AccountId: 011433970860
ContactId: 0acb9125-0dff-44ae-b0e5-325ca8183084
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 581309 ms
Total Talk Time (AGENT): 285652 ms
Total Talk Time (CUSTOMER): 257339 ms
Interruptions: 10
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/0acb9125-0dff-44ae-b0e5-325ca8183084_20250429T12:49_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, how are you? I started a claim, um, a while back and I submitted more documents um my claim. It keeps saying my claim is done, um, but I'm not seeing any updates on my account, like when I log in.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I wanna know if they're reimbursing me for what I paid.
[AGENT][POSITIVE] OK, I'll be glad to help.
[AGENT][NEUTRAL] OK, go ahead, give me your name and your policy number please.
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] And your policy number, [PII]?
[CUSTOMER][NEUTRAL] And my
[CUSTOMER][NEUTRAL] My policy number, what would that be? What would that be? Is it the group number, payer ID?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Certificate number.
[CUSTOMER][NEUTRAL] Certificate number oh, from, from the from the claim.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, it's gonna say certificate number starts like with 0102 7 digit number, yeah.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] One second.
[AGENT][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] 0, no, I don't see. Oh wait, did I have in hospitals benefit and then outpatient benefit. I, I don't see which one.
[AGENT][POSITIVE] Outpatient, that's what I need. That's what I want. Mhm.
[CUSTOMER][POSITIVE] Outpatient perfect. 0215.
[CUSTOMER][NEUTRAL] 273 5
[CUSTOMER][NEUTRAL] M as in Mary, L as in Larry, A as in the number 8.
[AGENT][NEUTRAL] Alright, so yeah, thank you for all that information. Now while I'm pulling this up, go ahead and give me a good return telephone call number please ma'am.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alrighty, [PII], thank you for all that information. Now go ahead and verify your date of birth and address for me, please, ma'am.
[CUSTOMER][NEUTRAL] [PII]. My address is [PII].
[AGENT][NEUTRAL] Alrighty, thank you for all that information. Now give me a data service of a claim you're checking on.
[CUSTOMER][NEUTRAL] I think [PII] if I'm not mistaken, let me log into the APL and I'll tell you.
[AGENT][NEUTRAL] [PII]. Well, let's see.
[CUSTOMER][NEUTRAL] I'm pretty sure it's [PII] or [PII].
[AGENT][NEUTRAL] Well, I'll just be scanning your file while you're doing that. Let's see what I can find.
[CUSTOMER][NEUTRAL] So the way they charged it, the, um, I explained it to the people I spoke to a while back.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Wait, what is this American public? Why can't I find?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] I say [PII]. That is that probably it?
[CUSTOMER][NEUTRAL] Yeah, it's a $500.05 yeah.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] Is this the claim that you sent in or a provider's office?
[CUSTOMER][NEUTRAL] No, no, it's a claim that I sent and I filled out the claim form. I sent um supporting documents, cause the doctor's office, first of all, they closed down, and they're an outpatient facility, OK, where I did my um procedure, it was in an outpatient facility, but the way they billed it was an in-office visit.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] And it's not because it was done at an out at, at their outpatient facility. And it took me time to figure out why they charged me. Um, but then I found supporting records that they billed my insurance as outpatient procedure. So that, that was the whole.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Um, yeah.
[AGENT][NEUTRAL] Mm, yeah. And then this is not, it's not the [PII] because that was sent in by the doctor's office. So, let me keep looking.
[CUSTOMER][NEUTRAL] [PII], yeah, [PII] is the procedure.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] That is
[AGENT][NEUTRAL] Yeah, OK, let me get that pulled back up. OK, because I do have a claim in from my doctor's office. It's not something that you submitted, but I do see the claim, but yeah, I see that that they build they build in a what we call patient treatment office treatment which is not covered under your plan.
[CUSTOMER][NEUTRAL] Yeah, Doctor [PII].
[AGENT][NEUTRAL] It would have had to been done at a facility outpatient hospital.
[CUSTOMER][NEUTRAL] It was done at an outpatient facility.
[AGENT][NEUTRAL] Oh, OK, yeah, well then what they're gonna have to do in order for go ahead.
[CUSTOMER][NEUTRAL] If you see
[CUSTOMER][NEUTRAL] If you see the if you see the documents that I I submitted.
[CUSTOMER][NEUTRAL] It, they billed my, my first insurance as an outpatient facility.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I wonder why they billed us, huh. 00 my.
[CUSTOMER][NEUTRAL] And there the office closed down.
[CUSTOMER][NEUTRAL] Yeah, the, the office like while I was back and forth with them they're like, well, we're sorry we're closing down our office, um, it is what it is and I'm like, no, so when, so when I spoke to APL, it was a few months ago they said don't worry, as long as you find it took me time to find these documents and I uploaded them to show that they billed my first insurance as an outpatient so APL should be covering.
[AGENT][POSITIVE] Oh wow.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so let me go now because I'm not seeing anything we've received from you lately. How long ago did you send that?
[AGENT][NEUTRAL] and [PII].
[CUSTOMER][NEUTRAL] I would say 223 weeks ago.
[AGENT][NEUTRAL] Oh no, we should have already had it by now. Mm mm.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, because I'm just looking through your whole history.
[CUSTOMER][NEUTRAL] It's, it's in there.
[AGENT][NEUTRAL] OK, well I'm definitely not finding anything for that, but hang on, let me keep looking. My computer is so slow so bear with me, [PII]. Just give me just a little bit to.
[AGENT][NEUTRAL] Look some of this up for you. Let's see.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] I mean, I have it in front of me. I can email it to you. I.
[AGENT][NEUTRAL] What's the doctor's name?
[AGENT][NEUTRAL] No, ma'am, that's OK.
[CUSTOMER][NEUTRAL] Doctor [PII].
[AGENT][NEUTRAL] OK, I do see that we have received something. OK, this is over in review. That's why I can't find it. Yeah, OK, yes ma'am. That's where it's at, so it is over in review at the moment, [PII].
[CUSTOMER][MIXED] OK, but I just received a text yesterday.
[AGENT][NEUTRAL] So I'm sure that
[CUSTOMER][NEUTRAL] I, I received a text yesterday and today. Your claim is now complete.
[AGENT][NEUTRAL] Well, I, what I'm saying is for 85, could that possibly be it?
[AGENT][NEUTRAL] Because I see
[CUSTOMER][NEUTRAL] That's 8585 is when they um when they requested for my first insurance to get approved for the outpatient procedure, but the actual procedure happened on [PII].
[AGENT][NEUTRAL] Oh, OK, because we have it.
[AGENT][NEUTRAL] Yeah, because we have it keyed in as 85. That's, that's what it is. Yeah, because, um.
[AGENT][NEUTRAL] Yeah, it looks like we have requested some other information, but I do, uh, I'm gonna have to send this over to for reviewing our um medical review department but it looks like we may have the information we need, but I tell you what, Simone, um, if, if they get back with me and tell me that we need something else, can I call you back at this number [PII]? OK.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] Yeah, because it might take a day or two, because it looks like this is, yeah, all in some kind of review, so I'm not quite sure at what point they're at or if they're needing any information, but I'll tell you what, I will, uh, double check on this, but if I need to respond to you I can call you at this number, right?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, yes, so what is the text that I received that says your your claim is now complete with the claim number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me that claim number.
[CUSTOMER][NEUTRAL] 359.
[CUSTOMER][NEUTRAL] 4570.
[AGENT][NEUTRAL] 4570. Let me key that in. Let's see.
[AGENT][NEUTRAL] 23,594,570.
[AGENT][NEUTRAL] That's on a, that's on the data service 47 for an office visit that was denied, so that's a completely different claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Yeah, I don't, don't go with this at all, yeah.
[AGENT][NEUTRAL] Yeah, but, but let me do some checking like I said, yes ma'am and I will let you know what's going on, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, so you'll get back to me?
[CUSTOMER][POSITIVE] Thank you, I appreciate it. Listen, that's a lot of money that I paid them.
[AGENT][NEUTRAL] Oh, yes, ma'am. Yes.
[CUSTOMER][NEUTRAL] And being a teacher, I don't make that much.
[AGENT][POSITIVE] Ma'am, I definitely understand that.
[AGENT][POSITIVE] Yes, ma'am. I understand every time matters. Well, yes, ma'am, Miss [PII] then, and is that all that I can help answer for you today?
[CUSTOMER][POSITIVE] Thank you so much and.
[CUSTOMER][POSITIVE] Yes, I'll be waiting for your call. Thank you, love.
[AGENT][POSITIVE] OK. Well, yes, ma'am. You're so welcome and you have a great rest of your day, OK?
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, ma'am. Bye-bye.