AccountId: 011433970860
ContactId: 34500712-71de-468f-8cfb-cb82c88484ca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 132339 ms
Total Talk Time (AGENT): 47984 ms
Total Talk Time (CUSTOMER): 80035 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-2.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/34500712-71de-468f-8cfb-cb82c88484ca_20250429T18:28_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] on the care team. How you doing?
[AGENT][NEUTRAL] Fine, how are you?
[CUSTOMER][NEUTRAL] I'm good. Um, I don't need a transfer. I really need, uh, can you look at this with me? It's a provider, um, it's 259-617-1.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Or uh Tierra Heel.
[CUSTOMER][NEGATIVE] Yeah, the provider is saying that they received a letter from us saying that there was no policy. We received the claim, but there was no policy found.
[CUSTOMER][NEGATIVE] But I don't see anything on OnBase showing that we sent it to her. She said she received the letter or the date on the letter is [PII]. There's nothing in OnBase after [PII]. There's no note and she does, the policy came right out, up with the policy number. I just didn't want to tell her to disregard it if it was something for real.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So she gave
[AGENT][NEUTRAL] So, on the letter, it, it gave that policy number?
[CUSTOMER][NEGATIVE] Yeah, on the letter, it gave the policy number that she gave me. No, no, no, there's no there's no there was no policy number on the letter. She has the member's ID card. She said the member came in and she um she called in, the, the provider called in to verify benefits and we told her back in March that there was no major coverage, but they still submitted the claim, I guess just to get the denial and then they received that letter in return.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, and the letter said that they, we, they couldn't locate that they had coverage?
[AGENT][NEUTRAL] Is that what
[CUSTOMER][NEGATIVE] Yeah, the letter said that we received the claim, but there's no we we're unable to locate a policy.
[AGENT][NEUTRAL] OK, so they must didn't, it was identifiable, so you wouldn't see anything in on base.
[AGENT][NEUTRAL] Because we couldn't locate them. So either they didn't put the policy number on the claim or their social for us to locate them in the system. So when that happens they send that letter out and we don't have any identifying information to locate them in the system with coverage.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So I would advise him to resubmit the claim, yes, with the policy number indicated on it.
[CUSTOMER][NEUTRAL] So tell her to resubmit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, got it, thank you.
[AGENT][POSITIVE] Mhm you're welcome.
[CUSTOMER][NEUTRAL] All right, bye bye.
[AGENT][NEUTRAL] Bye.