AccountId: 011433970860
ContactId: 1e968af7-77d0-4a49-9c09-8f21d5c6ae89
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 360609 ms
Total Talk Time (AGENT): 107505 ms
Total Talk Time (CUSTOMER): 163159 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/1e968af7-77d0-4a49-9c09-8f21d5c6ae89_20250616T19:52_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], uh, my name is [PII]. I'm calling for a member that has a gap policy with you all. I wanna see if a claim was submitted by a hospital for the member. I do have the member's, um, information for you.
[AGENT][POSITIVE] OK, and I'm so sorry, your name again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and you're calling from?
[CUSTOMER][NEUTRAL] And last name is [PII].
[CUSTOMER][NEUTRAL] I'm calling from the broker's office Legacy Financial Consulting.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you so much and what is your callback number?
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] Thank you so much and I'm ready for that policy number please [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. His policy number is 02447537.
[AGENT][NEUTRAL] Excuse me, OK, and then verify the member's name and date of birth.
[CUSTOMER][NEUTRAL] Um, the member's name, the, well, the patient is actually the dependent on the policy, but his name is [PII].
[AGENT][NEUTRAL] OK thank you very much and you have that date of birth for me please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, of course. OK. His date of birth is
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, thank you so much for the information, [PII], and you're calling to check receipt of a claim, excuse me. OK, I can assist you with that. And what is that date of service and the total charge amount please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, total charge amount one second is.
[CUSTOMER][NEUTRAL] Uh, these invoices, OK, total bills amount was 20,396.
[CUSTOMER][NEUTRAL] It was hospitalization, their copay on the on their AMed GHT plan is $2000 so that would have been what he would have been submitted as far as the patient responsibility, but the total bill amount was 20,396.
[AGENT][NEUTRAL] OK, now what date was that for?
[CUSTOMER][NEUTRAL] Uh, let's see, date of service.
[CUSTOMER][NEUTRAL] Uh, one second, let me see if she wrote it in the email.
[CUSTOMER][NEUTRAL] Uh, February, I'm looking for the date. One second. It was February of.
[CUSTOMER][NEUTRAL] [PII], so February of last year, oh, there it is, [PII].
[AGENT][POSITIVE] OK, that's [PII]. Alright, thank you so much for that date. Give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And you're checking to see if the insured has submitted that claim or the provider.
[CUSTOMER][NEUTRAL] The provider I think it would have been the provider.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] You did say hospitalization, so that would have been a date range. OK. Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I did not show where the provider has made the claim for the date range of [PII].
[AGENT][NEUTRAL] Through [PII], is that correct?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just wanna make sure.
[CUSTOMER][NEUTRAL] Uh, it doesn't, it only shows the date of service. It doesn't specify how many days he was there on what she sent me, but it might very well be.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I did not show that we have received the claim from the provider.
[AGENT][NEUTRAL] For that date range or date.
[CUSTOMER][NEUTRAL] No, no claimer.
[CUSTOMER][NEUTRAL] And that amount either the the 20,396, OK.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I show you where we received the claim from the insured for a date range of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] But nothing and it was not paid.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] But nothing from the provider.
[CUSTOMER][NEUTRAL] was not paid. Is there a reason?
[AGENT][NEUTRAL] Yes, give me one second.
[CUSTOMER][NEUTRAL] OK, and the insured, OK.
[AGENT][NEUTRAL] OK, we're asking for the diagnosis code for that date of service.
[AGENT][NEUTRAL] Diagnosis and procedural for the data service. Also the explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Diagnosis codes. OK, I'll have her submit that.
[CUSTOMER][POSITIVE] OK perfect thank you so much [PII]. I appreciate that um would you guys don't give the the reference numbers it's just your name right? [PII] on the date?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, last initial is [PII] and today's date. That's correct.
[CUSTOMER][POSITIVE] OK perfect thank you [PII] I appreciate it.
[AGENT][POSITIVE] You're welcome
[AGENT][POSITIVE] Just thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Alright you too bye bye.
[AGENT][NEUTRAL] Bye.