AccountId: 011433970860
ContactId: 51b89d3a-6cb1-41fa-bdc1-993364d1b969
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 740049 ms
Total Talk Time (AGENT): 346229 ms
Total Talk Time (CUSTOMER): 250936 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/51b89d3a-6cb1-41fa-bdc1-993364d1b969_20250528T20:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi there, um, we're new to using APL. We've used other, um, similar plan in the past. I actually handle our company's, um, benefits and stuff. I submitted, um, claims for myself.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And I submitted the, the explanation of benefits showing it was um a hospital, it was a deductible and.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I got a notice saying like I need to provide more information like bill statements or something like that so I went online I uploaded, you know, the statements from the provider and then that was also denied because it said it was a duplicate claim so somebody's one person's not talking to the other person.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright, I can help you with your claim information. um, can I please get your name and your callback number just in case the call is dropped.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, um [PII]
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And the number is [PII].
[AGENT][NEUTRAL] OK, thank you, Miss [PII] and then what is your policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] If I'm logged in, is it somewhere on here? I
[CUSTOMER][NEUTRAL] Like when I look online.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes, it'll say policy certification number or certificate number.
[AGENT][NEUTRAL] Member
[CUSTOMER][NEUTRAL] I know, but where do I go? Where do I go to see a
[AGENT][NEUTRAL] Uh, it would be on your policy that's in the online service center.
[CUSTOMER][NEUTRAL] OK, let me log out and log in again because I don't see anything, so I will try to get it for you again since you can't look it up.
[CUSTOMER][NEUTRAL] Hold on.
[AGENT][NEUTRAL] I can look it up. Let me try to look it up with your name. I just asked to see if you had it because it's a quicker process, but let me try to find by your name.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I'm logging back in again.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, policy number 2572507.
[AGENT][POSITIVE] 257-2507. OK, thank you very much, Miss [PII].
[CUSTOMER][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] OK, I'm gonna need for you to please verify your policy for me. Can you please give me your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, ma'am and then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, and then your phone number that we have on the policy for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, ma'am. I appreciate you verifying that information for me, Miss [PII].
[AGENT][NEUTRAL] OK, let me look at your claims here and see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What's going on? And it's a claim for yourself?
[CUSTOMER][NEUTRAL] Um, yeah.
[AGENT][NEUTRAL] OK, alright, do you have a claim number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, yeah, so there's two OSC 98031 and 32.
[CUSTOMER][NEUTRAL] That's the two that were denied and then I have a claim number when I gave the supporting documentation, which is a whole different number.
[CUSTOMER][NEUTRAL] You want that one too?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, so I'm showing that there was, there's two claims that were submitted on [PII], 1 on [PII] and one on [PII]. The one on [PII] is the one that you got the information on that it was a duplicate claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I showed one, the one that was submitted on [PII] was actually paid.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it's for
[CUSTOMER][NEGATIVE] Yeah, that was submitted by not me. I don't even care about that. Let's talk about the two that I'm calling about.
[AGENT][NEUTRAL] OK, let me look real quick see if I can see if there's.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, and what is the date of service for the one that you?
[AGENT][NEUTRAL] Are calling about.
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] It's gonna be just a minute while I research this real quick on these claim numbers.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so what it looks like to me is.
[AGENT][NEUTRAL] When it was submitted with the correct information.
[AGENT][NEUTRAL] And it was submitted through the online service center. It gave it a confirmation number, so it gave it a duplicate saying that it was duplicated. Did you submit only the EOB information or did you submit the complete claim again?
[CUSTOMER][NEUTRAL] Uh let me look.
[CUSTOMER][NEUTRAL] I mean I'm looking at the file no I submitted the complete thing, everything.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, that's why it it that's why it duplicated because they only needed that one piece of information to complete the claim.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And then, um,
[AGENT][NEUTRAL] That's the only reason why it's just because there was duplicate information.
[CUSTOMER][NEUTRAL] So, so let's let me be clear, let, wait a minute, let me be clear.
[CUSTOMER][NEUTRAL] When I filed the first time, I submitted the EOB.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] That's not enough for you to, for you to pay something?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Because it clearly states on because it's clearly states it's a deductible, you know, on the EOB.
[AGENT][NEUTRAL] Correct. We always need to have the explanation of benefits and always the itemized statement from the provider with the diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] So the itemized statement never has a diagnosis on it.
[AGENT][POSITIVE] Yes ma'am, they do.
[CUSTOMER][NEUTRAL] OK, so why don't you take a look at what I.
[AGENT][NEUTRAL] That has the diagnosis and procedure code.
[AGENT][NEUTRAL] OK, so I am not.
[CUSTOMER][NEUTRAL] So show me where I will see that.
[AGENT][NEUTRAL] OK, what I'll have to do is because I can't see the documentation that you sent in, I will have to get you a claims specialist so because they can look at the information that I can't see and they can go over it with you and show you.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The difference between the items my statement and the.
[CUSTOMER][NEUTRAL] Yeah, I've never had I'm, and I, I, yeah, because I've been managing, I mean, everybody does things differently. I've been managing our benefits for 8 years and work with other companies and I've never seen, I mean, I'm looking at statements all the time.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] They don't have a diagnosis code.
[AGENT][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] There's no diagnosis called on.
[AGENT][NEUTRAL] Yes ma'am, and the reason why we have to have both is because this is a secondary insurance, so we always have to have the explicitative benefits to show what the primary paid, and then this will follow up based on diagnosis codes and procedure codes to what this policy will pay.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So what?
[CUSTOMER][NEUTRAL] OK, but
[CUSTOMER][NEGATIVE] The diagnosis code is not on the statement and probably this is just not something you're aware of, which is why you have to switch me to somebody else now and I gotta go through this all over again.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] No, I can explain to her what's going on and, and also let her know or we can even have her call you back whichever you prefer.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] No, I listen, I, this, this, I don't want this to be painful, and I've, uh, you know, spending forever trying to solve something that should be simple, so I would like to get it taken care of now.
[AGENT][NEUTRAL] OK, OK, that's perfect. um, it's gonna be a brief hold while I transfer you on over and get you a claims specialist on the phone.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Thank you very much for calling APL Miss [PII].
[CUSTOMER][NEUTRAL] Ferring
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Hi [PII], it's [PII]. I have an insured on the phone. Her name is [PII]. Her policy number is 2572507.
[AGENT][NEUTRAL] She called a little bit spicy because she received the letter stating that her claim was a duplicate.
[AGENT][NEUTRAL] And that we had asked her to send in the explanation of benefits and itemized statement and she did that.
[AGENT][NEUTRAL] But she also sent in the whole rest of the claim, so I explained to her that's why it was duplicated because we only needed the information that was requested to finish the original claim.
[AGENT][NEUTRAL] She asked me how come we need the itemized statement? Isn't the explanation of benefits good enough? I told her that the itemized statement has the diagnosis and procedure codes that comes from the facility and we have to have that. She wants to argue about that because she's been doing insurance for 8 years for her company.
[AGENT][NEUTRAL] And she just wants
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Wants a better to talk to somebody in in the claims specialist department so that we can go over how we process our claims.
[CUSTOMER][NEUTRAL] Oh Jesus, OK, so what's what.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm assuming she's talking about the 1781 correct? claim ending in 1781.
[AGENT][NEUTRAL] Yeah, the 17
[AGENT][NEUTRAL] Yes, and then the um the 3,605,020 was the duplicated claim.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] I'm pulling up the mail number so I gotta pull up separately so I'm sorry and she's been verified [PII].
[AGENT][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] Yes. That's OK. Yes, she has been verified. Yes, ma'am.
[CUSTOMER][NEUTRAL] And that's her phone number?
[AGENT][NEUTRAL] Yes, her phone number is the, yes, and that's the number she's calling from is her call back.
[CUSTOMER][NEUTRAL] It's [PII], right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Alright, I'm gonna let you have her.
[CUSTOMER][NEUTRAL] Is it Picone or peone?
[AGENT][NEUTRAL] It's, um,
[CUSTOMER][NEUTRAL] You know?
[AGENT][NEUTRAL] Pecan, Pican.
[AGENT][NEUTRAL] Because I thought she said pecone and it's pecone.
[CUSTOMER][NEUTRAL] Pone, OK.
[CUSTOMER][NEUTRAL] OK, account got it.
[AGENT][NEUTRAL] OK, I just just calling her Miss [PII].
[AGENT][NEUTRAL] OK. Thanks, [PII]. Mm, bye-bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thanks, [PII]. Bye.
[AGENT][POSITIVE] You're welcome.