AccountId: 011433970860
ContactId: 48906259-e686-4b46-9ae4-b0eda3f651e9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 458399 ms
Total Talk Time (AGENT): 172071 ms
Total Talk Time (CUSTOMER): 194980 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.1, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/48906259-e686-4b46-9ae4-b0eda3f651e9_20250527T13:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] in Bricker Resources. I have a broker on the phone that's calling to check status of a claim on one of his employees into this group. I have the policy number. Oh, I did, yeah, I do. You ready?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment, whoopsies.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Sorry, my allergies are killing me.
[CUSTOMER][POSITIVE] Oh, I know, I can, I feel you.
[AGENT][NEUTRAL] OK. And what's the policy number?
[CUSTOMER][NEUTRAL] It's 256-521-8.
[CUSTOMER][NEUTRAL] [PII] or [PII].
[AGENT][NEUTRAL] 521 8.
[AGENT][NEUTRAL] Did he, did they verify the?
[AGENT][NEUTRAL] Patient, you said?
[CUSTOMER][NEUTRAL] He, I didn't verify the, I didn't verify the insured fully. I have [PII] who's the agent, and I've got his callback number.
[AGENT][NEUTRAL] OK, what's the callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] He's saying that he's calling regarding a claim that was filed and just wants the status of when it's gonna be processed.
[AGENT][POSITIVE] OK, I can help with that um you can send them over.
[CUSTOMER][NEUTRAL] OK. OK, just one second. Let me, OK, just 1 2nd.
[CUSTOMER][NEUTRAL] Hi [PII], can you hear me? Yeah I hear you. What's up? All right, I've got [PII] on the phone from our claims department and she's gonna help you with the status of that claim, OK? OK, OK, thank you.
[CUSTOMER][POSITIVE] Have a great day thanks for calling APO bye bye. OK thank you bye.
[AGENT][NEUTRAL] Hi [PII], I know you needed um.
[CUSTOMER][NEUTRAL] Hi
[AGENT][NEUTRAL] Some claim status. Can I go ahead and get you to verify your name and the uh
[AGENT][NEUTRAL] The agency you work for?
[CUSTOMER][NEUTRAL] The employee
[CUSTOMER][NEUTRAL] The it's a Centurion restaurant group. It's group number 21471.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK, I have, uh, let me see let me your employee.
[CUSTOMER][NEUTRAL] Date of birth, do I have it? Is it here? Of course it's not there.
[CUSTOMER][NEUTRAL] I give you his last 4 of his social.
[CUSTOMER][NEUTRAL] Will that work?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Well, what do you, what do you have for his social?
[AGENT][NEUTRAL] And his name.
[CUSTOMER][NEUTRAL] Uh, I have the I have the last four digits which is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm, I'm in your APL app.
[AGENT][NEUTRAL] Your name?
[CUSTOMER][NEUTRAL] His name is [PII].
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh the claims are in there. I see the claims in there because I put I think I put them in myself way back when.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Back on [PII] and I'm just trying to find out what the status is because they called me on Friday and they called me too late on Friday for me to call you but I'm trying to figure something out, see if I can give you an answer.
[CUSTOMER][NEUTRAL] When he should be expecting something or how much.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So you're needing it for, well they have the same claim number, so let me see.
[AGENT][NEGATIVE] It looks like they were denied.
[AGENT][NEUTRAL] Let me see why.
[CUSTOMER][NEUTRAL] It was
[CUSTOMER][NEUTRAL] It was denied?
[AGENT][NEUTRAL] Yes, um, here we go. It looks like we need the uh copy of the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Why?
[AGENT][NEUTRAL] And then
[CUSTOMER][NEGATIVE] Well, nobody sent me an. Why didn't anyone send me an email asking me for this stuff because I would try to look for it.
[AGENT][NEUTRAL] I don't know why you wouldn't have gotten one.
[AGENT][NEUTRAL] Um, I can send you, would you like me to send you the, uh, denial reason?
[CUSTOMER][NEUTRAL] Yeah, please.
[AGENT][NEUTRAL] It'll be an REOB. Let me pull it up real quick, make sure that it pulls up properly before I give it to you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It'll have both of those on there, um, and you can just resubmit it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] With the claim number and I can give you the claim number and it'll be on the paper that I give you as well.
[CUSTOMER][POSITIVE] OK, I'm ready whenever you are.
[AGENT][NEUTRAL] OK, it's taking a while to pull up.
[CUSTOMER][NEUTRAL] What's the what's the claim number?
[AGENT][NEUTRAL] The claim number is 35.
[AGENT][NEUTRAL] 90
[AGENT][NEUTRAL] 642.
[AGENT][NEUTRAL] And I'm just waiting for it to pull up.
[CUSTOMER][NEGATIVE] Yeah, because I mean jeez, it's already, it's already the end of May and it should have been done. I mean someone should have sent me something a long time ago.
[AGENT][NEUTRAL] Let me see what this one is.
[CUSTOMER][NEUTRAL] Because your website's very vague, it just says processed I'm like, alright, what does that mean?
[AGENT][NEGATIVE] Oh, OK. Yeah, cause it shows, it shows denied.
[AGENT][NEUTRAL] OK. And would you like this through fax?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Would you like me to send you the denial through fax so that you can get it quicker email? OK.
[CUSTOMER][NEUTRAL] No email.
[CUSTOMER][NEUTRAL] No email yeah.
[AGENT][NEUTRAL] And can you verify the email to make sure I have one on file, the right one on file? Mhm.
[CUSTOMER][NEUTRAL] You're ready?
[CUSTOMER][NEUTRAL] OK, [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I will get that out to you. Give me about 5 minutes after this call, um, check your spam just in case it goes there, um, but expect the email within 5 to 10 minutes, OK?
[CUSTOMER][NEUTRAL] I will.
[CUSTOMER][NEUTRAL] Alright, [PII]o if I get the, so if I get the EOB, uh, then, uh, they'll review the claim again?
[AGENT][NEUTRAL] Yeah it's looking like it needed more documentation to um.
[AGENT][NEUTRAL] Let me see supporting documentation.
[CUSTOMER][NEUTRAL] Let me, let, let me know so I can let the client know and so she can get the information from the guy because I, I sent, that's where I sent the receipt I sent the uh.
[CUSTOMER][NEGATIVE] They're supposed to be discharge instructions.
[AGENT][NEUTRAL] Yeah, it looks like it's needing something such as the itemized bills with diagnosis codes, office notes, hospital admission. um, it'll say more in the remark description in the EOB that I'm about to send you.
[CUSTOMER][NEUTRAL] Oh, so it'll it'll it
[CUSTOMER][NEUTRAL] It'll all be in the email what I need?
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][POSITIVE] OK wonderful OK
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEGATIVE] I mean it's very unprofessional.
[CUSTOMER][NEGATIVE] No, no, I just wish, I just wish, I wish I could understand why if I submitted something on [PII] and then now it's the end of May and I haven't heard anything back from you guys, I think it's very unprofessional. Why didn't I get notification?
[AGENT][NEUTRAL] It looks like it sent the email to or I'm sorry, it looks like it sent the mail to the patient.
[CUSTOMER][NEGATIVE] I just got denied. Did they even
[CUSTOMER][NEUTRAL] They sent them to the patient
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] Oh Jesus, no wonder he doesn't speak English that well, so that's why he probably didn't even know what the hell he got. Alright, just send me that so I can get it over to the to the HR person that, uh, so so you can try to get it from the guy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, I'll wait for the email. Thank you so much. No, that's it. OK, thank you, bye.
[AGENT][NEUTRAL] Alright, is there anything else you need? OK.
[AGENT][POSITIVE] Alright, thank you for calling ATL have a great day.
[CUSTOMER][POSITIVE] OK you too bye.
[AGENT][NEUTRAL] Bye.