AccountId: 011433970860
ContactId: f54d2ee5-2732-4a30-b81a-01b8475b2f97
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 727059 ms
Total Talk Time (AGENT): 321147 ms
Total Talk Time (CUSTOMER): 326424 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/f54d2ee5-2732-4a30-b81a-01b8475b2f97_20250221T17:07_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I am calling from Cruise Planners. We're one of your customers, and I needed some assistance. I have a team member that has gap insurance and she cannot locate her card. Does she need to, uh, have card in hand in order to.
[CUSTOMER][NEUTRAL] Submit a claim or present it to a physician she's not been able to do that she's dealing with a health issue and it's going to be um ongoing for a bit and she knows she has gap. I know she has it but she hasn't been able to do anything in terms of submitting a claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Walk me through what that looks like for her.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am. OK, Mr. [PII], I can help you with um the gap insurance questions. First, can I get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Sure [PII].
[AGENT][NEUTRAL] OK. And then, um, what is the insured's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Name is [PII].
[CUSTOMER][NEUTRAL] Last name is [PII]
[CUSTOMER][NEUTRAL] And let me get to her pertinent info here.
[CUSTOMER][NEUTRAL] OK, you said you needed our personal info, so you need date of date of birth [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then also her policy number.
[CUSTOMER][NEUTRAL] I do not have that because I do not hold on let me go in here and get it. I can get if you need to, I can go in I guess and get it from the invoice that should be on there, right?
[AGENT][NEUTRAL] OK, yes, ma'am. And you're um you're with the group, Ms. [PII]?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] Yeah I am um everything comes to me for the group.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is your
[AGENT][NEUTRAL] Yes. What is your, um, group number, please?
[CUSTOMER][NEUTRAL] OK, give me one sec, let me just get to this. I wanna get to.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] Policy group number 15821.
[CUSTOMER][NEUTRAL] And waiting for it to load my invoice so I can give you her invoice her policy number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Who [PII].
[CUSTOMER][NEUTRAL] [PII] EE number. I'm guessing that's her EE number or policy number here we go, 234.
[CUSTOMER][NEUTRAL] 2969.
[AGENT][POSITIVE] OK, thank you so much for that information. And um can you please verify the address of the group?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much. I appreciate you verifying that information for me. Now let me pull in the insured.
[AGENT][NEUTRAL] OK, I do show her policy um as active. I can, let's see.
[AGENT][NEUTRAL] About
[AGENT][NEUTRAL] OK, so if I were to order her a new card, it would go directly to the group.
[AGENT][NEUTRAL] It's the way that it's set up.
[CUSTOMER][NEUTRAL] So we come to the office that's fine yeah that's fine. I'll get it to her.
[AGENT][POSITIVE] Yes ma'am. OK, yes ma'am, I can do that, order her a new card and then um.
[AGENT][NEUTRAL] As far as being able to file her claim, she doesn't have to have a card, she just really needs her policy number and she can do it several different ways we have the online service center where she can do it electronically if she wants to or when she visits the facility.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, if she gives them her primary insurance card and this as the secondary, the facility can call and verify her benefits and um.
[AGENT][NEUTRAL] We offer them to be able to send electronically through fax or even mail in the claim if they if they would do that and they can also use the online service center but it would have to be after they have filed one claim with us so that their patient account number will match our patient account number.
[CUSTOMER][NEUTRAL] The only problem is, is this, so if she doesn't have the card, then she's gonna give them just her policy number. Will they take just her policy number to do what is in other words, here's the thing, she's, she's going through a lot right now. She's fighting cancer, so she's going through a lot. It's, it's.
[AGENT][POSITIVE] Oh blessed. Yeah.
[CUSTOMER][NEUTRAL] And so she's got a lot going on and she's like, [PII], I, I because I told her I said, you know, we need to talk about your FMLA. We need to talk about short term disability. Let's talk about all that. And I said, [PII], you know, forget you have gaps. She goes, yeah, but I can't find the card. Can I still use it? I'm like, yeah.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I will call them and find out what it is we need to do. So my question is this she walks in and it's not, she's not the only one you walk in and you say I have a gap insurance you have a gap plan gap insurance. A lot of these places, they won't even take the card from you. They're like, nope, you've got to file that claim separately. I don't, I wanna make it as easy for her as possible. How do I do that without the card in hand? Does she contact Gap and give them her her policy? What does she need to do?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it's all up to the individual facility on how they process the claim. If she doesn't have her card yet, which I'm ordering for her, she can walk in with her policy number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me give you the group number. She'll need the group number, the 15821.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She'll also need her effect
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The day service which is June.
[CUSTOMER][NEUTRAL] Effective date. Oh, you're breaking up. OK, effective date which is uh huh.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that the policy is paid current.
[CUSTOMER][NEUTRAL] OK, so our policy.
[AGENT][NEUTRAL] And it's still active.
[CUSTOMER][NEUTRAL] Current and active OK.
[CUSTOMER][NEUTRAL] Alright, so she will, what is the, is there a phone number that they need to call? What will they do? How will they?
[AGENT][NEUTRAL] If they
[AGENT][NEUTRAL] Right. If they need to.
[CUSTOMER][NEUTRAL] Verify her yeah.
[AGENT][NEUTRAL] If they need to verify her benefits, they can call the same number you called and we can verify the benefits over the phone for them.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Excellent.
[CUSTOMER][NEUTRAL] OK, and that number again was customer service [PII]. I'm just writing everything down so I can share that with her an email [PII] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Monday to Friday you are Central time OK [PII] central, OK.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Alright, so she will need to give them her policy number, the effective date is current and active, the group number, and they just need to call this number to verify um her coverage, OK.
[AGENT][NEUTRAL] Yes ma'am, yes ma'am, and that should be all she needs until she gets her card and then you know of course she can hand them the card.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And all that information will be on the card.
[CUSTOMER][NEUTRAL] OK, so now
[CUSTOMER][NEUTRAL] So will she be the one to fill out paperwork for the claim or will whoever the provider is be the one to do that?
[AGENT][NEUTRAL] If the provider will file the claim for her that would be awesome that way she wouldn't have to worry about it if the provider does not file the claim for her, then she can file through the online service center.
[CUSTOMER][NEUTRAL] The sales
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] She can file it there or if she wanted to submit a paper file she can go to our website and get the claim form.
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEUTRAL] And that's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] that is the site that she would go to to either do it electronically or to print a form, correct?
[AGENT][NEUTRAL] That is to get the form. Um let me give you the site to for the online service center that is secured S C C U R E D.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] and that's where she would sign up for the online service center.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] When she goes to the website if she chooses to do it by mail.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, once she gets to that website, that first page of the Medli claim form gives her, uh, it's cheat sheet. It gives her everything that she needs to send in with her claim, which is the explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the itemized statement from the facility.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me give you the claim's mailing address.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's APL claims.
[AGENT][NEUTRAL] And that's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then the zip code is [PII].
[CUSTOMER][NEUTRAL] APL.
[CUSTOMER][POSITIVE] Just OK, just read that back to me let me make sure I didn't miss anything.
[AGENT][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect, OK.
[AGENT][NEUTRAL] If the facility decides to file the claim for her if they will be kind enough to do that um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] They're going to need our payer ID number and let me give that to you.
[CUSTOMER][NEUTRAL] Ok, hold on, uh, da da da da da OK payer.
[AGENT][NEUTRAL] It's
[CUSTOMER][NEUTRAL] ID number OK.
[AGENT][NEUTRAL] It's 60801.
[CUSTOMER][NEUTRAL] 60801 and that's the payer ID number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] If provider will file provider.
[AGENT][NEUTRAL] Right, they could file electronic.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Ironically that way
[CUSTOMER][NEUTRAL] Claim OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] I think that is everything in a nutshell and I'm gonna order her a new card and of course you know they'll come to the office there so you can give it to her.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] All right awesome and I'll keep an eye out for that thank you so much I appreciate your help.
[AGENT][NEUTRAL] OK, you're very.
[AGENT][POSITIVE] Very, very welcome, Ms. [PII]. I hope you guys have a great weekend and thanks for calling APL.
[CUSTOMER][NEUTRAL] You as well alright bye bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.