AccountId: 011433970860
ContactId: 2abaa888-4639-4e62-a5a0-e2fa9f12f962
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 690750 ms
Total Talk Time (AGENT): 163933 ms
Total Talk Time (CUSTOMER): 208389 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/2abaa888-4639-4e62-a5a0-e2fa9f12f962_20250214T17:51_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey [PII], it's [PII] out of Broker Resources. How are you?
[AGENT][NEUTRAL] I'm fine. I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] Yeah, [PII] at a broker, yeah, Morgan Web, um, I have, um, somebody from the broker's office. She's looking into a meddling claim, and I have a claims number. Do you mind helping her? Her name is [PII].
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the claims number is 3562514.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Yeah, and I can give you her callback number too whenever you're ready.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And her name is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Yeah, I'll join you guys now. Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] [PII]. Yes, um, I have meddling claims department on the line for you and she'll take it from here, OK? Thank you so much [PII] I appreciate it thank you uh have a great day. Mhm.
[AGENT][NEUTRAL] This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I am calling from the broker associated Financial Consultants, and I need help with just checking on the status of a claim that was sent over.
[AGENT][NEUTRAL] OK, she gave me the claim number um.
[AGENT][NEUTRAL] And the dates of services were.
[AGENT][NEUTRAL] 12, 4 and 126.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] There was 124, 126, and 1211.
[AGENT][NEUTRAL] And 1211.
[AGENT][NEUTRAL] Hold on one moment, let me look at the client.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, the claim number she gave me, it looks like the insured submitted it, but the doctor submitted it first, so it was paid to the provider.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So I don't mm.
[CUSTOMER][NEUTRAL] Hold on
[CUSTOMER][NEUTRAL] So it was paid to the provider.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] That means nothing's gonna go to the member. I'm so confused.
[AGENT][NEUTRAL] Right, it was paid to the provider.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Do you know when that was done?
[AGENT][NEUTRAL] Hold on just a moment, I'm looking it up.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Alright, she's saying that it was paid to the provider.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That was paid on [PII].
[CUSTOMER][NEUTRAL] 116 of 25 it was paid to the provider.
[AGENT][NEUTRAL] To the provider.
[CUSTOMER][NEUTRAL] to
[CUSTOMER][NEUTRAL] What you said you sent it to the provider because they submitted it first before the insurance?
[AGENT][NEUTRAL] First, right.
[AGENT][NEUTRAL] If they submit it to us first with assignment of benefits we have to pay them.
[CUSTOMER][NEUTRAL] They pay it out if the provider submits it first and they pay it out to them.
[CUSTOMER][NEUTRAL] And that was for every single day, all three claims the [PII], the [PII], the [PII], and the.
[AGENT][NEUTRAL] I can look it up and make sure. Hold on just a second.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We're gonna try and figure it hanging up.
[CUSTOMER][NEGATIVE] Provider was trying to double dip this.
[CUSTOMER][NEUTRAL] the provider submitted the claim she said yeah.
[AGENT][NEUTRAL] Yes, ma'am. That's for every one of them.
[CUSTOMER][NEUTRAL] Yeah, for every single one the providers submitted it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On [PII] is when it was paid out to the provider, correct?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] I have to go back
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] Do you know the amount for each one that was paid out?
[AGENT][NEUTRAL] Hold on just a moment, let me see if it all went at one time.
[CUSTOMER][NEUTRAL] Get the check numbers
[AGENT][NEUTRAL] OK, for 1211.
[AGENT][NEUTRAL] It was 5375.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 5375, do you have that check number by chance?
[AGENT][NEUTRAL] 2023331.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on just a second, let me look at the other ones.
[AGENT][NEUTRAL] Um, for 12 6, it was 5375.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's 202-669-8.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] 669-8. OK.
[AGENT][NEUTRAL] That was for 126, 126 to 1211 and 124. Let's see.
[AGENT][NEUTRAL] And for
[AGENT][NEUTRAL] 124, it was 8980.
[CUSTOMER][NEUTRAL] 8980.
[AGENT][NEUTRAL] And that's 202-669-3.
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][NEUTRAL] Why wasn't the full amount of the $90 paid out?
[AGENT][NEUTRAL] And if she goes on our online service center, she'll be able to see all this.
[CUSTOMER][NEUTRAL] Could you tell me why the full, what was it $90?
[CUSTOMER][NEUTRAL] What do we submit for $90 each time?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah, $90 there.
[CUSTOMER][NEUTRAL] When you see what well like comparing to what we submitted the payment receipts by the.
[CUSTOMER][NEUTRAL] By Mr. [PII], is there a reason why that wasn't paid out?
[AGENT][NEUTRAL] On these dates of service?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's because let me pull one of these claims up from provider we have to go by whatever's on his explanation of benefits we don't go by what he paid out.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] Could
[CUSTOMER][NEGATIVE] To whatever is on the explanation of benefits, could you possibly send me over that explanation of benefits?
[AGENT][NEGATIVE] She should have gotten it from her primary insurance.
[CUSTOMER][NEUTRAL] Is there any way though that you could send it over for us to review it further?
[AGENT][NEUTRAL] Is she sitting there with yo[PII]?
[CUSTOMER][NEUTRAL] Yeah, hold on one second.
[CUSTOMER][NEUTRAL] So you can't just send me send it over to me without talking to the number?
[AGENT][NEUTRAL] Let me find out if I can actually send a copy of the explanation of benefits um and what's your name, [PII]?
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] And you're with Broker Resources?
[CUSTOMER][NEUTRAL] I'm with the broker associated financial consultants.
[AGENT][NEUTRAL] Associated financial.
[CUSTOMER][NEUTRAL] Consultants.
[AGENT][NEUTRAL] Consultant.
[AGENT][NEUTRAL] So I'll have to look and see if we have a.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Where we can talk to you all on file.
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][NEUTRAL] Um, and I can give you a call back. Let me find out. I'm not sure if I'm able to send you that information or not.
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][NEUTRAL] And your number is [PII]?
[CUSTOMER][NEUTRAL] Yeah, that's uh uh let me give you a direct number um that way because it's not, uh, just in case I'm not at my desk [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK. I'll give you a call back.
[CUSTOMER][POSITIVE] OK, thank you so much I appreciate it, [PII], you're welcome.
[AGENT][POSITIVE] Thank you, [PII] for calling APL. You have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.