AccountId: 011433970860
ContactId: 276dc960-f05c-4f17-8e94-43d5b70a2555
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 603380 ms
Total Talk Time (AGENT): 228301 ms
Total Talk Time (CUSTOMER): 135290 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/276dc960-f05c-4f17-8e94-43d5b70a2555_20250411T13:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], this is [PII] in [PII]. How are you doing?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][POSITIVE] Doing great, doing great. I'm a broker. I'm just calling to check on a claim for one of our customers.
[AGENT][NEUTRAL] OK, I can help you with that. Um, let me get this pulled up. Do you have the policy number of the member?
[CUSTOMER][NEUTRAL] Yes, it is 233.
[CUSTOMER][NEUTRAL] 1673.
[AGENT][NEUTRAL] And the member name and date of birth?
[CUSTOMER][NEUTRAL] Let's take a look here.
[CUSTOMER][NEGATIVE] I had it on the screen of course the minute I click off of it it won't log back in it OK.
[CUSTOMER][NEUTRAL] Here we go. OK, date of birth, it is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] And [PII], do you have a good callback number just in case I lose you?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, and lastly, what is your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much. OK, what date are we looking at?
[CUSTOMER][NEUTRAL] Um, it should be the hopefully the only claim on file for him. I'm looking at it right here. Looks like it ends in 617 and 338. It's all the same claim.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK, looks like we just processed we're making a payment of 300.
[AGENT][NEUTRAL] And like that went out yesterday.
[CUSTOMER][NEUTRAL] OK, um, can you tell me what was processed on there? What was the, the breakdown of the 300 was that?
[AGENT][NEUTRAL] Uh, let's see, let me pull that up.
[CUSTOMER][NEUTRAL] Let me look at the bill.
[CUSTOMER][NEUTRAL] I know he had to go to the.
[CUSTOMER][NEUTRAL] He was in a car accident and went to the emergency room, I believe.
[CUSTOMER][NEUTRAL] Let's take a look. I'm thinking it would have been the 300 and the and the X-ray benefit. Let's see.
[AGENT][NEUTRAL] Uh, it looks like it was an ER.
[AGENT][NEUTRAL] Um
[AGENT][NEGATIVE] I'm just a bit slow.
[CUSTOMER][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] I'm looking at it right here too. I'm trying to see.
[AGENT][NEUTRAL] Yeah it's an emergency room treatment, so it looks like it's paying under that ER benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The 300 for the ER um.
[CUSTOMER][NEUTRAL] But I see he had the X-ray as well. Did they not process the payment for the X-ray as well?
[AGENT][NEUTRAL] Um, let's see. What did we get?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, they put two claims on here. I think they're duplicate, so let's see.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] OK, that's the
[AGENT][NEUTRAL] Yeah, there was one other claim. Let me see.
[AGENT][NEUTRAL] OK, that was info request. OK, let's see.
[AGENT][NEUTRAL] Well, I'm trying to see where the X-ray is. um.
[CUSTOMER][NEGATIVE] It is, if you look at the itemized bill, if you scroll down it says Saint Tammany at the top, and then when you scroll down, it's on the 2nd page, it's the 2nd charge X-ray.
[CUSTOMER][NEUTRAL] $198.
[AGENT][NEUTRAL] I see we've got the, it looks like we sent a request for a direct deposit.
[AGENT][NEUTRAL] And I see the claim that was uploaded. Let me see.
[AGENT][NEUTRAL] I don't know why I can't see the charges. That's weird. Um, let's see.
[CUSTOMER][NEUTRAL] It looks like there's 3 separate attachments. It's the one that says, let's see.
[CUSTOMER][NEUTRAL] My computers of course doing what it wants to do here. Let's see.
[AGENT][NEUTRAL] OK, it looks like it's on the other claim number. OK, let me see. I don't know why they categorized it like that.
[AGENT][NEUTRAL] OK, [PII], uh, yeah, [PII], yeah, OK, I see.
[CUSTOMER][NEUTRAL] Yeah, it looks like for some reason they have.
[AGENT][NEUTRAL] Um, OK, so 14,000.
[AGENT][NEUTRAL] OK, yeah, they put it on the different claim number, that's what was confusing me. I don't know.
[AGENT][NEUTRAL] Why they put it on a different one, OK.
[AGENT][NEUTRAL] OK, I see that. Let me see what is on the policy.
[AGENT][POSITIVE] Wow.
[AGENT][NEUTRAL] OK, that's what they're paying for is the X-ray and the ER.
[AGENT][NEUTRAL] It's a $300 benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, it's OK, so it's 600 total is what you're saying?
[AGENT][NEUTRAL] Uh, I'm trying to find
[CUSTOMER][NEUTRAL] Because uh the ER benefit is 300 on the plan.
[AGENT][NEUTRAL] I see that 300 and then 300 for an X-ray. Um, OK. Let me
[AGENT][NEUTRAL] Let me send this back through and see if it can get researched um.
[AGENT][NEUTRAL] I don't know if maybe they missed it cause it was, I mean they shouldn't know, but.
[AGENT][NEUTRAL] OK, cause I see.
[CUSTOMER][NEUTRAL] And this particular guy just happens to be one of the head people, so he's clocking me daily on this claim.
[AGENT][POSITIVE] I got it, yeah, totally understand.
[AGENT][NEUTRAL] OK, so the X-ray, OK, I see the X-ray specifically. I see this was rendered in the emergency room. So yeah, it looks like it should be an additional $300 benefit. So, I'm gonna send this back through um to our claims department and then um
[AGENT][NEUTRAL] I'll, I'll put your number down just in case there's any issues at all, but I don't foresee that there would be. I guess maybe they just missed it, so.
[AGENT][NEUTRAL] Um, but yeah, I see, I see both of those benefits on the policy should be, um, reimbursed, so.
[AGENT][NEUTRAL] Right now I just got the 300.
[CUSTOMER][NEUTRAL] OK, the, the 300.
[CUSTOMER][NEUTRAL] The 300 that was released, was that direct deposited?
[AGENT][NEUTRAL] It was, it was direct deposited, uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, um, alright, I'll tell him at least that the 300 is being direct deposited and we're gonna have the other 300 reviewed and processed shortly.
[AGENT][NEUTRAL] Yeah, let me make for sure and check one other thing before I let you go.
[AGENT][NEUTRAL] It doesn't show 600, so OK, OK, yes, I'm gonna get this sent back through so if there's any issues at all, um, let me read this note real quick.
[AGENT][NEUTRAL] Sends payable once per year person certificate blah blah blah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Treatment in an emergency room.
[AGENT][NEUTRAL] OK, so it does say, OK, I'm glad I read this. So it says if treatment is in an emergency room.
[AGENT][NEUTRAL] And our urgent care facility as applicable under the certificate occur on the same day.
[AGENT][NEUTRAL] Only the highest benefit is payable.
[AGENT][NEUTRAL] This payment represents the maximum payable amount under this benefit for this date of service.
[AGENT][NEUTRAL] So that's
[AGENT][NEUTRAL] Now I'm interpreting that as you can only collect on one of the benefits because it happened on the same date of service.
[CUSTOMER][NEUTRAL] They're saying if you went to multiple ERs or doctors, um, we do hundreds of claims on this plane all the time, and it's always 300 and 300. I think they just missed it.
[AGENT][NEUTRAL] OK, OK. Well, I'll send this back through, [PII].
[CUSTOMER][NEUTRAL] Because it because it's two separate benefits, yeah.
[AGENT][NEUTRAL] OK, I'll send this back through [PII]. If there's any issues, um, I'll uh I've got your contact number and then the claims department would give you a call back OK?
[CUSTOMER][POSITIVE] I appreciate it I appreciate you doing that.
[CUSTOMER][POSITIVE] Sounds great. I appreciate your time.
[AGENT][POSITIVE] OK, well, thank you for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Bye bye.