AccountId: 011433970860
ContactId: 0858aae5-47f8-4761-b465-f744cd92814b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 753979 ms
Total Talk Time (AGENT): 330980 ms
Total Talk Time (CUSTOMER): 338198 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/0858aae5-47f8-4761-b465-f744cd92814b_20250131T18:49_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Oh, I can barely hear you.
[AGENT][POSITIVE] I'm so sorry. Is that any better
[CUSTOMER][NEUTRAL] Oh, barely.
[AGENT][POSITIVE] No, I'm sorry about that.
[CUSTOMER][NEUTRAL] Let, let me see if this, hang on one second, let me see if this is better.
[CUSTOMER][NEUTRAL] Try that.
[AGENT][NEUTRAL] Any better?
[CUSTOMER][POSITIVE] Yes, that's better. That's better.
[AGENT][POSITIVE] OK, awesome. How can I help you today?
[CUSTOMER][NEUTRAL] Well, I am trying to help someone on a claim. I was the writing agent on her policy a number of years ago, cancer policy, and um she signed the form that I can call and help her with the information. So I was calling.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, we sent in a number of claims, gosh, week before last.
[CUSTOMER][NEUTRAL] And so I have the downloaded information in front of me, some of it. So I just wanted to see if you could help explain to me so I could explain to her.
[AGENT][NEUTRAL] OK, yeah, I can definitely take a look at those claims for you today. Um, do you have the policy number handy that we want to look at?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, let me go all the way back here.
[CUSTOMER][NEUTRAL] And I will find that. It is um 782-463.
[AGENT][NEUTRAL] 782-463
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Are you, are you gonna ask me for her birthday and all that too?
[AGENT][NEUTRAL] I will, but it doesn't look like this is the policy I'm wanting to pull up. So let me check something real fast.
[CUSTOMER][NEUTRAL] How about 728463. I, I think I reversed my numbers. 728.
[AGENT][NEUTRAL] 728. OK, let me try that one.
[AGENT][NEUTRAL] All right, that is the cancer policy. Yes, what is her, what's her name for for me?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] And what is your name, my friend?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, Ms. [PII], and I do see you was released to speak on her behalf. Um.
[CUSTOMER][NEUTRAL] And you know
[CUSTOMER][NEGATIVE] Yes, and now all of a sudden my computer has frozen up. Oh my gosh, let me.
[CUSTOMER][NEUTRAL] But go ahead.
[AGENT][NEUTRAL] No worries. Um, I do just need to go through the whole verification process with you still. Um, if you could verify the mailing address for me.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Well, let me go get her file. Hang on, I've got a file on let me just um.
[AGENT][POSITIVE] No worries. Take your time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hey, uh, for some reason I thought y'all closed at [PII] today.
[AGENT][NEUTRAL] No, we're open till [PII] every day of the week.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Oh my goodness. OK, let me see. You want all I think.
[CUSTOMER][POSITIVE] It has it all very good, yeah.
[CUSTOMER][NEUTRAL] OK, her address will be
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEGATIVE] We're gonna have to put down.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. And if you can,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm so sorry. Now everything on my side's loadings so um if you could uh verify for me, and if you don't have it, that's OK too, but the email on file and the phone number.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Phone number let me see where he is on this [PII].
[AGENT][POSITIVE] Perfect and.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so I do see.
[AGENT][NEUTRAL] Ms. [PII] here, it looks like she had a claim come in earlier this year, the [PII], and it looks like it was processed on the [PII] with benefits payable of $807.75.
[CUSTOMER][NEUTRAL] OK, hang on one second on that. I wanna go look at that, uh, let's see, um.
[CUSTOMER][NEUTRAL] It was we turned it in March. It was for March, I think y'all needed an EOB or something on it, is that correct?
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Hospital
[CUSTOMER][NEUTRAL] You said [PII].
[CUSTOMER][NEUTRAL] I think that was her initial.
[AGENT][NEUTRAL] Yes, I'm seeing the dates of service through [PII]. Looks like one in April.
[AGENT][NEUTRAL] Um, and let me look at this. They had to break it into two different sections, um, but I'm also seeing.
[AGENT][NEUTRAL] Stuff from [PII] on here as well.
[CUSTOMER][NEUTRAL] Yes, those are some things.
[AGENT][NEUTRAL] In October.
[CUSTOMER][NEUTRAL] I think that
[CUSTOMER][NEUTRAL] It seems like I uploaded about 11 things that she sent me not too long ago and I.
[CUSTOMER][NEUTRAL] Uh, let me see something real quick.
[CUSTOMER][NEUTRAL] OK, 328 24, was she just paid for that?
[AGENT][NEUTRAL] Um, OK, so let's take a look on these remarks real quick. Um, for particularly for the service date [PII], um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's like [PII].
[AGENT][NEUTRAL] So on that recent one they actually say that it's a duplicate of previously submitted expenses so let me go back and see.
[AGENT][NEUTRAL] What has happened in the past?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 24. OK, so it looks like those were submitted.
[CUSTOMER][NEUTRAL] OK, OK, so it looks like there was another.
[AGENT][NEUTRAL] November of last year as well.
[CUSTOMER][NEUTRAL] November of last year, OK.
[AGENT][NEUTRAL] Oh, and then they say on there that they're.
[AGENT][NEUTRAL] Duplicate, so let me go back again. We'll keep going back till we find the original, um.
[CUSTOMER][NEUTRAL] All of it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I do some surgery benefit. Let me see.
[CUSTOMER][NEUTRAL] Surgery
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Of like 486 20 and then.
[CUSTOMER][NEUTRAL] I see anesthesia. I'm 21, something other.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And then surgical facility.
[CUSTOMER][NEUTRAL] OK, that's most recent check.
[AGENT][NEUTRAL] So it looks like from [PII] that those were paid, they were originally submitted the first time in [PII], and they were both paid out then.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] They were or weren't?
[AGENT][NEUTRAL] They were. So the first one was for the outpatient, I believe that's surgical facility based on its coding for $200 and the next one was an anesthesia benefit for 4905.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So this was just paid.
[AGENT][NEUTRAL] So those were paid.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] Those ones
[CUSTOMER][NEUTRAL] Since 12
[CUSTOMER][NEUTRAL] 127 25 they completed.
[CUSTOMER][NEGATIVE] They received, I don't know what they received this.
[AGENT][NEUTRAL] So they received as a date like we received the documents on our side, um.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, I think the original we had filed all of this, and they needed, they paid some stuff, but they didn't have the stuff on the actual surgery, anesthesia and and facility.
[CUSTOMER][NEUTRAL] So I think they're just now, I think they're just now catching up with that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's what this is is that 807-75.
[CUSTOMER][NEUTRAL] But that pertains to March, correct?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, so what I'm seeing is there was a surgical benefit, an anesthesia benefit, and a facility benefit for [PII], and it was paid in August of last year.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, under a different claim, claim number 3490121. On the claim you're looking at, it shows it was denied as a duplicate. So it's saying that we had already paid out a claim for that expense and it was doubly submitted.
[CUSTOMER][NEUTRAL] Well, it shows
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Uh, let me see. Let me see if I can.
[CUSTOMER][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] But it says the amount paid 80775, so when was that paid?
[AGENT][NEUTRAL] So that was paid, but it was for other benefits on different service dates, so it was not for the date of service.
[AGENT][NEUTRAL] Um, here, let me make a note of.
[CUSTOMER][NEUTRAL] Are you sure? Because they've been waiting.
[CUSTOMER][NEUTRAL] For EOB on the actual facility.
[CUSTOMER][NEUTRAL] Since summer of last year we've been trying to get that to you guys and what I'm looking at.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] So what was paid was for December, was a surgical benefit, an anesthesia benefit, and an outpatient benefit for [PII], and those were the three benefits that were paid on this last claim on the [PII].
[CUSTOMER][NEUTRAL] We'll focus on them.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK I have.
[CUSTOMER][NEUTRAL] OK, even though it says data service 126 to 126, I don't know anything about [PII]. It says 12:06, 1206.
[AGENT][NEUTRAL] Oh, I'm sorry, [PII], I misread that, [PII].
[CUSTOMER][NEUTRAL] OK, 12 6.
[CUSTOMER][NEUTRAL] [PII]. OK. And I'm trying to go back to the
[CUSTOMER][NEUTRAL] The downloads
[CUSTOMER][NEGATIVE] I have a hard time doing this kind of filing because when I I was I was actually a.
[CUSTOMER][NEUTRAL] An insurance policy holder years ago and I'm into breast cancer.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And everything we did, I just got the bill with me and I mailed it in. So now that, now that y'all are downloading stuff, it's like, oh my gosh, it's really kind of confusing on my end.
[AGENT][POSITIVE] No, I think trying to go back and forth between like different documents and looking at all the different numbers, yes, absolutely.
[CUSTOMER][NEUTRAL] Trying to find
[CUSTOMER][NEUTRAL] Find it
[CUSTOMER][NEUTRAL] Yeah, OK, so.
[CUSTOMER][NEUTRAL] I'm try to open it up.
[CUSTOMER][NEUTRAL] OK, I got a bunch of EOBs here. Let's see.
[CUSTOMER][NEUTRAL] Claim number
[CUSTOMER][NEUTRAL] Well, and I guess maybe um.
[CUSTOMER][NEUTRAL] They received. I'm looking on here for the dates.
[CUSTOMER][NEGATIVE] I don't see anything from dates received.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] They're just all I uploaded a whole bunch of stuff. I want to say I thought in October.
[CUSTOMER][NEUTRAL] Or even November.
[AGENT][NEUTRAL] Yeah, I do see um a claim from [PII]. Um it was received [PII] and it was processed [PII], and that claim number would be the one that ends in 996.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yep, I see that. But I thought I had some for November that I uploaded.
[AGENT][NEUTRAL] Hm, I'm not showing any from November. I'm sorry.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] OK, and what is your name again?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] OK, well let me do some more research on my end and um maybe they didn't, maybe they didn't attach.
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] And then I'll, I'll call you back. Thank you so much.
[AGENT][NEUTRAL] And then, um, just so you have it, so you know the claim number I was looking at earlier where I was seeing the stuff paid out from March, um, that claim number I was looking at is the 3490121, and that's where I'm showing those March benefits paid for you.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] On what date?
[AGENT][NEUTRAL] Um, it looks like the, you mean the date of service or the date we received it?
[CUSTOMER][NEUTRAL] Date of service.
[AGENT][NEUTRAL] The date of service, that was the [PII] claim.
[CUSTOMER][NEUTRAL] And does it include hospital facility and surgery and all that?
[AGENT][NEUTRAL] It has the surgical, the anesthesia, and the outpatient facility and the imaging all included in that one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How much was that?
[AGENT][NEUTRAL] That payout was $595.25.
[CUSTOMER][MIXED] OK, but that was back in March, paid.
[AGENT][NEUTRAL] Yes, that was the March paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. All right.
[AGENT][POSITIVE] If you need help navigating through any of them, like, I'm here all day, I'm paid by the hour, just call back and let us know, and I'll do everything I can to help you out, OK?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sure. Thank you very much. I appreciate that. All right.
[AGENT][POSITIVE] Hey, it's my pleasure. You take care.
[CUSTOMER][NEUTRAL] OK. You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.