AccountId: 011433970860
ContactId: 4e5659fd-07f1-49ea-945c-9c27c4eed01a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 613580 ms
Total Talk Time (AGENT): 234506 ms
Total Talk Time (CUSTOMER): 162911 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/4e5659fd-07f1-49ea-945c-9c27c4eed01a_20250404T18:59_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] in [PII]. How are you doing?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][POSITIVE] Doing great, doing great, um.
[CUSTOMER][NEUTRAL] I apologize I was trying to jump back to the screen for you.
[AGENT][POSITIVE] That's OK, no worries.
[CUSTOMER][NEUTRAL] OK, sorry about that. OK, I was just calling to see if I could check on a claim for one of our customers.
[AGENT][NEUTRAL] Yeah, absolutely. We can check on a claim. What's the patient policy number?
[CUSTOMER][NEUTRAL] OK, policy number should be, let's see.
[CUSTOMER][NEUTRAL] 221-6237
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] And can I get the patient name and date of birth?
[CUSTOMER][NEUTRAL] Should be uh [PII] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what is the data service?
[CUSTOMER][NEUTRAL] Um, let me see if that's on here.
[CUSTOMER][NEUTRAL] It may be 8:11 24.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It was an accident.
[AGENT][NEUTRAL] Let's see, do we have a charge amount?
[CUSTOMER][NEUTRAL] No, I know that
[CUSTOMER][NEUTRAL] It was the one that was received on 3-21-25.
[AGENT][NEUTRAL] OK, let's see 3.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Let me see if I have a
[AGENT][NEUTRAL] I think there's just
[CUSTOMER][NEUTRAL] Actually I have a claim number ends in 80.
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] It's OK, it ends in 880, the claim number.
[AGENT][NEUTRAL] OK. Yeah, I was gonna say there's only 2 claims so I was gonna.
[AGENT][NEUTRAL] OK, let me pull this claim up here.
[AGENT][NEUTRAL] Alright. So looks like claim was processed on 3-24-25. Uh, looks like a benefit payment was sent in the amount of $1050 and that was to the insured and it was in the form of a single check.
[CUSTOMER][NEUTRAL] OK, um, do you feel that it cleared?
[AGENT][NEUTRAL] Uh, let me double check that for you, one sec.
[AGENT][POSITIVE] Oh, looks like it is still showing outstanding. Um, it was sent to [PII], it looks like 70634.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Let me go look real quick here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry, I'm gonna have to go log out and.
[AGENT][POSITIVE] No, no worries.
[CUSTOMER][NEGATIVE] Problem is I have like 5 sign-ins for the APL website which in turn makes it every time I'm trying to run in and do something quick I'm like wait.
[AGENT][NEUTRAL] It's not so
[CUSTOMER][NEUTRAL] What broker is it under what?
[AGENT][NEUTRAL] Yeah, it's not so quick, huh?
[CUSTOMER][NEUTRAL] Yeah, let's see here. I'm sorry, makes me nervous that they're not receiving these payments um.
[AGENT][POSITIVE] No, no worries.
[CUSTOMER][NEUTRAL] I tell everybody to do direct deposit, but some people are just hard headed.
[AGENT][NEUTRAL] I know. Well, and then it's, it's interesting sometimes too. You'll get somebody that calls and it's like, well, that was direct deposited, and they're like, no, I didn't get that. They're like, I surely would have seen if I had that amount of money like charged or, you know, deposited and then they go check and it's there and you're like, OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Funny.
[CUSTOMER][NEUTRAL] So yes, I see [PII].
[AGENT][POSITIVE] Uh-huh, yeah, that's what we got as well. Yeah.
[CUSTOMER][NEUTRAL] OK, and the.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And you said it was sent out on.
[AGENT][NEUTRAL] It's processed it looks like on the.
[AGENT][NEUTRAL] Go back to the date here.
[AGENT][NEUTRAL] On [PII], so.
[AGENT][NEUTRAL] Go back to a calendar and see. So the [PII] was a Monday.
[AGENT][NEUTRAL] That would have been a week ago from this Monday that it, so if it was issued on the [PII], it would have been mailed out uh like the next day. So I feel like the insured should have had it by this point.
[CUSTOMER][NEUTRAL] OK, I'll reach out to the group, um.
[CUSTOMER][NEUTRAL] OK, do you show any other checks like, like under her hospital plan? Was there a check processed on there for this claim as well?
[AGENT][NEUTRAL] Oh, for the hospital? Let me check her hospital policy. Give me just a second here.
[AGENT][NEUTRAL] I'm on the
[AGENT][NEUTRAL] A
[AGENT][NEUTRAL] Alright
[AGENT][NEUTRAL] So there was a claim process on the hospital policy, claim number ending in 1192, that one paid. Let me pull that up here.
[AGENT][NEUTRAL] Uh, so that sent the, excuse me, the insured a benefit check in the amount of $100. And so that was issued on [PII]. That would have been, it looks like a few days later.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But that's the only.
[CUSTOMER][NEUTRAL] OK, so the, the.
[AGENT][NEUTRAL] That's the last one.
[CUSTOMER][NEUTRAL] And that one has not been cash, correct?
[AGENT][NEUTRAL] Oh yeah, let's see.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] Correct, yeah, still showing outstanding.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Alright, I'll reach out to her and uh see what we can do. I'm, I'm thinking I probably need to get that checking info.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] All right. Was there anything else I can check on for you?
[CUSTOMER][NEUTRAL] Oh, you know what, I apologize. Her husband was actually in the car with her and filed an accident claim, but I wanna say.
[CUSTOMER][NEUTRAL] Something may have um.
[CUSTOMER][NEUTRAL] Happened on his.
[AGENT][NEUTRAL] Well, let's go back to the accident.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so his claim looks like was denied. It was in order to complete the processing of this claim, we need an itemized statement of services provided with diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What's crazy is I think he, she had a UB04 and he had something different.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] But I know he had.
[CUSTOMER][NEUTRAL] He had a claim form that was clean. He had an itemized bill that shows.
[CUSTOMER][NEUTRAL] I'm looking at it real quick it's got.
[CUSTOMER][NEGATIVE] Got a bunch of charges.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] CT scan.
[CUSTOMER][NEUTRAL] Got an ambulance bill.
[CUSTOMER][MIXED] Got the accident report. It's pretty clean. The only thing I don't see is the diagnosis codes on here.
[CUSTOMER][NEUTRAL] Let's see.
[AGENT][NEUTRAL] And he doesn't need to uh resubmit everything, honestly, like if he could just submit the diagnosis, that's it, and they'll continue to process the claim, so he doesn't have to redo everything.
[CUSTOMER][NEUTRAL] OK, you know, I wish they would always just include diagnosis codes on these bills, you know, and make it so much easier, um, a lot of these places separate the code.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It would, it would.
[CUSTOMER][NEUTRAL] For some reason, a lot of these places separate the code from the billing.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] Right. And then, well, and a lot of people, if they're doing it on their own, you know, at no fault of their own, just don't know what a diagnosis code is supposed to look like, you know. So, I get it, yeah.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][POSITIVE] OK, I will be sure and let them know and uh I appreciate your time.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah, not a problem. Anything else?
[CUSTOMER][POSITIVE] That's it. Have a great day.
[AGENT][NEUTRAL] You too. Bye bye.
[CUSTOMER][POSITIVE] Thank you bye bye.