AccountId: 011433970860
ContactId: 2226e829-3840-4ad1-a3cc-fc2efad5e4df
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 441459 ms
Total Talk Time (AGENT): 231313 ms
Total Talk Time (CUSTOMER): 124732 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/2226e829-3840-4ad1-a3cc-fc2efad5e4df_20250213T20:17_UTC.wav
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[AGENT][POSITIVE] Good Afternoon. Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, yes, I've got a hospital bugging me for payment, and I wanna check and see if you all ever received a uh INCA claim.
[AGENT][NEUTRAL] OK, sure. Yes, I can check and see if we received that claim. Um, may I have your name?
[CUSTOMER][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Last name is [PII]
[AGENT][NEUTRAL] OK, and Miss [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Thank you. And do you have the policy number?
[CUSTOMER][NEUTRAL] I do. It's 02214938.
[CUSTOMER][NEUTRAL] And with the group number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you. No, it's fine. Let me just pull the policy. Thank you.
[AGENT][NEUTRAL] Alright, for security, may I have your date of birth, mailing address and email address, Miss [PII].
[CUSTOMER][NEUTRAL] It's [PII], um, no, one minute. Birthday is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And my PO box was [PII].
[AGENT][POSITIVE] OK. All right, thank you.
[AGENT][NEUTRAL] And what is the date of service for the claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] of last year.
[AGENT][NEUTRAL] [PII]. Let me check and see if we got that claim. One moment.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] No, we have not received a claim for [PII].
[AGENT][NEUTRAL] Of [PII]. Um, the only one that I see here on around April is [PII]. Uh, now that, mhm, go ahead.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Go ahead, I'm sorry.
[AGENT][NEUTRAL] No, the one.
[CUSTOMER][NEUTRAL] I had my knee. Go ahead, I'm sorry.
[AGENT][NEUTRAL] Mhm, go ahead.
[CUSTOMER][NEGATIVE] Sorry, I'll keep my mouth shut. Go ahead, you talk.
[AGENT][POSITIVE] That's right.
[AGENT][NEGATIVE] No, the one we received on [PII], it looks like we never received the explanation of benefits from the primary insurance, uh, to process the claim, and that's what we were asking for.
[CUSTOMER][NEGATIVE] OK. They, they are just driving me nuts. Now they're getting ready to send me the collections and, and I keep telling, I have called them so many times and give them your all information and phone number and address, and I just can't seem to get through with them. And they are, they are just impossible, and I'm not the only one that's ever had issues with them, from what I understand. So, OK, so you're waiting on what now?
[AGENT][NEUTRAL] Oh boy.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] If this facility charges, if it's coming from the hospital directly and it's for date of service [PII], we need the copy of the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] OK, you need the EOB, but do you show that as my knee replacement date? I thought it was the [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, based on what I got here, the only thing I got for the facility is [PII]. Um, let me look at the papers, make sure that that date is accurate, OK? You're welcome. Let me.
[CUSTOMER][NEUTRAL] Maybe I've got
[CUSTOMER][POSITIVE] OK, great, thank you.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] One moment, let's see what claim number is this? OK.
[AGENT][NEUTRAL] 63.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] and this is for Saint John Broken Arrow.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I, the one we received was for [PII], um.
[AGENT][NEUTRAL] Let me see what.
[CUSTOMER][NEGATIVE] And it doesn't seem to be for a knee replacement.
[AGENT][NEUTRAL] Let me check the procedure codes and see if there's a knee replacement, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK
[CUSTOMER][NEGATIVE] Gosh, I hate calling them again.
[CUSTOMER][NEGATIVE] There's such a pain in the butt.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Metabolic panel, OK.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Right now.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] Our account balance.
[AGENT][NEUTRAL] I'm just going through the post and see if I can find one that says that it's a knee replacement.
[CUSTOMER][NEUTRAL] That's fine.
[AGENT][NEUTRAL] La.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this was a CT of a lower um remedy.
[AGENT][NEUTRAL] It looks like it was left um.
[AGENT][NEUTRAL] OK, so this was probably the pre um pre-operation probably because it's just some tests that they ran and the CT scan and all that. This was on [PII]. Yes, on [PII], we have no claims on file for [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's all I need to know. So I guess I'll call him and I'll get a manager on the phone this time.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm yeah and if you need to do a 3 way call with us, you can, you can just um do a 3 way call and put us on the line so we can confirm that we have not received the claim if you wanna do that, OK?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK. I appreciate your help so much. Thank you.
[AGENT][POSITIVE] You're welcome, no problem. Is there anything else I may help you with today? Any other questions or concerns Miss We?
[CUSTOMER][POSITIVE] Not today, but I might be calling you again. So but thank you so much. OK. Thank you. You too. Bye-bye.
[AGENT][POSITIVE] OK. Sure, no problem. You're welcome. Have a good afternoon, Ms. You're welcome. Bye-bye.