AccountId: 011433970860
ContactId: 3f5a8d53-df97-4d2f-b639-ffd63c999976
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 561020 ms
Total Talk Time (AGENT): 93123 ms
Total Talk Time (CUSTOMER): 78359 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=-1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/3f5a8d53-df97-4d2f-b639-ffd63c999976_20250129T17:03_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, um, I'm calling on behalf of a member to, um, I guess find out why, um, a claim was only paid out for $30.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I guess they're just confused as to um.
[CUSTOMER][NEUTRAL] Why I guess they didn't.
[CUSTOMER][NEUTRAL] Get more for this claim.
[AGENT][NEUTRAL] Are you the provider or the um like a family member? Who are you?
[CUSTOMER][NEUTRAL] I'm with the broker's office.
[AGENT][NEUTRAL] Can I have your name and a callback number for you?
[CUSTOMER][NEUTRAL] [PII] and my callback number is [PII].
[CUSTOMER][NEUTRAL] 5743571
[AGENT][NEUTRAL] Can I have a policy number of the member that you're inquiring claim status for?
[CUSTOMER][NEUTRAL] 241-9432
[AGENT][NEUTRAL] And what is this member's name and date of birth that you're inquiring claim status for?
[CUSTOMER][NEUTRAL] So it's for the dependent [PII].
[CUSTOMER][NEUTRAL] And I can get his um.
[CUSTOMER][NEUTRAL] His date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service that you're inquiring claim status for?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what was your name? I forgot your name just to say.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] is fine.
[AGENT][NEUTRAL] So it looks like $30 went towards the deductible for 99203.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] $235.
[AGENT][NEUTRAL] to the deductible for 930901.
[AGENT][NEUTRAL] I'll place you on a brief hold.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you. I'll be right back.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding. So I've sent that information over to the adjuster to review this the to review the claim and repro the claim with reprocess the claim with additional payments to the provider.
[CUSTOMER][NEUTRAL] OK, so it's gonna go to the provider then not the member?
[AGENT][NEUTRAL] Right, the first payment went to the provider instead of the member.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, um, is there any kind of like um reference number or something that we can use?
[AGENT][NEUTRAL] Um, we don't provide reference numbers, but would you like the claim number?
[CUSTOMER][NEUTRAL] Um, to give, maybe to give to the provider.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Would you like that claim number?
[CUSTOMER][POSITIVE] Um, yes, that would be great.
[AGENT][NEUTRAL] 352-789-5 that's 352-7895 and the provider received the $30 payment so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and then so um it's gonna go back for reprocessing for some additional payments then correct?
[AGENT][NEGATIVE] Additional payment needs to be paid.
[AGENT][NEUTRAL] Mhm, yes, and you said your name was?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alrighty, so I sent that information over to the adjuster for them to reprocess the claim and make additional payments. Is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] That's it thank you.
[AGENT][POSITIVE] Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.