AccountId: 011433970860
ContactId: 24b4f8e5-b297-46ac-b0bd-612741585bd9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 341700 ms
Total Talk Time (AGENT): 192913 ms
Total Talk Time (CUSTOMER): 97627 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/24b4f8e5-b297-46ac-b0bd-612741585bd9_20250206T19:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh yes, sir. I want to check on a claim that's been processed.
[AGENT][NEUTRAL] OK, yeah, I can check on a claim for you. uh, what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Alright, and can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, it is 252-744-1.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right. Thank you.
[AGENT][NEUTRAL] And I'm just gonna verify some information really quick. [PII]. Can I get a good call back number from or I'm so sorry, can you verify your date of birth please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Perfect. The last thing I need is the email address that we've got on file for you. uh, looks like it might be through your employer.
[CUSTOMER][NEUTRAL] I'm change
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, thank you so much for verifying that information. OK, and uh was this claim for you or was it for Dwayne?
[CUSTOMER][NEUTRAL] For Dwayne
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] All right, yes, so I am showing that we had a claim we just received yesterday um it looks like it just finished.
[CUSTOMER][NEUTRAL] Right.
[AGENT][POSITIVE] Or it's being uh finished processing just a little bit ago, um, so we did pay a benefit of $500 for this claim.
[AGENT][NEUTRAL] Give me just a moment and you did have direct deposit set up, is that right?
[CUSTOMER][POSITIVE] Great.
[AGENT][POSITIVE] Perfect. OK, yes.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] For the for the one that was submitted on the one something, I can't remember the date.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] That's what I'm checking on. Let me see who the one.
[AGENT][NEUTRAL] Oh, OK. Sorry about that. Uh, [PII]?
[CUSTOMER][NEUTRAL] Yes, no, hold on, let me see. The one from [PII] well data service is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Got it. OK, no, that's fine. It looks like we did get it on the [PII], so but I do see that. Alrighty, give me just a moment, let me take a look.
[CUSTOMER][NEUTRAL] I can't
[AGENT][NEUTRAL] OK, so it looks like this claim did have a few different items on it, um, so for the first and I, uh, for the looks like this the chemo benefit, um, we are needing the.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Fully itemized hospital or facility um billing with all of the charges fully identified so the itemized statement that we received if we did receive one did not have all of the information that we needed and you can get that from the provider.
[CUSTOMER][NEUTRAL] Mm
[AGENT][POSITIVE] And they're more than welcome to give us a call too if they have any questions for us.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK, so here's, OK, so here's my concern. I don't, I've always been told to send the EOB cause you need to see what the insurance did.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And I've always sent the.
[CUSTOMER][NEUTRAL] So now you tell me you need both of them?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So you're saying in the past that's all you would have sent and we did uh pay those claims, OK, so in that case if you don't mind [PII], I'm gonna put you on a brief hold and I'm going to reach out to our claims specialist just so that they can review what was submitted, um, make sure that there was no mistakes or anything like that, um, so bear with me one moment, OK?
[CUSTOMER][NEUTRAL] That's all I've seen.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APA. You're speaking with [PII]. How may I help you today?
[AGENT][NEUTRAL] Hi Miss [PII], this is [PII] over on the care team. How are you?
[CUSTOMER][POSITIVE] I'm good.
[AGENT][MIXED] Glad to hear it. I've got an insured on the line. Uh, she is calling regarding a cancer claim that she filed. Uh, we denied it as, um, apparently we need more information from a fully itemized hospital bill. She wants to go over with y'all what was submitted. She said that she did submit everything that she always has, um, for chemo and it's always paid before, so she's a bit confused by this.
[CUSTOMER][NEUTRAL] OK, what's the policy number?
[AGENT][NEUTRAL] Yes, it is 252-744-1.
[CUSTOMER][NEUTRAL] OK, give me one second. OK, and what's the name supposed to be?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So we are speaking with [PII] um but it is for part two, and I got the claim number in question when you're ready.
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] It is 356-030-07.
[CUSTOMER][NEGATIVE] 307 office bills are not covered. That's why in the chemo, but they need the itemized bill for that chemo. Who did, yeah.
[AGENT][NEUTRAL] Yeah, she did say that she sent in all I guess you know she had filed for this before and she said that she sent in all of that information and wants to just make sure that that's accurate.
[CUSTOMER][NEUTRAL] OK, I can, I can speak to her. I can see, can I help her? OK.
[AGENT][POSITIVE] All right. I sure appreciate it. Thank you. All right, bye bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.