may I assist you today?
[CUSTOMER][NEUTRAL] OK, so every year I would get my, I mean, I would get my um mammogram done and then I, uh, I was also, I also needed to do an ultrasound. So my insurance will pay the mammogram and a public, an American public would cover the ultrasound. So they were a little behind on billing. I don't know when I went in for my mammogram on the [PII], they had not billed [PII] yet, and I guess they saw it in the system and billed it and APL paid it.
[CUSTOMER][NEUTRAL] But now they've been billing for the one for date of [PII] and it, it gets rejected so now they're asking me to pay for it but I was covered at that time.
[CUSTOMER][NEUTRAL] With APL as well.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] And they covered the the years prior to that, so I don't know why I don't know that they're billing it wrong.
[AGENT][NEUTRAL] Yeah, let's see.
[AGENT][NEUTRAL] Let me pull this information and see exactly what's going on, OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you know how much is it for?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] All I have in my hand is.
[CUSTOMER][NEUTRAL] It's not a bill. Let me see how much I think they.
[CUSTOMER][NEUTRAL] I think so. I don't know. I think they built 500. I don't have it in front of me, but um, I know the year before APL pay 3 something.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] On it
[AGENT][NEUTRAL] Let me check this code really quick just to make sure this is one moment.
[CUSTOMER][NEUTRAL] The one I have in my hand for APL is for claim claim number 3554245.
[AGENT][NEUTRAL] Yeah, yeah, we're just needing the explanation of benefits from the primary insurance to continue the processing of this claim, uh, they send us an incomplete claim.
[CUSTOMER][NEUTRAL] Oh, that's what it is? They're not an incomplete claim.
[AGENT][POSITIVE] Yes. Mhm. Yes, yes.
[CUSTOMER][NEGATIVE] Alright, because they're calling me and asking me for payment and I said why would I pay you? I was covered with my insurance because now I'm no longer with that insurance because I'm on Medicare, um, but when I had my service done, I was still on my company's insurance and APL was my gap, um, and, and they paid it previously, so it's that they're not doing something right. They're not saying sending in what the full claim, the full.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm. Yeah.
[AGENT][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] Yes, yeah, we need um the explanation of benefits from the primary insurance um to process the claim. So they sent us the claim but we did not get the copy of the explanation of benefits. So that's what we're waiting for.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Got it. OK, good. I'm glad I called you so I can call them and make sure that they know what they need to do. All right, thank you so much. I appreciate your help.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You're welcome. Is there anything else I may help you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, so even though, uh, one more question, even though I'm no longer on that insurance, but at the time of service I was, so it shouldn't be a problem, right? OK, great. OK, thank you. Have a great weekend.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct. Correct, yes. Mhm.
[AGENT][POSITIVE] You're welcome. You as well, Ms. [PII], and thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.
[CUSTOMER][POSITIVE] Bye bye thank you bye.
[AGENT][POSITIVE] You're welcome.