AccountId: 011433970860
ContactId: 0267d3f1-f234-4f4c-b72c-4419f884e423
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 489559 ms
Total Talk Time (AGENT): 303095 ms
Total Talk Time (CUSTOMER): 190811 ms
Interruptions: 11
Overall Sentiment: AGENT=0.2, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/0267d3f1-f234-4f4c-b72c-4419f884e423_20250519T20:44_UTC.wav
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[AGENT][NEUTRAL] Afternoon, thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hello, Miss [PII]. This is [PII]. How are you there?
[AGENT][POSITIVE] I'm good. I'm a sausage. How are you?
[CUSTOMER][NEUTRAL] I can imagine. I'm watching y'all's phones. You're not getting done with one before another one is ringing through. I'm like going, oh my gosh. Oh my gosh.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][MIXED] Uh, yeah, I can imagine. Yeah. I mean, yeah, OK. It, it's freaking me out even. Oh Lord have mercy. So, honey, it's not horrible, but it's, you know, she just like kinda to see why her baby's birth was not covered on the gap.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Oh boy, OK.
[CUSTOMER][MIXED] And you're ready, tell me, yeah, I know it's not horrible, but it's not a great one either.
[AGENT][NEUTRAL] OK, what is the policy number? Spanish.
[CUSTOMER][NEUTRAL] She is Spanish.
[CUSTOMER][NEUTRAL] OK, it is 246-5902. I'd say she's Spanish. I don't know one English accent from another when it comes to British and Australian, so I'm just assuming, OK.
[AGENT][POSITIVE] Yeah, I think you're right. The name, the name, the name is a giveaway, uh, yeah, yeah.
[CUSTOMER][POSITIVE] Yeah, the Geminis and the way she pronounced it with the H. Yeah, that kind of gave it away a little bit. But she's very sweet. She just wants to know why her baby's, you know, her delivery wasn't covered. So, and I did verify all of her information. It has been updated and corrected in the system.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, you know, she may not be getting anything because it was, you know,
[CUSTOMER][NEGATIVE] Didn't have the right address anymore.
[AGENT][NEUTRAL] OK, she is, she's the main holder, right? It's [PII]?
[CUSTOMER][NEUTRAL] Um, yes, [PII].
[AGENT][NEUTRAL] Did she say OK.
[AGENT][NEUTRAL] OK, let me pull this EOB just to be prepared. Give me just a minute.
[CUSTOMER][POSITIVE] You do what you got to do, honey. Catch your breath and do what you got to do.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right, let's see.
[CUSTOMER][NEUTRAL] I'm just sitting here watching y'all's calls.
[AGENT][NEUTRAL] Yeah, it's just, uh, it's like you get out and you just wanna sleep. OK, um.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Let me pull this one.
[AGENT][NEUTRAL] Mm mm.
[AGENT][NEGATIVE] Oh and then this on base is so slow.
[CUSTOMER][NEGATIVE] Everything's going slow today.
[AGENT][NEGATIVE] Yeah, it's not.
[CUSTOMER][POSITIVE] I'm surprised my lion has stayed up this time.
[CUSTOMER][NEGATIVE] My line screens won't even stay up.
[AGENT][NEUTRAL] Oh boy. Uh, yeah, it is, it's Monday. It's just even the computer knows it's Monday. It's like, uh, whatever, it's Monday. Leave me alone.
[CUSTOMER][NEUTRAL] For very long.
[CUSTOMER][POSITIVE] Yeah, yeah, that's it. That's right, girl. That's right.
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] OK, so, uh, alright, she probably just needs to send more information. OK dokey. I'm ready for Ms. [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Thank you, dear. Have a good day. Bye.
[AGENT][NEUTRAL] Yeah, you too. Bye bye bye.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Good afternoon. This is so on the care teams. Yes, Ms. [PII], I'm gonna go ahead and assist you with the information that you need from your policy about the claim. Hi, how are you?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yes, hi.
[CUSTOMER][POSITIVE] Good, thank you.
[AGENT][NEUTRAL] All right. So Miss [PII] was letting me know that you're calling because uh we did not pay for uh for the delivery of the baby. Is that correct?
[CUSTOMER][NEUTRAL] T.
[CUSTOMER][NEUTRAL] That's just the remaining balance that was left after my primary insurance over the rest.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Oh, OK. So, um, based on the claim that we recently received, um, which it was for date of service, let's see.
[CUSTOMER][NEUTRAL] What?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right. So based on the information they sent, it looks like um the explanation of benefits we received was probably sent too soon because it was not completed by the major medical. So there's nothing applied towards the deductible co-payment or co-insurance on this one.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So if you have an updated explanation of benefits from United Healthcare indicating the amount they apply towards the deductible co-payment of co-insurance, we just need a copy of that because on this one it's just indicating that they pay in full. So if you still have a balance there, you know.
[CUSTOMER][NEUTRAL] Yes, I have it. I have it that says that that there is a pending balance of $4000.
[AGENT][NEUTRAL] OK, so just go ahead and send us a copy of the explanation of benefits from the primary insurance so we can reprocess the claim with the correct DOB.
[CUSTOMER][POSITIVE] OK, perfect. And where, where extended?
[AGENT][NEUTRAL] Because
[AGENT][NEUTRAL] Um, you can send it by fax, you can send it by mail, or if you have registered online, you can upload it to your account. Which one would you like?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] It, it cannot be email, right?
[AGENT][NEUTRAL] No, we don't take claims by email.
[AGENT][NEUTRAL] For security.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Then, uh, I'll send it in through mail. How, how does, or fax, how does it work? Can I have both options and then I'll look it up?
[AGENT][NEUTRAL] Male
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. Well, the information should be on your card in the back of the card, um, but I can go ahead and give it to you. Um, the fax number is
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII] City, [PII]. And the zip code is [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Perfect. Do I need to do anything in particular? send anything, let everybody know anything?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Or just send it over.
[AGENT][NEUTRAL] Just send it over. You can go ahead and again you can also register online through our website at [PII] and send it electronic if you want to do that. Um, you just need to send the copy of the explanation of benefits. Now the claim that I'm looking at is for Mercy Hospital and the total charge on this one is 42,706. So the amount on the explanation of benefits needs to match this one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, again, the total charge is 42706. OK, so yes, if you have the copy, just send it to us and we just need a copy of the explanation of benefits and we'll reprocess the claim.
[CUSTOMER][NEUTRAL] Yes, that's the amount.
[CUSTOMER][NEUTRAL] It's 42.
[AGENT][NEUTRAL] 706 42706.
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEUTRAL] Let me, let me just confirm. 42706. Yes, that's exactly you know.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, is there anything else I may help you with today?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][NEUTRAL] All right, well, thank you for calling APL. Have a good afternoon. Oh yeah, go ahead. Mhm. OK.
[CUSTOMER][NEUTRAL] Once, I'm sorry, I'm sorry, yes, actually, yes. On that, once that's um, the insurance will cover the $4000 right?
[AGENT][NEUTRAL] I cannot guarantee any payments over the phone. We need to have the claim and we need to review the claim in order to determine um the benefit amount that you have under this policy, and this is not a guarantee of payment, just a verification of coverage. You have a maximum benefit of 4000 per year.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] OK. You're welcome and thank you for calling ATO. Have a good afternoon.
[CUSTOMER][POSITIVE] OK, bye, thank you.
[AGENT][POSITIVE] You're welcome