AccountId: 011433970860
ContactId: 5256bc71-c212-47b9-9569-51b8005309f8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 604419 ms
Total Talk Time (AGENT): 276170 ms
Total Talk Time (CUSTOMER): 221039 ms
Interruptions: 7
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/5256bc71-c212-47b9-9569-51b8005309f8_20250528T14:53_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I, I sent it out several faxes to make uh for claims. I just wanna make sure you got them and it's in process. Let me give you.
[CUSTOMER][NEUTRAL] It's one there's a couple of outpatient and one inpatient, but let me, let me give you just the first start with uh in hospital.
[CUSTOMER][NEUTRAL] Uh, er my benefit number. Are you ready?
[AGENT][POSITIVE] Yes, sir. I'm ready.
[CUSTOMER][NEUTRAL] 019
[CUSTOMER][NEUTRAL] 864
[CUSTOMER][NEUTRAL] 54
[CUSTOMER][NEUTRAL] M as in Minnesota. L as in Louisiana, #7.
[AGENT][NEUTRAL] OK, thank you sir and may I get your name and your call back number just in case the call is disconnected.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII], phone number [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And then, um, let me look up this policy number real quick.
[AGENT][NEUTRAL] So that I can check claim status for you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] All right. And we'll need to verify your policy, please, sir. Will you give me your date of birth?
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] Thank you. And then what is your address, phone number, and email address that we have on the policy for you, Mr. [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Birth date [PII], phone number [PII].
[AGENT][NEUTRAL] OK, and then one last verification, may I have your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you. I appreciate you verifying your policy for me. All right, I do see that on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] We did receive 2 claims.
[AGENT][POSITIVE] And they are in progress.
[CUSTOMER][NEUTRAL] OK, 2 clients, there's actually 3, so there's that's the one, there's 1 for hospital with that number.
[CUSTOMER][NEUTRAL] And then the other one ends in ML8. There's two claims inpatient.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So it's a total of 3, is that correct? It 3 in process?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, and did you send one on [PII]?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Yeah, OK, yes, sir. Yes, those are the one that was sent on [PII] has a remark on it. Let me tell you what that says, sir.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You should be getting a letter on this one. office visits are not covered under your policy, so the claim was denied.
[CUSTOMER][NEUTRAL] OK, but it's not an office, is it?
[AGENT][NEUTRAL] On that one.
[AGENT][NEUTRAL] The one that was sent on the [PII].
[CUSTOMER][NEUTRAL] It's like crazy. That's the way you feel.
[CUSTOMER][NEUTRAL] On the [PII], it's a kidney stone.
[CUSTOMER][NEUTRAL] Removal in an inpatient surgery and I sent all the documentation including the bill so it's not there's when they do an explanation of benefits, then they include everything because they're not gonna go just with one procedure. The procedure was $6500. It had to be, it's a surgery.
[AGENT][NEUTRAL] OK, yes sir, um, now if you wanted to, you can speak with a claims specialist on this one so that they can explain to you how they went through the claim for you, but the other ones, yes sir, we do see that they have come in and they are in progress.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Let's do it.
[CUSTOMER][NEUTRAL] Fine, do it.
[CUSTOMER][NEUTRAL] By the same problem with all kinds of comments and delays, delays, delays, but yes, let's talk to a claims specialist.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on a quick hold and I'll be and transfer you on over to a claims specialist. Is there anything else I can help you with, Mr. [PII], before we go? OK, well you take care, sir. Thank you for calling.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] So, OK, what, what which claim is that? What's the name of the what what claim number is it? Let's talk about that first so I can explain to you.
[AGENT][NEUTRAL] OK. Yes, sir. It's 35.
[CUSTOMER][NEUTRAL] May 7
[AGENT][NEUTRAL] This is for uh data service of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim number is 35999.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Of 23? Are you sure? I think it's, I think it's 22.
[AGENT][NEUTRAL] Let me look.
[AGENT][NEUTRAL] There's multiple dates of service on this claim. We've got [PII].
[AGENT][NEUTRAL] We've got [PII].
[AGENT][NEUTRAL] We've got [PII].
[AGENT][NEUTRAL] We've got March, yes, sir. There's many, but that was, that was.
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEUTRAL] It can't be two different years.
[CUSTOMER][NEUTRAL] The which is the one that you said had an issue?
[AGENT][NEUTRAL] That was
[AGENT][NEUTRAL] This is it.
[AGENT][NEUTRAL] It's claim number 3599598.
[CUSTOMER][NEUTRAL] But why would you have multiple years?
[AGENT][NEUTRAL] It looks like they sent multiple.
[AGENT][NEUTRAL] Dates of service at one time, Alexander Hol Bethesda Hospital.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's crazy.
[CUSTOMER][NEUTRAL] Let me see, I have to go back and see what I sent you on, but.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] You gave me a May date first you said, oh, for May whatever, [PII] I think you said.
[AGENT][NEUTRAL] Yes, let me go back to that.
[AGENT][NEUTRAL] Yes, this was reported on [PII] and processed on [PII].
[AGENT][NEUTRAL] This says 25, that'd be 24.
[CUSTOMER][NEUTRAL] OK, that was the one. OK, that was submitted [PII]. OK, got it. OK, now that particular, uh, one.
[AGENT][NEUTRAL] Yes sir, submitted on [PII].
[CUSTOMER][NEUTRAL] It's, it's for, for, uh, a surgery in [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Uh, let me go with the dates again. There is a
[AGENT][NEUTRAL] It looks like it's multiple doctors.
[CUSTOMER][NEUTRAL] I think it's a 2 it's I think it's [PII] I think it's [PII].
[AGENT][NEUTRAL] Yes, there was a [PII] data service on this claim. Let me look that up again.
[AGENT][NEUTRAL] That was for [PII] at Bethesda Hospital.
[CUSTOMER][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII], OK.
[CUSTOMER][NEUTRAL] It was actually April was it [PII]?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Let me look on the dates. I do see an [PII] for [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] You know what, I've got it right here. Sorry.
[CUSTOMER][NEUTRAL] So I think I've got here what I sent you.
[AGENT][NEUTRAL] That looks like this is multiple dates of service.
[CUSTOMER][POSITIVE] Oh my gosh.
[CUSTOMER][NEUTRAL] No, it's, it's you asked for it, you ask for an EOB.
[AGENT][NEUTRAL] With multiple
[CUSTOMER][NEUTRAL] And then I marked.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] What you had what you needed to uh to look at on the site which is the date.
[CUSTOMER][NEUTRAL] Of the actual surgery, one moment.
[AGENT][NEUTRAL] OK, so what I'm gonna need to do sir is still go ahead and transfer you on over to a claims specialist because I can't see the documentation that you're looking at but they can.
[CUSTOMER][NEUTRAL] OK, transfer me then transfer.
[CUSTOMER][NEUTRAL] OK, transfer.
[AGENT][NEUTRAL] So, yes, sir, be a brief hold. Thank you for calling APL, sir.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL, this is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, Ms. [PII]. This is [PII] in the care team. I've got, hi, I've got Mr. [PII] on the phone.
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] Uh, his policy number is 1986454.
[AGENT][NEUTRAL] I have verified him. His callback number is actually the number he's calling from the [PII]. He is.
[CUSTOMER][NEUTRAL] OK, what is he calling in regards to?
[AGENT][NEUTRAL] He called because he wanted to know if we received the claims that he sent in and I told him yes and one of them was sent on [PII] and it had a remark so I read the remarks and he has further questions.
[CUSTOMER][NEUTRAL] On that particular claim, the 35999598?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, the 359-959-8.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You can send them to me.
[AGENT][POSITIVE] All right thanks, [PII] bye bye.
[CUSTOMER][POSITIVE] Thank you, you're