AccountId: 011433970860
ContactId: 4fc0971a-09cc-4383-a379-f1248b00b312
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 375119 ms
Total Talk Time (AGENT): 184806 ms
Total Talk Time (CUSTOMER): 182509 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/4fc0971a-09cc-4383-a379-f1248b00b312_20250307T20:50_UTC.wav
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[AGENT][POSITIVE] Good afternoon thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, I was calling because I received a letter from you guys saying that there is a claim on my policy and that the claim has the review of the claim has started. Um, I haven't worked for, um, the contracting agency that I have this policy with since June. So what, what is the claim?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] I would be the same way. I'll be happy to help you with that. Do you have your policy number available?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You know, I don't, I tossed basically everything after because I figured I don't have size anymore. So is there another way to look it up?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Not a problem, yes ma'am, it would it be OK to use your social?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And that number?
[CUSTOMER][NEUTRAL] It's um
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And what is your name?
[CUSTOMER][NEUTRAL] [PII] excuse me, [PII].
[AGENT][NEUTRAL] All right. Thank you, Ms. [PII]. Can you verify your date of birth and current mailing address?
[CUSTOMER][NEUTRAL] Um, [PII] and my address is [PII].
[AGENT][NEUTRAL] OK, and then what is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, that's it.
[AGENT][NEUTRAL] OK, that's [PII].
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, it looks like your um there was a facility that sent in a claim.
[AGENT][NEUTRAL] Looks they probably had still had your policy information. Let me see who sent that in. Texas Oncology.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] Oh, wait, wait, wait, wait. I'm sorry, let me, let me do that again. Hang on.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I pulled up a different one. Premier diagnostic.
[AGENT][NEUTRAL] Sent in a claim.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] OK, um, do you guys have like a number or something for them? Um, because what what ended up happening was, um, after I stopped working for, um, the contracting agency, um, I applied for medical financial assistance through the through the hospital that I went to, and I was approved, but the kicker is that none of those, uh, they never apply it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Automatically I have to call and remind them that I have it, which is kind of a pain, but I have to do it. So if you have like a number or something I can reach them and let them know to apply my medical financial assistance that should wipe this claim away like a claim.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So I pulled up the claim and there is no phone number for them.
[CUSTOMER][NEUTRAL] Oh, OK. What was their name again?
[AGENT][NEUTRAL] Uh, Premier Diagnostic, it was also [PII] Mission Hills.
[CUSTOMER][NEGATIVE] That is not OK.
[AGENT][NEUTRAL] They they see Mission Hills was where the service was rendered. Their billing provider is Premier Diagnostic. That's who they bill through.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEGATIVE] Gotcha.
[CUSTOMER][NEUTRAL] They bill them. OK, I'll contact [PII] and get a contact number from them. Um, is there a way to tell you guys like I'll take care of it, don't worry about it, or like because I once I get this sorted out, like there shouldn't be an existing claim.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, so what'll happen um and now if a provider sends in a claim then we are bound, you know, to process the claim.
[AGENT][NEUTRAL] And I was just checking.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And we did just receive another claim from them.
[AGENT][NEUTRAL] And this one was for data service.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] 225, the one that we processed in March was for data service 4824.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Well, yeah, at 4 824 I was still working, so that one is OK, but.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] OK, um, but you guys, so like I haven't paid into this, so when you guys receive a claim from someone that's not a policy holder anymore, don't you just tell them like we don't, this person isn't like one of ours anymore?
[AGENT][NEUTRAL] So, uh, for example, your policy was paid through [PII] prior to that, you know, we would honor any claims sent in because there's no timely filing if it is for a data service after [PII], then the claim would be denied as no um services were rendered after the policy lapsed, so they'll get a notification that the policy had in fact turned but of course for these dates of service your policy was still.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Active.
[CUSTOMER][NEUTRAL] Was it really?
[AGENT][NEUTRAL] Well, oh, no, no. I'm sorry, [PII], no, ma'am. I'm sorry. I still have trouble with [PII] sometimes. I do apologize.
[CUSTOMER][NEUTRAL] Right, yeah.
[CUSTOMER][NEUTRAL] That's OK. So, I wanted to make sure cause I was like, I'm not paying any, any into it, so like, I don't know who's paying for it. Um, OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, OK, I'll, I'll get it sorted out and then I'm sure you guys will, you know, do your part to realize like I'm, I haven't been.
[CUSTOMER][NEUTRAL] In what is it, you know, in the policy for quite some time, OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, yeah.
[AGENT][NEUTRAL] Right, and that's not a problem. I mean, even, but like I said, if we receive a claim document we have to process it, so that's why you're getting that explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got you. OK. Well, um, I'll try to sort this out today.
[AGENT][NEUTRAL] Well, if you need anything else, you don't hesitate to give us a call. Do you want your policy number that these claims are coming in on? That way if you have to call back or whatever. It's policy number 246.
[CUSTOMER][NEUTRAL] Oh sure, that
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 1025.
[CUSTOMER][NEUTRAL] 246
[CUSTOMER][NEUTRAL] 10252461025
[AGENT][POSITIVE] That's right.
[CUSTOMER][POSITIVE] Oh, OK, thank you so much, [PII]. I appreciate your help.
[AGENT][POSITIVE] Well, it's been such a pleasure to assist you and Ms. [PII], you have a wonderful weekend. Let us know if we can be of any further assistance.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] I