AccountId: 011433970860
ContactId: 19fabd20-246b-41d9-9e07-7b670027309b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 903940 ms
Total Talk Time (AGENT): 332018 ms
Total Talk Time (CUSTOMER): 362116 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/19fabd20-246b-41d9-9e07-7b670027309b_20250109T15:24_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] in customer services. How are you?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][POSITIVE] I'm good. Um, I have an insured.
[CUSTOMER][NEUTRAL] Daughter on the phone.
[CUSTOMER][NEUTRAL] And I've got permission to speak to her because she does not speak English.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] She's calling with help on uh some client bills.
[AGENT][NEUTRAL] OK, what's that policy number?
[CUSTOMER][NEUTRAL] 2507462
[AGENT][NEUTRAL] OK, um, good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what's the daughter's name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yeah, I'll just call her ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Uh, give me just a second, let me get this pulled up.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] And it's for part one.
[CUSTOMER][NEUTRAL] Yes, uh-huh, and I
[CUSTOMER][NEUTRAL] Um, all she can speak in English is yes and no, and she said yes to speak to her daughter.
[CUSTOMER][NEUTRAL] And I did verify all the other information, uh, she gave me her, her email and I didn't change it because it was the daughter's email.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that's fine you can put them through.
[CUSTOMER][POSITIVE] All right, thank you, and here she is.
[AGENT][POSITIVE] OK, thanks.
[AGENT][NEUTRAL] Ma'am.
[CUSTOMER][NEUTRAL] Yes, hello.
[AGENT][NEUTRAL] Hey this is [PII] in the claims department. How are you?
[CUSTOMER][POSITIVE] I'm good good are you?
[AGENT][NEUTRAL] I'm good. I understand you have questions regarding a claim.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, do you have the data service? I understand it's for your mother, correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, do you know the data services?
[CUSTOMER][NEUTRAL] I have a date of service.
[CUSTOMER][NEUTRAL] Yes, ma'am. It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it, it looks like we have several claims on file.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For that same data service.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so you wanna go over all of them?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, I need to file all the uh all of them, yes.
[AGENT][NEUTRAL] OK, so you're wanting to review all the claim denials?
[CUSTOMER][NEUTRAL] Uh, can you tell me again, please? So, uh, she gets a lots of services that they, they, some of is already, uh, sort out and some is, um, uh, leftover. So can you
[CUSTOMER][NEUTRAL] Tell me again, please, which one is not done yet.
[AGENT][NEUTRAL] OK, um, I guess I'm a little confused.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] It looks like the claims I'm sorry, it looks like the claims have already been filed by the provider's office and they've already been processed and denied.
[CUSTOMER][NEUTRAL] What happened? Like,
[AGENT][NEUTRAL] So are you wanting to go over those denial reasons or?
[AGENT][NEUTRAL] I guess I'm just a little confused of what we need to do.
[CUSTOMER][NEUTRAL] So, which
[CUSTOMER][NEUTRAL] Uh, actually I wanna tell you one thing before, uh, I call you, I call diagnosis, uh, office where she done her service, so they say make a conference call and, uh, I don't know, they, they told me like that, but, uh, when I call, uh, 90 degree department they send my call and transfer my call to you and they said you need to claim all the rest of things which one is not sort out yet.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so it looks like um I understand that the facility or the provider's office is telling you that they can do a one on one call with us.
[AGENT][NEUTRAL] But however, it looks like each claim that was sent in, um, they were all denied because they're non-covered under the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so what need to do the next?
[AGENT][NEUTRAL] So the provider's office can always submit an appeal.
[AGENT][NEUTRAL] If they don't agree with the denial.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEGATIVE] But like I said, they're non-covered under the policy, therefore, they're not gonna be covered benefits.
[CUSTOMER][NEUTRAL] So what, what she needs to do, my mom needs to do what she needs to do the next because she has a, uh, she pay every month insurance and uh.
[CUSTOMER][NEUTRAL] You know,
[AGENT][NEUTRAL] Oh, I definitely understand that you know she definitely pays the benefits every month, but however, these services that she went in for for the dates of service they're just non covered under the policy so therefore no benefits are gonna be payable for this date of service for any of these claims.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, so what we need to do the next then?
[AGENT][NEUTRAL] Um, with these claims, the only thing that can be done at this point is have the provider submit an appeal.
[AGENT][NEUTRAL] If they don't agree with the denial reason.
[CUSTOMER][NEUTRAL] OK, so she needs to pay by her pocket?
[AGENT][NEUTRAL] She would have to contact the facility or the provider's office to set up that payment arrangement if that's what she decides to move forward with doing without them submitting an appeal, yes, ma'am.
[CUSTOMER][NEUTRAL] Can
[CUSTOMER][POSITIVE] Uh yeah, can you help me to uh make a conference 11 on one with them and uh you guys uh talk with each other and sort out these things please for her?
[AGENT][POSITIVE] Um, they're always more than welcome to call in and go over the claim status with us.
[AGENT][NEUTRAL] And we can let them know why it's not covered under the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] You make a call right now or uh?
[AGENT][NEUTRAL] No ma'am, they would have to call in in order for us to go over these claims with them.
[CUSTOMER][NEUTRAL] What is the next?
[CUSTOMER][NEGATIVE] I don't understand these things because I call over there, they told me, uh, like insurance call us to make uh uh things to sort out and you guys told me they call you. I don't know what happened with the all of these, and my mom pay every month bill, uh, like insurance, so I, I do not understand the things what's going on.
[AGENT][NEUTRAL] Um, unfortunately, it's gonna be the provider's responsibility since they submitted the claim in order to file that appeal. Like I said, if they don't agree with that, then no reason.
[AGENT][NEUTRAL] But as of right now, as it stands with everything that was billed, it's just not a covered benefit under the policy.
[CUSTOMER][NEUTRAL] OK, so, uh, the rest of the, uh, services, you, can you check again if you are done uh something sort of like she get a lot of services you see at that day.
[CUSTOMER][NEUTRAL] Can you check for me again, please?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] For a different data service or for that data service?
[CUSTOMER][NEUTRAL] No, the same, she just go one day only, that service only.
[CUSTOMER][NEUTRAL] Uh, uh, [PII]. Can you check for me again, please?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so looking at the claim.
[AGENT][NEGATIVE] There are 3 different claims on file and then 1 did denies the duplicate.
[AGENT][NEUTRAL] Two of them are denied as non-covered benefits under the policy, and then there's one that's denied stating that vea puncture is non-covered under the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] So, as I stated, the provider would have to call in or submit an appeal if they don't agree with this decision, but as it stands, these benefits are non-payable.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so at the end of the day, they, uh, you guys not pay her, uh, the rest of the services bill, right?
[AGENT][NEUTRAL] No, ma'am, we can't send your mom um any benefits or any payment amounts for benefits that are noncovered.
[CUSTOMER][NEUTRAL] OK. Can you check for me how much is the rest um.
[CUSTOMER][NEUTRAL] Total amount she need to pay?
[AGENT][NEUTRAL] Um, give me just a second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm not sure if that's something I can actually look at here in the claims department, so give me just a second.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] No problem.
[AGENT][POSITIVE] Bear with me a minute, let me see if I can actually get a little bit of help with this.
[CUSTOMER][POSITIVE] Mhm, no problem. Take your time.
[CUSTOMER][NEUTRAL] Yeah, please.
[AGENT][NEUTRAL] So you're wanting to know how much your premium is?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so bear with me.
[AGENT][NEUTRAL] And we'll see if I can take a look at it. If not, um, unfortunately.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] I would have to transfer you back and I definitely don't want to do that since you were just transferred to me.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let's see, I got someone else actually trying to help me with it because it's not something that we typically look at here in the claims department, so bear with me a minute.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm gonna place you on a brief hold, OK, while they're checking into this, so just bear with me for just a minute, OK?
[CUSTOMER][POSITIVE] OK, no problem. I'm on hold. Thank you, no problem.
[AGENT][POSITIVE] Alright thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] A week
[AGENT][NEUTRAL] OK, ma'am.
[CUSTOMER][POSITIVE] Yes, ma'am. I'm right here.
[AGENT][NEUTRAL] OK, so she, I had someone else help me with this and it looks like the premium is $17.36 per week.
[CUSTOMER][NEUTRAL] $17 and
[AGENT][NEUTRAL] Uh, it's 17.36 per week.
[CUSTOMER][NEUTRAL] OK, per week. So, how many total weeks you make?
[AGENT][NEUTRAL] Um, what, what do you mean?
[CUSTOMER][NEUTRAL] So how many weeks you need to pay? Like $17.36? How many total weeks?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] I'm assuming it comes out of her paycheck, doesn't it?
[AGENT][NEUTRAL] Yeah, it looks like it comes out of her paycheck every week.
[CUSTOMER][NEUTRAL] Oh, in every week. Uh, OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK, uh, do not done this one yet because I need to call again, uh, the quiz department if they do something, uh, more relief to my mom, then, uh, it will be good for her, right?
[AGENT][NEUTRAL] If you call the provider's office.
[CUSTOMER][POSITIVE] I need to call again with the quest department so they can uh if they sort out some more things to contact with you guys, it will be relief for my mom.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, you can contact them and let them know that if they have any questions regarding the claim denial, to give us a call or they can file an appeal.
[CUSTOMER][NEUTRAL] OK, so they can file the appeal, so maybe sort of something more. OK, no problem. Yeah, uh, I just, uh, I just told you, uh, do not uh add this money with my mom's check.
[AGENT][NEUTRAL] OK, so that you're not wanting the money taken out of her check?
[CUSTOMER][NEGATIVE] No, you told me $17.36 per week you guys add with my mom's uh paycheck, right?
[AGENT][NEUTRAL] That's what she
[CUSTOMER][NEUTRAL] But I said do not done yet.
[AGENT][NEUTRAL] OK, that's what she pays through her job to have this health insurance or to have this insurance. You would have to contact her jobs human resources department if you want anything done with the insurance.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK. I just have the thing. You do not change anything with her insurance, whatever she pay in her check.
[AGENT][NEUTRAL] OK, yeah, we don't have the capability of doing that that would be up to her human resources department to contact us.
[CUSTOMER][POSITIVE] OK, yeah, please, thank you, thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Uh, no, that's all.
[AGENT][POSITIVE] OK, well thank you for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] Uh hi. Uh, you too. Thank you. I have one more question. Uh, I have one more question about my dad's bill. He has something, he has the same insurance. Uh, he has a bill like $38.69. Can you check, uh, for his, please?
[AGENT][NEUTRAL] All right bye bye.
[AGENT][NEUTRAL] Uh-huh. Go ahead.
[CUSTOMER][NEUTRAL] Can you guys done his claim, his bill?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Is he on the same policy as your mom?
[CUSTOMER][NEUTRAL] Yeah, she has a, he has the same policy with my mom, yeah.
[AGENT][NEUTRAL] What's your dad's name?
[CUSTOMER][NEUTRAL] Uh, spouse. Uh, his name is [PII].
[CUSTOMER][NEUTRAL] [PII] last name [PII]
[AGENT][NEUTRAL] And what's his date of birth?
[CUSTOMER][NEUTRAL] Uh, it's a [PII].
[AGENT][NEUTRAL] OK, so looking at his policy, it don't look like we have any claims on file. So whoever he's getting a bill from, they need to bill his insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No problem. I just need to make sure. Thank you very much. I do not have another question.
[AGENT][POSITIVE] OK, well thank you for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] You too. Bye-bye. Thank you.
[AGENT][NEUTRAL] Alright bye bye.