AccountId: 011433970860
ContactId: 4fdfcc37-b15e-448e-8280-6e04263357fd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1162260 ms
Total Talk Time (AGENT): 238779 ms
Total Talk Time (CUSTOMER): 281813 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.1, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/4fdfcc37-b15e-448e-8280-6e04263357fd_20250314T21:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, I was trying to check up on the uh claim. I had, I had a claim and then I, they needed more information and I sent all my uh explanation of benefits uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, I'm happy to check on the claim for you today. Do you by chance have your policy number?
[CUSTOMER][NEUTRAL] Uh, I do. Let me, I gotta look for it. uh, oh, hold on, I got it. I think right here, uh, 252-329-4.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, let me pull this up here.
[AGENT][NEUTRAL] And then if I could get your first and last name and date of birth.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Date of birth please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then if I could get your address that we should have on file, [PII].
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] All right, thank you so much.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then the email address on file is a [PII] account. Is that one still good for you?
[CUSTOMER][NEUTRAL] Yes, yes, ma'am.
[AGENT][NEUTRAL] OK, great. Alright [PII], so it looks like the claim was processed today, so there was a benefit payment made in the amount of $3,382.52. It looks like that's gonna be direct deposited, so you should have that in the next few days. It may be Monday or Tuesday since it's a Friday today.
[CUSTOMER][NEUTRAL] And, uh, uh, you cut out how much it is you pay?
[AGENT][NEUTRAL] It was $3,382.52.
[CUSTOMER][NEUTRAL] OK, so that's probably the whole claim that I did because I, OK, because I sent them all separate, so that's probably the whole thing or is it just one of them?
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Yeah, it looks like it is. The only thing that I see on here.
[CUSTOMER][NEUTRAL] Do
[AGENT][NEGATIVE] That looks like did not process.
[AGENT][NEUTRAL] You had some radiation.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so the radiation was not paid out. It looks like we need itemized bill for that.
[CUSTOMER][NEUTRAL] I did. I sent them.
[AGENT][NEUTRAL] Did you? OK, let's see.
[CUSTOMER][NEUTRAL] That's why I say uh-huh, I sent them.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah, all of the radiations that you, you, uh, they sent uh the uh what is it? they was asking for the explanation of benefit.
[AGENT][NEUTRAL] So I know that there are, like, I know, um, let me see what else this may say on the, if there's any more claim details. Cause I know sometimes they do need the explanation of benefits from the primary, but with like radiation and chemotherapy, they'll ask for like an itemized bill showing the dates in which you received the radiation.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, and that's on the, uh, that's the ones that I sent in first, and when I sent those in first, that's when they asked for the uh explanation of benefits. The radiation is what I sent in first, and then that's when they asked for the explanation of benefits and then I had to get all the explanation of benefits.
[AGENT][NEUTRAL] Mm.
[AGENT][NEGATIVE] I'm tired.
[AGENT][NEUTRAL] I'm just trying to pull up what you had submit here.
[CUSTOMER][NEUTRAL] Yes ma'am, no ma'am.
[CUSTOMER][NEUTRAL] Go here. Oh, my hand.
[CUSTOMER][NEUTRAL] Oh, it's been a long day today.
[AGENT][NEUTRAL] Let's
[AGENT][NEUTRAL] I see what you had uploaded so.
[AGENT][NEUTRAL] Let me see if I can reach out [PII] to the examiner to see if they can tell me exactly what it is that you don't have here that maybe is needed for that, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, all right, thank you so much uh huh.
[AGENT][NEUTRAL] All right, thank you. One moment. Uh-huh.
[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][POSITIVE] Thank you so much for your patience and waiting, [PII]. So in in looking at this, it looks like there were just two dates where it was missing. So everything was submitted, but we didn't get it for [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And then [PII], the itemized bill.
[CUSTOMER][NEUTRAL] [PII] and [PII]?
[AGENT][NEUTRAL] Mhm. Those were, it looks like the dates of service because those were the two that are showing denied. Everything else had a paid next to it. So,
[CUSTOMER][NEUTRAL] January then that's what they need the uh.
[CUSTOMER][NEUTRAL] You said the itemized for that?
[AGENT][NEUTRAL] Right, the itemized billing from the provider with the procedure code just for
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] [PII] and then the [PII] date.
[CUSTOMER][NEUTRAL] OK, hold on, just let me see on my uh.
[CUSTOMER][NEUTRAL] See.
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Thank you. That's the uh.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] And all my automatic deals together.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it's January, I mean, yeah, the [PII].
[CUSTOMER][NEUTRAL] They had um
[CUSTOMER][NEUTRAL] In February with a
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that I, I got it right here. They have to have missed it.
[AGENT][NEGATIVE] I scrolled through the 16 pages and I just didn't see those.
[CUSTOMER][NEUTRAL] The 6
[AGENT][NEGATIVE] Dates, unfortunately.
[CUSTOMER][NEUTRAL] I got um.
[CUSTOMER][NEUTRAL] It's got
[CUSTOMER][NEUTRAL] Um, I see [PII] and then they got that D uh 20 and then it's got 1410 and then it's got HM 3 1410.
[CUSTOMER][NEUTRAL] And for the [PII] is God.
[CUSTOMER][NEUTRAL] Uh, D 201337 and then MHM 3 1337. I don't know because and it's and I sent that this this thing.
[CUSTOMER][NEUTRAL] That's weird.
[CUSTOMER][NEUTRAL] And what cos are they looking for? Cause it's got here posted on the [PII] of on [PII] they got 772-80 therapy radiation, um.
[CUSTOMER][NEUTRAL] Simulation aid and field sitting.
[CUSTOMER][NEUTRAL] For that, they got another code, a G602. Ma, do I just send this and then for the.
[CUSTOMER][NEUTRAL] They got it for the [PII].
[CUSTOMER][NEUTRAL] Posted the [PII]. This service was on the [PII].
[CUSTOMER][NEUTRAL] And this is the service that's on the [PII]. It was posted on the [PII] and it's got service on the [PII] and they got codes too. Do I send these two pages for them or?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, you would send yes you would send those with those dates of service because when I scrolled through and looked at the invoices I just don't see those dates so it's a lot of paperwork it may have just, you know, it didn't.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yes, it is, it, it is.
[AGENT][NEUTRAL] It just, yeah, I just, I may have gotten missed, and it's not a big deal. You can just upload those two for the [PII] and [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, because I was gonna say I could, uh, I'll send them and I could, uh, if it'll be 3 page I could circle them or because uh it it is a lot of stuff and I don't even know what what I'd be looking at, but uh.
[AGENT][NEUTRAL] Yeah, so if you have what you were talking about that invoice with the G6 what send that for the [PII] and just [PII], and then I'll give you this claim number if you need it. You can write that on top of it.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] On top of it, OK, hold on, give me a second.
[CUSTOMER][NEUTRAL] And then I just send it like I sent that other one.
[CUSTOMER][NEUTRAL] I put attention APL claim department.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, now when I go to find a pen, you can't find a pen when you're not looking for a pin.
[CUSTOMER][NEUTRAL] Oh, OK, what's the claim number?
[AGENT][NEUTRAL] Well.
[AGENT][NEUTRAL] So claim number is going to be 357.
[AGENT][NEUTRAL] 59.
[AGENT][NEUTRAL] 00.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then I'll put attention APL claim department and then put my policy number on there.
[AGENT][NEUTRAL] Mhm. Exactly, yup.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you so much. I appreciate that.
[AGENT][POSITIVE] My pleasure. You have a blessed day, [PII].
[CUSTOMER][POSITIVE] Uh-huh, thank you.
[AGENT][NEUTRAL] Bye bye.