AccountId: 011433970860
ContactId: 32124c26-9d69-46b3-a621-8105d8d9de56
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 520347 ms
Total Talk Time (AGENT): 89034 ms
Total Talk Time (CUSTOMER): 201941 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/32124c26-9d69-46b3-a621-8105d8d9de56_20250116T14:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] And you said your name is [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, my name is, uh, [PII], and my, uh, husband's name is [PII]. He's the, he's the, um,
[CUSTOMER][NEUTRAL] One with the policy, uh, and I'm, I am, uh, there's a um form out there that says you can talk to me, um, so what can I give you to get the ball rolling here?
[AGENT][NEUTRAL] I'm needing the policy number.
[CUSTOMER][NEUTRAL] 01897865.
[AGENT][NEUTRAL] And what was your name again, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And may I please have a callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And may I have the mailing address listed on file please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Let me verify.
[AGENT][NEUTRAL] The authorization.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK I see we sent the form.
[AGENT][NEUTRAL] OK, and how may I assist you, Miss [PII]?
[CUSTOMER][NEUTRAL] Um, so,
[CUSTOMER][NEGATIVE] If you look at his claims, uh, someone was supposed to call me back, but I never got a call back. Um, there's kind of a mix up. Let me see if I can get to the right place.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] If you look at um 912, there's a um.
[CUSTOMER][NEUTRAL] few entries there and it looks like.
[CUSTOMER][NEGATIVE] Instead of paying $73 whoever processed it paid $7.30.
[CUSTOMER][NEUTRAL] Um, on 13. So yesterday I loaded my.
[CUSTOMER][NEUTRAL] Explanation of benefits for this, um, and if you're, you look at that, um,
[CUSTOMER][NEUTRAL] At the very end,
[CUSTOMER][NEGATIVE] Of that explanation of benefits because it hit list all of them highlighted is the $210 and the $73 that should have been paid by you guys.
[CUSTOMER][NEUTRAL] To the provider but was only paid $7 and
[CUSTOMER][NEGATIVE] 3 cents or 30 cents she said that uh she couldn't find the explanation of benefits and when I didn't hear back from her I figured go ahead and upload it.
[AGENT][NEUTRAL] And that is for the data service of the 912.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] And I'm gonna pull that claim image up as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so for this claim.
[AGENT][NEUTRAL] The actual data service that I'm seeing is 35.
[CUSTOMER][NEUTRAL] Well that's the bill and I don't, yeah, they, they attached that bill, but there was another bill that I sent.
[AGENT][NEUTRAL] For that claim.
[CUSTOMER][NEUTRAL] Um, for 9:12 and if I need to resend that I can do that. I'm just trying not to confuse the issue because it's already jacked up.
[AGENT][NEUTRAL] OK, so you, you're talking about the image that you submitted in yesterday?
[CUSTOMER][NEUTRAL] Uh, no, that the image that I submitted yesterday, um, uh, the person I spoke to said they couldn't find the explanation of benefits and they were going back to the person who issued the $7.30.
[CUSTOMER][NEUTRAL] To find out.
[CUSTOMER][NEGATIVE] How they processed it but I never heard back from them so I uploaded the uh explanation of benefits and again it's on the very last page what I want paid. I don't none of the rest matters at this moment in time, um.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And let me see um.
[AGENT][NEUTRAL] And that's for the providers [PII].
[CUSTOMER][NEUTRAL] Right, or Saint Louis pathology. They're all in one,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so what I can do, I do, I did highlight that if you wanted to be paid, which is the 9 1224 where they paid the provider $7.30 instead of $73. So what I would do, I will send this EOB over to that examiner and have them to reprocess that claim with the additional amount paid out to that provider.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, um, and the, the, uh, the original claim number.
[CUSTOMER][NEUTRAL] Um, hold on here. The original claim number is the 3544954. That's where they asked at the end of the year for, uh, the explanation of benefits, and I thought I sent it over, but apparently I, I didn't, I couldn't find it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I did, I did pull that up and that's what I'm gonna do I'm go ahead and I'm gonna send that over for the examiner to reprocess and they would just issue the additional payment to that provider if eligible.
[CUSTOMER][POSITIVE] OK, I appreciate it, [PII]. Thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] You're welcome. Thank you so much for calling American Public Life, Miss and have a great day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you, bye.