AccountId: 011433970860
ContactId: 47a9602f-ad4f-4091-aed2-4fbaa22ef3ee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 925510 ms
Total Talk Time (AGENT): 254841 ms
Total Talk Time (CUSTOMER): 372248 ms
Interruptions: 7
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/47a9602f-ad4f-4091-aed2-4fbaa22ef3ee_20250523T18:56_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, I'm sorry, I didn't catch your name.
[AGENT][NEUTRAL] Excuse me, I'm sorry, it's [PII]
[CUSTOMER][NEUTRAL] [PII], hi, hi, [PII], how are you doing today? This is [PII].
[AGENT][NEUTRAL] Hi.
[AGENT][POSITIVE] I'm good.
[CUSTOMER][POSITIVE] Good good.
[CUSTOMER][NEUTRAL] [PII], I'm hoping you can help me with this. Um, I have a member and I have a claim date. I wanna see if.
[CUSTOMER][NEUTRAL] Any claims are on file with you guys for this specific date.
[AGENT][NEUTRAL] OK, yes, ma'am. Excuse me, I can verify claim status for you.
[AGENT][NEUTRAL] And Ms. [PII], do you have that, uh, policy number?
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] I do. It is 216-657-1.
[CUSTOMER][NEUTRAL] And the member is [PII].
[AGENT][NEUTRAL] OK. And the date of birth?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, and let's see, what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] The date of service was [PII] and the total was 13,350 97 cents.
[AGENT][NEUTRAL] OK. And do you have the balance after primary?
[CUSTOMER][NEUTRAL] I believe it was 3,492 and 28 cents.
[AGENT][POSITIVE] OK, thank you. Give me one moment.
[AGENT][NEUTRAL] And was this for facility charges, I'm assuming?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, I believe this was a hospital.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Stay it was uh uh outpatient hospital outpatient.
[AGENT][NEUTRAL] Excuse me, and I'm so sorry, uh, you're calling from again, Ms. uh, [PII]?
[CUSTOMER][NEUTRAL] A policy number?
[AGENT][NEUTRAL] No, you're calling from?
[CUSTOMER][NEUTRAL] Oh, the office, I'm sorry, I'm calling from [PII]'s office.
[AGENT][NEUTRAL] Oh, OK, so you're with Crescent City benefits?
[AGENT][NEGATIVE] Oh no, that's no.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] My bad. I don't know.
[CUSTOMER][NEUTRAL] Medical group benefits, that's OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I'm from the agent's office.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEGATIVE] Excuse me. I'm sorry I keep coughing your ear. I took a sip and went down the wrong way.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Oh no, that's OK.
[CUSTOMER][NEGATIVE] I hate when that happens.
[AGENT][NEGATIVE] Oh, me too. I've had it to where coffee has shot out my nose and it was just horrible, like.
[CUSTOMER][NEGATIVE] Oh no. Oh my gosh, I can't imagine my burning.
[AGENT][NEGATIVE] I was smelling coffee for a good while. Yeah, it was pretty bad.
[CUSTOMER][MIXED] Oh my gosh, not a bad smell though. I do like the smell of coffee, but I can't imagine how bad that burned.
[AGENT][NEUTRAL] No.
[AGENT][NEGATIVE] Oh, it was horrible. I was like, try not to do that again.
[CUSTOMER][NEUTRAL] I'm done.
[CUSTOMER][NEGATIVE] Yeah, no.
[AGENT][NEUTRAL] OK, I do show that claim was processed and the benefits were paid to the provider.
[CUSTOMER][NEUTRAL] OK, and another question, did that, it was, um, what was the date I guess that she maxed out her benefit in [PII]?
[CUSTOMER][NEUTRAL] Can you see that on your end?
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Give me one, let me see.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] If it's max 48.
[AGENT][NEUTRAL] 0
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Looks like
[AGENT][NEUTRAL] She had maxed her benefit, um, like [PII] of this year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what about last year?
[AGENT][NEUTRAL] Oh well, that, I'm sorry, that was for last year.
[CUSTOMER][NEUTRAL] OK, so she, she maxed out [PII] her outpatient benefit, the 4800.
[AGENT][NEUTRAL] I'm sorry, of 25. That's when the last claim for [PII] was paid.
[AGENT][NEUTRAL] Oh, that date, um, the date of service looked like it was [PII]. So I guess [PII] is when she met her max.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, because, yeah, she, because she still had a like a patient responsibility about 900 bucks, so that's why I was just trying to figure out if that the 2500, I believe the you all paid out $2500.28 on this particular claim if if she had maxed out at that point, so she must have then [PII] was when she maxed out in [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Correct, OK, OK, well I appreciate your help. Thank you so much, [PII].
[AGENT][POSITIVE] Yes, ma'am. You have a great day. And is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] There might be one other actually.
[CUSTOMER][NEUTRAL] Yes, OK, hold on, let me get the sheet really quick.
[AGENT][NEUTRAL] Is it for a different patient or, oh, OK.
[CUSTOMER][NEUTRAL] There's one other method.
[CUSTOMER][NEUTRAL] Different group, yeah, give me one second.
[AGENT][NEUTRAL] Let me type in this note real quick.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just let me know when you're ready.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Y'all are in [PII], right?
[CUSTOMER][POSITIVE] Yes we are.
[AGENT][NEUTRAL] Have they caught those um
[AGENT][NEUTRAL] The people that broke away, yeah, did they catch the inmates.
[CUSTOMER][NEUTRAL] The inmates.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEGATIVE] I think there's still like 4 that they haven't caught.
[AGENT][POSITIVE] Oh wow.
[CUSTOMER][NEUTRAL] So yeah, it's still, and they caught a lot of them in the French Quarter just roaming around so it's like we're staying away in the French Quarter, yeah, downtown [PII], so we're kind of just steering clear for until it's all clear, you know.
[AGENT][NEUTRAL] In the French Quarter?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] I guess because tours is there.
[CUSTOMER][NEUTRAL] Crazy, just.
[CUSTOMER][NEUTRAL] Yeah, I just, I can't imagine, you know, like, uh, what, what goes into escaping from prison? Like you gotta have a plan, you know, you gotta get out of state if you wanna stay out of prison, but they're just roaming the streets of [PII]
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] It's like, let me just go to the French Quarter.
[CUSTOMER][NEUTRAL] Right, exactly. Like.
[AGENT][NEUTRAL] Wearing orange jump, you know, inconspicuous.
[CUSTOMER][NEUTRAL] It's crazy. They and they have them, they're catching them on camera left and right, you know, all the hotels around there, any business that has cameras outside, they're just, they're catching them on camera, but they have them, um, I wanna say it's like.
[CUSTOMER][NEUTRAL] Uh, if you, if you see one or report one, you get like $20,000 per inmate that you report. Yeah.
[AGENT][NEUTRAL] Oh, what? I need to go there for a day. I can be hunting down for y'all.
[CUSTOMER][NEUTRAL] Yeah, that's what all my friends have been telling me. They're like, you better go get out there and look for him. You need that.
[AGENT][NEUTRAL] Right, let me be a bounty hunter.
[CUSTOMER][POSITIVE] Oh yes. Yeah.
[AGENT][NEUTRAL] I'll be the snitch. I was there right there. Give me my 20,000.
[CUSTOMER][NEUTRAL] Oh man, it's crazy.
[CUSTOMER][POSITIVE] Right. Yes, exactly.
[AGENT][NEUTRAL] That is wild.
[CUSTOMER][POSITIVE] Oh my goodness. It is.
[AGENT][POSITIVE] That's a big incentive for sure.
[CUSTOMER][NEUTRAL] It right, I know. I wanna say they started it lower than that and now I don't know, I guess they're getting desperate. They raised it to 20,000.
[AGENT][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] So crazy.
[AGENT][NEUTRAL] Hopefully you don't have to file taxes for it, if you have.
[AGENT][NEUTRAL] catch somebody, you know what I mean, just straight up 20,000.
[CUSTOMER][NEUTRAL] Right, but I, right, but I can imagine cause that's what I was thinking too. I was like, well, you probably be taxed on it, you know.
[AGENT][NEUTRAL] That would be mean. OK, I'm ready. What's the next policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] The next number is 1,912,980. This is [PII].
[AGENT][NEUTRAL] OK. And uh her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Awesome and what was that date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII]. I'm just trying to check and see if you all have any claims on file for that date.
[AGENT][NEUTRAL] Uh, see several claims for the daily service. Do you have a particular provider or amount?
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It was
[CUSTOMER][NEUTRAL] Do you see?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The total was 1,121 and 90 cents.
[AGENT][NEUTRAL] Do you happen to have the balance after primary?
[CUSTOMER][NEUTRAL] Do you see that?
[CUSTOMER][NEUTRAL] I was, I think that actually is the balance after primary.
[CUSTOMER][NEUTRAL] The total was actually 2616.
[AGENT][NEUTRAL] Uh, and was this for the facility or physician's charge?
[CUSTOMER][NEUTRAL] It was a facility.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] MGA gastrointestinal diagnostic and Therapeutic Center.
[AGENT][NEUTRAL] OK, that's
[AGENT][NEUTRAL] Mm let me see.
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh wait, let me see.
[CUSTOMER][NEUTRAL] Maybe do some math.
[AGENT][NEUTRAL] Come on computer.
[AGENT][POSITIVE] I think he's ready for a vacation too.
[CUSTOMER][NEUTRAL] Aren't we all?
[AGENT][NEGATIVE] Uh no.
[CUSTOMER][NEUTRAL] Do you see, OK, maybe, do you see an amount, maybe it's $1,494.10?
[AGENT][NEUTRAL] I'm trying to pull up the claim to look at the amount to see if it's the one you're inquiring about.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Because there were several for this data service.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] OK, yes, uh, it looks like we did receive that claim and.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the payment was sent to the insured.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK, payment was sent.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Do you know how much? Can you see how much it was?
[AGENT][NEUTRAL] 78532.
[CUSTOMER][NEUTRAL] OK, and can you, can you tell when that was sent out?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, this was sent out on [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. OK, got you.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][POSITIVE] OK, well, that's, that's all I need from you today. That's all the ones that I had on my, on my list. So I appreciate your help so much, Key.
[AGENT][POSITIVE] Alright, you're welcome, Ms. [PII]. Thanks for calling APL. You have a great weekend and try to get that 20,000.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] If you can, be careful.
[CUSTOMER][POSITIVE] Thank you. I'm gonna, I'm gonna go out on the hunt. I'm gonna go out on the hunt this weekend.
[AGENT][NEUTRAL] Just be careful.
[CUSTOMER][POSITIVE] I know, I know, thank you so much have a good weekend.
[AGENT][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye.