AccountId: 011433970860
ContactId: 1b8ad34e-2728-4e37-9bff-e58a7ba683d2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 752380 ms
Total Talk Time (AGENT): 306973 ms
Total Talk Time (CUSTOMER): 326211 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/1b8ad34e-2728-4e37-9bff-e58a7ba683d2_20250522T17:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I just got off the phone with the hospital that I had a procedure, surgical procedure done back in February, um, and, um, we're waiting, they're waiting for the claim that was sent to APL. Um, it's been over 90 days to have some type of um conclusion to it so that they can finalize.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Um, like payments through my insurance as well as potentially give us money back that we had to pay up front for something that wasn't done, and she said she did not have a claim number, but she did say that I could give you my information and the cost and you might be able to look up why it's taking so long on your end um for something to be uh communicated back to them.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, alright, I'll be able to help and what they're looking for is the explanation of benefits um on our side after the claim was submitted, is that correct?
[CUSTOMER][NEGATIVE] No, it seemed, I, I, she made it sound like they were waiting to see I guess they all she said was we, we put out, you know, they sent whatever to you, whatever the cost was, and they just haven't received anything back whether you're paying some of it, whether you're not, there hasn't been any communication back.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so I guess just starting with seeing if you guys have any information on that through my name and information might, yeah.
[AGENT][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] OK, what is your name and.
[CUSTOMER][NEUTRAL] So my name is
[AGENT][NEUTRAL] Yes, ma'am. Go ahead.
[CUSTOMER][NEUTRAL] Date of birth, it's [PII].
[AGENT][NEUTRAL] Your, well, your name and your
[AGENT][NEUTRAL] OK, Ms. [PII], and what is your callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And then what is your policy number?
[CUSTOMER][NEUTRAL] I don't have my card on me.
[AGENT][NEUTRAL] OK, I can look it up with your social if you can give that to me, it'll pull in all your policies for us.
[CUSTOMER][NEUTRAL] OK, and if it's underneath my husband, would it need to be his social or would it still be mine?
[AGENT][NEUTRAL] It would still be yours.
[CUSTOMER][NEUTRAL] OK, so it's [PII].
[AGENT][NEUTRAL] OK, let me see if I can find you real quick.
[CUSTOMER][NEUTRAL] And it, it, it was, um, the date of service was [PII], and it would be coming from Saint Luke's Presbyterian Hospital Health one out of [PII].
[AGENT][POSITIVE] OK, alright, let me look up your information real quick and we'll get you some answers.
[CUSTOMER][POSITIVE] Thank you. It's just they, they owe me $5000 and, and I, I'm, I'm like.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] A little irritated with them because I've called them about 16 times and um they just.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Haven't been giving enough answer to say the least.
[AGENT][NEUTRAL] I understand, and that can be frustrating. Um, Ms. [PII], can you please um spell your first and last name for me?
[CUSTOMER][NEUTRAL] It is [PII] [PII]
[AGENT][NEUTRAL] OK. [PII]?
[CUSTOMER][NEUTRAL] Yes, so it's [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me see if I can find you.
[AGENT][NEUTRAL] OK. Why don't you go ahead and give me your husband's email, I'm sorry, your husband's social so I can try to find you. I'm having a hard time finding you by your social and your name.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, it's [PII] and it's [PII].
[AGENT][NEUTRAL] And it's [PII], correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, thank you very much.
[CUSTOMER][NEUTRAL] It's wait, [PII], right?
[AGENT][NEUTRAL] Yes, ma'am. [PII] OK, I think I have found you, Ms. [PII]. Can you please uh verify your date of birth for me?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it's [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is your address, phone number and email address that would be on the policy for you?
[CUSTOMER][NEUTRAL] Um, it should be [PII], but his company's HR department is small and inconsistent, so if you have a different address, I can provide you with that.
[AGENT][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] No, ma'am, that's the one I'm showing, um, and I'll just need the.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and the phone number.
[AGENT][NEUTRAL] Yes, ma'am. Go ahead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So what did you need for the address?
[AGENT][NEUTRAL] Uh, nothing for the uh, the address, but I was looking at the email address and the cell phone number that's on the policy.
[CUSTOMER][NEUTRAL] So it should be [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the email address I, I don't know which one my husband would have put down. I'm there's two, so there's [PII].
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and thank you very much, Ms. [PII] for verifying your policy for me. And you said the date of service was going to be [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me see what we have.
[AGENT][NEUTRAL] On file for that data service.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's gonna be just a moment while I try to pull it up.
[AGENT][NEUTRAL] I've got some other claims that were submitted on that day so I'm looking to see Saint Luke's Presbyterian if it was from them.
[AGENT][NEUTRAL] No, it's from Anesthesia Partners of Colorado.
[AGENT][NEUTRAL] We had 2 claims sent in for an anesthesia partners, but Saint Luke's has not submitted a claim for that date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh my [PII], they told me that they submitted a claim and that the number was $187,046.45 which I like that was my reference number to give, um, so they have not.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] A claim to you. So is there a specific reference or number or something I can tell them like, uh, is there a claim fact specific? OK.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes ma'am, um, like I said, the only claims we received on that data service was from the anesthesiologist, um, let me give you the payer ID number, they can submit it electronically they can do it right from the computer. It is 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or if they want to fax in the claim we've got a fax number let me give that to you also.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yes ma'am and then we also have a mailing address that they prefer to mail it and that would be the APL claims.
[AGENT][NEUTRAL] And that is PO Box.
[AGENT][NEUTRAL] 248,950.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] I'm sorry, my thing.
[CUSTOMER][NEUTRAL] I hold on my PO box. What was the PO box number again?
[AGENT][NEUTRAL] Ma'am.
[AGENT][NEUTRAL] 248.
[AGENT][NEUTRAL] 950.
[CUSTOMER][NEUTRAL] And you said [PII]?
[AGENT][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so the pay payer ID is 60801.
[CUSTOMER][NEUTRAL] Uh, the fax number is [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] OK, so I'm gonna call them back because this is, you know, it's this is frustrating me. So, OK, so, um.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] And now looking further, looking further, I was trying to see if anything else was turned in after um [PII], and I do see that they did submit a claim for $350 for the ER but that's it and we paid the $50 co-pay for that.
[CUSTOMER][NEUTRAL] Yeah, yeah, I went to ER.
[CUSTOMER][NEUTRAL] Yeah, I was like 4 days later due to complications from the surgery, but so anesthesiologist and the ER at Health One sent a claim, but the original claim for the original surgery date was not there has not been sent in.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK, thank you so much. I'm gonna call them back. Thank you for your help. And is there, is there
[AGENT][POSITIVE] Oh, you're welcome. You're very welcome. And just let them know, they may, um, go ahead.
[CUSTOMER][NEUTRAL] Is there a number you can give me so the next time I can like just give the people my number like uh my policy number? Do you, are you allowed to give that to me or no?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Absolutely, um, your policy number is
[AGENT][NEUTRAL] 229-7912.
[CUSTOMER][POSITIVE] OK, thank you. And what were you gonna say? I'm sorry.
[AGENT][NEUTRAL] And they
[AGENT][NEUTRAL] Yes ma'am, they may ask you what the timely filing limit is to submit a claim. A lot of places give you a time limit on when you can submit a claim. Let them know that we do not have a timely filing limit as long as your policy was active on the date of service, they can submit a claim at any time.
[CUSTOMER][POSITIVE] OK, that's good to know. Thank you for giving me that information. They've been very complicated.
[AGENT][NEUTRAL] Yes ma'am, that way if you get.
[AGENT][NEUTRAL] Well, when you told me you were getting a little bit of push back, I figured I'd let you know that so that you would have that information to know that they can send it at any time.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, perfect. Thank you so much. I hope you have a nice day.
[AGENT][POSITIVE] Well, you too, Ms. [PII], you guys have a blessed Memorial Day weekend and we thank you so much for calling APL.
[CUSTOMER][POSITIVE] Thank you. Thank you. Bye.
[AGENT][NEUTRAL] Mm bye-bye, ma'am.