AccountId: 011433970860
ContactId: ff418dbe-a07e-452b-9bdd-e598ec6bf41e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 347230 ms
Total Talk Time (AGENT): 122558 ms
Total Talk Time (CUSTOMER): 117885 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/ff418dbe-a07e-452b-9bdd-e598ec6bf41e_20250610T18:04_UTC.wav
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[AGENT][NEUTRAL] For calling ATM. My name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. Good afternoon. My name is [PII]. How are you doing?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][NEGATIVE] Good. I was calling because um I'm having an issue. I have a medical bill for my son that keeps coming back and I'm not sure what's going on with it.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I see my insurance paid out already, but um I know I have the gap insurance. I'm not sure what they're supposed to pay out.
[AGENT][POSITIVE] OK, I'd be happy to assist with your claim. Um, if I can get a good callback number for you.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] It is hold on give me one second.
[CUSTOMER][NEUTRAL] Uh, I have the, would that be the certification number, the group number?
[AGENT][NEUTRAL] Yes, certification number.
[CUSTOMER][NEUTRAL] The 01719341.
[CUSTOMER][NEUTRAL] M
[CUSTOMER][NEUTRAL] As in Mary, L as in Larry, and 7.
[AGENT][NEUTRAL] And if you can please verify your.
[AGENT][NEUTRAL] Date of birth and mailing address?
[CUSTOMER][NEUTRAL] Yeah, is it OK if it's under my husband's um information?
[AGENT][NEUTRAL] Yes, since I'm talking to you, I need your information.
[CUSTOMER][NEUTRAL] Does it matter?
[CUSTOMER][NEUTRAL] OK. It's [PII].
[CUSTOMER][NEUTRAL] And my mailing address is [PII].
[AGENT][NEUTRAL] And what is the dependent's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII], it's [PII].
[AGENT][NEUTRAL] Thank you for that information and what's the date of service for the claim?
[CUSTOMER][NEUTRAL] Uh, they have [PII].
[AGENT][NEUTRAL] OK, they submitted the claim and.
[AGENT][NEGATIVE] We denied it we needed the um explanation of benefits from the primary and they never sent it.
[CUSTOMER][NEUTRAL] It's from the primary? What primary? His primary doctor?
[AGENT][NEUTRAL] The this is a facility claim, so.
[AGENT][NEUTRAL] They submitted the claim.
[CUSTOMER][NEUTRAL] Yeah, he was in the hospital.
[AGENT][NEUTRAL] Right, so the hospital submitted the claim and we told them, hey, we need the explanation of benefits from the primary so we can finish processing the claim, and they never sent it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Mm, OK, but this was the same problem I had because I called previously.
[CUSTOMER][NEUTRAL] Oh, with um.
[CUSTOMER][NEUTRAL] So I'm not sure what I should do, how should I explain it? Maybe I'm wording it wrong when I'm talking to them, cause I talked to them back in April about this.
[AGENT][NEUTRAL] Well, call, call your, who's your insurance?
[CUSTOMER][NEUTRAL] No, my insurance paid out though, they paid out 22577.
[AGENT][NEUTRAL] I'm asking
[AGENT][NEUTRAL] Can you please tell me who your insurance is?
[CUSTOMER][NEUTRAL] Cigna.
[AGENT][NEUTRAL] OK, call Cigna and say, can you please send me the explanation of benefits for [PII] for [PII].
[AGENT][NEUTRAL] They'll send it to you or they'll tell you how you can get it uh you may be able to just sign into the signal website and get it, but they'll tell you how to get a copy of that and then you can just submit it yourself so that the bill can get paid.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because it's been over a year and they're not gonna wanna file because they're gonna think that it's too late for them to file but we don't have a timely filing limit so they can still file the claim they probably just don't know it and so that's probably why they're not sending it.
[AGENT][NEUTRAL] To us, so it may be faster if you just send us the explanation of benefits so the claim can get processed.
[CUSTOMER][NEUTRAL] OK, do you have a fax or email I could send it to?
[AGENT][NEUTRAL] Yes, I'll give you the fax number. Let me know when you're ready.
[CUSTOMER][NEUTRAL] Yeah, go ahead.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] 3.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And do I have to put anything like uh reference to or?
[AGENT][NEUTRAL] Let me give you the claim number so you can um just put the they'll know that it's for this claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that claim number is 341.
[AGENT][NEUTRAL] 9311.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, sounds good.
[AGENT][NEUTRAL] OK, was there anything else I can assist with today?
[CUSTOMER][POSITIVE] No, that's it. Thank you.
[AGENT][POSITIVE] Thank you for calling APO you have a good day.
[CUSTOMER][NEUTRAL] You too.