AccountId: 011433970860
ContactId: 317111db-5f48-4855-a3b1-4b1e3d63dd69
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 592739 ms
Total Talk Time (AGENT): 270330 ms
Total Talk Time (CUSTOMER): 201693 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/317111db-5f48-4855-a3b1-4b1e3d63dd69_20250311T14:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, hi [PII], my name is [PII], and I'm with the broker's office. Um, how are you this morning?
[AGENT][POSITIVE] I'm doing well, Ms. [PII]. How are you doing?
[CUSTOMER][POSITIVE] I'm good I'm good, um.
[AGENT][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] I need to check to see if y'all have a claim. I've called about this.
[CUSTOMER][NEGATIVE] A couple of times the provider keeps telling me that they're um filing a claim but when I checked back y'all didn't have it and um anyway policy number is.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, Ms. [PII]. Uh-huh.
[CUSTOMER][NEUTRAL] Um, OK, policy 022-03757.
[AGENT][NEUTRAL] OK, and Miss [PII], what is the group number?
[CUSTOMER][NEUTRAL] The group number?
[AGENT][NEUTRAL] Yes ma'am, I have to verify the.
[CUSTOMER][NEUTRAL] Never had to give that before.
[CUSTOMER][NEUTRAL] He usually just give the policy number um hold on I'll have to look that up.
[AGENT][POSITIVE] Yes ma'am, thank you.
[CUSTOMER][NEUTRAL] 25546
[AGENT][POSITIVE] Thank you and um.
[AGENT][NEUTRAL] For verification purposes, can you please just give me the the email address for yourself?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. I appreciate it, Ms. [PII]. Thank you so much.
[AGENT][NEUTRAL] OK, let me look up this patient real quick. Are they insured?
[AGENT][NEUTRAL] OK and uh who is the insured and their date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK and then what is the date of service and charge amount, do you know?
[CUSTOMER][NEUTRAL] [PII] $1210.67.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me go and look that up real quick and is that the amount before primary paid?
[CUSTOMER][NEUTRAL] Uh, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, let me look him up real quick.
[AGENT][NEUTRAL] Yeah, you've been trying to take care of this for a while if it's from [PII].
[CUSTOMER][NEUTRAL] Um, well, we didn't start on it until sometime last year, but it's still been a, it's been a little bit.
[AGENT][NEGATIVE] Poor thing.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, I'm looking under [PII].
[AGENT][NEUTRAL] And looking under date [PII], I do not find a claim on file.
[AGENT][NEUTRAL] For the data service.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And let me look and see when the last claim was submitted for him.
[AGENT][NEUTRAL] I don't have any claims that have been submitted for him on this policy.
[CUSTOMER][NEGATIVE] They keep telling me that they're gonna file it. I told them I'd file it that I'd file it, you know, I had a claim form ready to go. I'd file it but I needed the you know the itemized thing from them and they said that they wouldn't give it to me.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So they said they were gonna file the claim.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] I wonder if he can get it and then give it to you so you can get it filed for him they should be able to give it to him.
[CUSTOMER][NEGATIVE] All they keep sending them is just the bill.
[CUSTOMER][NEGATIVE] They don't send the itemized things showing diagnosis codes and.
[AGENT][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] Whatnot like that they said they couldn't give that to the patient.
[CUSTOMER][NEGATIVE] They could give diagnosis codes to APL, but they couldn't give them to the patient, which makes no sense to me but.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] That's what I'm dealing with.
[AGENT][NEGATIVE] No, that doesn't make sense. You would think that you'd be able to get your own medical records and be able to get it out of my statement that says what you were diagnosed with and what they did to help you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Exactly, mhm.
[AGENT][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] This was the ambulance service.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I don't know what diagnosis kind of codes and ambulance service bills with I don't know if they.
[CUSTOMER][NEUTRAL] You know, I don't know how ambulance billing works, so I don't know if they use an actual diagnosis code on their claims or they just bill for, you know, mileage and transport and don't put diagnosis codes. I don't know, but.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, they just said that they couldn't provide the diagnosis codes to the patient.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Miss [PII], I'm going to see if.
[CUSTOMER][NEUTRAL] This was on [PII] when they.
[AGENT][NEUTRAL] I'm going to see if there's somebody in the claims department that can assist you and maybe there's another route to go that maybe I'm not aware of to see if um we can further that way even if it's the claims department calling and requesting the information maybe.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] So we can get this taken care of for him.
[CUSTOMER][POSITIVE] OK, that'd be great.
[AGENT][NEUTRAL] OK, OK, Ms. [PII], it's gonna be a brief hold while I transfer you on over. I appreciate you calling APL today.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome, ma'am.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], it's [PII].
[CUSTOMER][NEUTRAL] Hey [PII].
[AGENT][NEUTRAL] I've got um hey I've got a broker on the phone. Her name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And she is [PII] and I have verified her.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She calls often actually um her she's calling about policy number 220.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 3757 for [PII].
[CUSTOMER][NEUTRAL] OK, give me just a second to get over there.
[AGENT][NEUTRAL] OK, there are no claims that have been filed for him and the provider keeps telling her that they're going to send it, but they don't. It's an a service for him and the date of service was on [PII], so that tells you she's been trying for a while to get this claim taken care of for him.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And they will not give the patient the itemized statement.
[CUSTOMER][NEGATIVE] What the heck?
[AGENT][NEUTRAL] Right? They said they can't give that to him, but if APL calls and asks for it, they can give it to APL so I'm.
[CUSTOMER][NEUTRAL] They're just gonna give it to us without an authorization or anything on file.
[AGENT][NEUTRAL] I guess
[CUSTOMER][NEGATIVE] That, I doubt it.
[AGENT][NEUTRAL] Yes, I don't know, but she's called. I've helped her a couple of times she's called several times to see if the provider has submitted the claim and they haven't, and I was just wondering if maybe there's another direction, maybe you might know something that she can do to help get that claim in here.
[CUSTOMER][NEUTRAL] OK, will you give me that policy number again because for whatever reason it I think I missed a digit.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, it's 220-3757.
[CUSTOMER][NEUTRAL] 57. OK, I did.
[CUSTOMER][NEGATIVE] I was like, I, I know I'm missing something because this is not pulling up nobody.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Compass, OK.
[CUSTOMER][NEUTRAL] And he has been active since [PII], so it's not like it could be on a previous policy or anything.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, I checked that already too, yeah.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] So I'm gonna let you speak to her maybe you guys can work something out um.
[AGENT][POSITIVE] If they're saying that [PII] can ask for it maybe we can do that and be able to get this taken care of for him.
[CUSTOMER][NEUTRAL] I mean,
[AGENT][NEUTRAL] Through the ambulance service.
[CUSTOMER][NEGATIVE] So they're not submitting.
[CUSTOMER][NEGATIVE] They haven't even submitted the claim to us period.
[AGENT][NEGATIVE] Correct. Nothing.
[CUSTOMER][NEGATIVE] Like their insurance, why, why can then insured not even request their claim be submitted to their insurance?
[AGENT][NEUTRAL] Right.
[AGENT][NEGATIVE] Correct and they won't give him the they won't give him the paperwork to be able to submit it. They said they can't give that to him they just keep sending him a bill.
[CUSTOMER][NEGATIVE] [PII], I, I'd be mad as heck. OK.
[AGENT][POSITIVE] Yes, but Miss [PII]'s honest. She's really sweet. I think you'll like her. She's a nice lady. OK. All right. Thanks, [PII]. Bye-bye.
[CUSTOMER][POSITIVE] OK, cool.
[CUSTOMER][POSITIVE] Thanks [PII].
[CUSTOMER][NEUTRAL] Bye.