AccountId: 011433970860
ContactId: 525ee635-d269-461a-a520-966e4afb30b0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 678979 ms
Total Talk Time (AGENT): 229991 ms
Total Talk Time (CUSTOMER): 210696 ms
Interruptions: 4
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/525ee635-d269-461a-a520-966e4afb30b0_20250611T14:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I have a couple of questions about some claims I submitted.
[AGENT][NEUTRAL] Yeah, I can help you with claim status. Uh, can I get your name and a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, uh, my name is [PII], and telephone number is [PII].
[AGENT][NEUTRAL] And what is your policy number?
[CUSTOMER][NEUTRAL] 1836605
[AGENT][NEUTRAL] 1836605
[CUSTOMER][NEUTRAL] 05, yes ma'am.
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] And [PII], can I get you to uh verify your uh date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the address that we have on file?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] And do you have the date of service or the claim number?
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] It should be uh [PII] [PII].
[AGENT][NEUTRAL] [PII] alright.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] that
[AGENT][NEUTRAL] All right, I'm not showing.
[AGENT][NEUTRAL] [PII], let me see.
[CUSTOMER][NEUTRAL] It's for um it's for my daughter [PII] I'm sorry.
[AGENT][NEUTRAL] Oh, it's for your daughter? OK, give me just one moment.
[CUSTOMER][POSITIVE] Yeah, I'm sorry about that mhm.
[AGENT][NEUTRAL] And what is her date of birth?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, is it Miss [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, give me just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] I do show that you submitted 12 days ago. I will say that one is being processed right now, so I won't be able to give you much more information than that.
[AGENT][NEUTRAL] Um, but let me see about the.
[AGENT][NEUTRAL] One from the [PII].
[AGENT][NEUTRAL] It looks like there was 2. What is the provider name or the hospital name?
[CUSTOMER][NEUTRAL] Uh, northern Louisiana Medical Center and then there's an anesthesi one.
[AGENT][NEUTRAL] OK, and you want status on both of them?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Ma'am.
[AGENT][NEUTRAL] You wanted status on both of those claims, correct?
[CUSTOMER][NEGATIVE] Oh yes ma'am, because one, I had an alert saying one was finished, but it was denied. I don't know which one that was that was denied.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me look here.
[AGENT][NEUTRAL] Um, it looks like it was this one.
[AGENT][NEUTRAL] Let me see why.
[AGENT][NEGATIVE] It looks like it was denied because the maximum benefit for that data service has been met.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEGATIVE] Oh shit, well.
[AGENT][NEUTRAL] And that was for
[AGENT][NEUTRAL] It looks like the surgery.
[AGENT][NEUTRAL] Let me look at the other one that was anesthesiology.
[AGENT][NEUTRAL] For anesthesia.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Yeah it looks like there was 2 for that date of service um it looks like we uh processed one of them and we paid $296 towards it and then the other one got denied because um.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The calendar year maximum had been met.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Oh, OK, cause I, oh, OK, the, the other ones probably get denied it because um I remember y'all send a thing saying like we couldn't pay out because there was 0, there was no charge for the surgery and I found out later that they that um the orthopedic clinic, they didn't include the bill that came from the hospital. I actually had to get that because they hadn't sent it to me, so that is what I uploaded um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So it said like claim denied well when I got the paper from you guys, it said like couldn't pay for surgery because of um there was no surge charge.
[CUSTOMER][NEUTRAL] And so
[AGENT][NEUTRAL] Yeah, I am. I was seeing that one too.
[CUSTOMER][NEUTRAL] I then got the surgery charge.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, yeah, and then that's probably why the other one was denied as well as I'm looking at it, um, is because with that, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What was it? $265 the $296 that's when you met your calendar year maximum.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it wouldn't have mattered if the surgery charge had been there or not.
[AGENT][NEUTRAL] Or maximum for that date of service.
[CUSTOMER][NEUTRAL] Uh, OK, so it wouldn't have mattered if we those charts.
[AGENT][NEUTRAL] Um, I would still send them in, yeah.
[AGENT][NEUTRAL] Yeah, it, yeah, OK, OK, yeah.
[CUSTOMER][NEUTRAL] Well, no, I did, I did send it in, but um.
[AGENT][NEUTRAL] Yeah, but we do have, we, I do see it on record.
[CUSTOMER][NEUTRAL] It's just, it may be tricky to understand. I hope I'm explaining it clearly to you, but yeah, when they gave me the rundown from um the orthopedic clinic with their charges for surgery, it said 0, and so that was a separate bill that I had to get from Northern Louisiana Medical Center, um, I did not know that.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] And so when I finally got it, I was like, well this was the missing, this is the other part that should have gone with that initial claim.
[CUSTOMER][NEUTRAL] Uh, so that's why I had sent it back in.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yeah, let me look.
[AGENT][NEUTRAL] Yeah, because it looks like we processed the first one that was paid out um back in [PII]. Let's see when the other stuff got added and we included the anesthesia benefit. Let me see.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] Yeah and that one was processed yesterday.
[CUSTOMER][NEUTRAL] That was the one that was denied, right? Yeah.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] And then the other claim that you um submitted is still being processed.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] And what claim is that? I don't even know anymore um.
[AGENT][NEUTRAL] It would have been oh, maybe not 2 days ago. Yeah, 2 days ago. Um, unless that's when you send in the medical records and then it might go back towards the other one.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Let me see if I can pull it up.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Yeah, I'm not able to see what you sent in yet because it's being processed.
[CUSTOMER][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] Uh, OK then, um.
[CUSTOMER][NEUTRAL] I guess I'll just hang tight.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, and since it was saved about 2 days ago, um, it should be able to be done being processed by the end of the week, um.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Because we did receive that it looks like on Monday.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] So I'd give it till the end of the week, um.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And you said you were able to get uh text messages, correct?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, I got a text message and the claim had been um processed and it was.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, but I just wanted, yeah, I was just trying to clarify that to um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Whoever was working on the claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah and since I'm unable to see what was sent in because I don't I'm not in claims um I tried looking it up um it's still being processed so it might go towards one of those depending on what you sent in.
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][POSITIVE] And then hopefully, you'll, you'll get some more answers after that's done being processed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so you said it's currently being processed or in line to be processed?
[AGENT][NEGATIVE] Right, it's, it's currently being processed. I'm unable to look at it.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. All right. Well, um,
[CUSTOMER][NEUTRAL] I think the other lady I spoke to kinda left a note for the claim, uh, the claim specialist or adjuster whatever kind of explain what was going on. So, um, what to hang tight and see. Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. I'll put it in your notes. Um, is there anything else I can help you with until then?
[CUSTOMER][NEUTRAL] No, ma'am, that's it.
[AGENT][POSITIVE] Great, thank you so much for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye.