AccountId: 011433970860
ContactId: 1a944abb-d5bb-43c9-b554-bc5074c063ad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 480059 ms
Total Talk Time (AGENT): 127430 ms
Total Talk Time (CUSTOMER): 175095 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/1a944abb-d5bb-43c9-b554-bc5074c063ad_20250522T16:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Thank you, I just want to check on the status of my claim, please.
[AGENT][NEUTRAL] Sure, I can help you with claim status. Can I get your name and a good phone number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] And I don't have my policy number, but I can give you my social.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And what's your social?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And what's your last name?
[CUSTOMER][NEUTRAL] [PII], [PII]
[AGENT][NEUTRAL] Can I get you to verify your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And is the phone number we have on file the same number that you're calling from?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Would you like me to give you your policy number to write down?
[CUSTOMER][NEUTRAL] No, I, I really have it's just that I don't have it right here with me. I did, um, go online and I did look like they have completed the claim and um there's an amount showing I wanna verify that's it and.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] If it is already mailed out or whether I can give uh account number for it to be put in I don't know how that process is can you check for me?
[AGENT][NEUTRAL] OK, uh, do you have the claim number or the date of service?
[CUSTOMER][NEUTRAL] Uh, the date of service is the date of service is 2 [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yeah, through [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And the claim was just closed out on May.
[CUSTOMER][NEUTRAL] Maybe [PII].
[CUSTOMER][NEUTRAL] So it was just done.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] Do you know what the total bill amount was?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, total bill amount. I know the amount that.
[CUSTOMER][NEUTRAL] It says that they fund it was like 4,5 something.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That was how much they paid out it it looks like to me.
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] And do you know what the provider or the hospital name was?
[CUSTOMER][NEUTRAL] It is um
[CUSTOMER][NEGATIVE] Uh, one second here. Oh jeez.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh Lord, what is the house it's not [PII]. It is.
[CUSTOMER][NEUTRAL] [PII] man.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I know something's going on with this head of mine.
[CUSTOMER][NEUTRAL] Does it should if you give me the name I can confirm it's not.
[CUSTOMER][NEUTRAL] If you give me a name I can confirm.
[AGENT][NEUTRAL] Could it be Northside?
[CUSTOMER][NEUTRAL] That's it? Northside Hospital.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] In [PII] it was it's [PII].
[AGENT][NEUTRAL] OK, I'm showing that we received that claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII]. It looks like we did pay.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For the radiation services.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, the transportation portion was denied. Uh, the policy provides benefits for transportation to the place of treatment when the distance is at least 50 miles from your legal residence. Uh, according to the information in your file, the legal residence is less than 50 miles from the place of your current treatment. Therefore, um, it was unable, it was denied.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then there was another portion that got denied because we need copies of your explanation of benefits from your primary insurance carrier.
[CUSTOMER][NEUTRAL] OK, so that one should be coming, so I guess when I get it I send it in.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I um
[CUSTOMER][NEUTRAL] And uh so what was approved? Any anything approved?
[AGENT][NEUTRAL] Uh, it looks like there were partial.
[AGENT][POSITIVE] Approvals, let me see.
[AGENT][NEUTRAL] It looks like there are some radiation treatments that were.
[AGENT][POSITIVE] Approved
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Alright, did they pay out anything?
[AGENT][NEUTRAL] Yes, ma'am. Let me see.
[CUSTOMER][NEUTRAL] They told me last that they were waiting for the explanation of benefit.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] In March and um
[CUSTOMER][NEUTRAL] So I called the hospital and they're supposed to send it to me, hopefully another week or so. So I was just
[CUSTOMER][NEUTRAL] Figure that they're aren't gonna do anything until they get the explanation of benefits.
[CUSTOMER][NEUTRAL] So it sounds looks like they have done something so I'm trying to figure out what have they done.
[AGENT][NEUTRAL] Yes, it does look like a check was sent out.
[AGENT][NEUTRAL] To you on
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] For an amount of $4540.97 and it looks like it is going to be sent to your address.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so in other words, they made their decision based on what else, whatever they had without the other stuff they were waiting for, OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Well, all right, I don't know they'll make any other decisions, so when I get the explanation of benefits.
[CUSTOMER][NEUTRAL] Is that I'll just send it in and see what else happened right, so that check should be coming.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] All right. Well, I do appreciate you. Thank you so much, OK?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] All right, bye bye.
[AGENT][NEUTRAL] Bye.