AccountId: 011433970860
ContactId: 587c7ea4-6626-4082-a7d4-d95f2a21fba4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 456000 ms
Total Talk Time (AGENT): 196885 ms
Total Talk Time (CUSTOMER): 174109 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/587c7ea4-6626-4082-a7d4-d95f2a21fba4_20250411T17:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], I just had a quick question around submitting a claim to insurance. I had, when I went to my hospital visit, I had wanted to pay out of pocket, but they had submitted it to insurance. Is there a way I can cancel the claim?
[AGENT][NEUTRAL] OK. And it was submitted by the um hospital itself?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, the hospital would have to cancel that, or what will happen is the claim will go.
[CUSTOMER][NEUTRAL] They had told me that once it's something.
[CUSTOMER][NEUTRAL] Sorry, they had told me once it was submitted, it can't be redacted on their end.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right. Um.
[CUSTOMER][NEUTRAL] I don't know if anything on your end you can cancel.
[AGENT][NEUTRAL] Um, not when it's submitted by the provider, the, um, we can't cancel the claim.
[CUSTOMER][NEUTRAL] I, I, I think it was submitted by the provider. I, I couldn't.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] My husband provided the insurance information, but I want to pay out of pocket. I was in X-rays when he provided the insurance information. So I don't know if we ended up submitting it or the I'm assuming the hospital submitted it. I, I don't, I, I have no idea what happened since I wasn't, you know, I wasn't in the room.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes ma'am, um.
[AGENT][NEUTRAL] Look and see uh where we are as far as the status. Can you please give me your name and your callback number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um my first name is [PII]. My last, my last name is [PII], [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Best callback number would be [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you and what is the policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Oh, give me just a moment let me find my.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Let me find my card.
[CUSTOMER][NEUTRAL] I have a claims number here but let me find my uh let me grab my wallet.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Now if you want I can look it up with your social too.
[CUSTOMER][NEUTRAL] OK, um, let me see.
[CUSTOMER][NEUTRAL] Yeah, I'll give you my social.
[CUSTOMER][NEUTRAL] Let me know when you're ready.
[AGENT][POSITIVE] I'm ready for it.
[CUSTOMER][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. And that's [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, let me look real quick.
[AGENT][NEUTRAL] OK, um, Miss [PII], on which policy did you send the claim was the claim sent in? Was it hospital indemnity or dental?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, it was probably hospital indemnity. I was on Cobra at the time.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Probably hospital indemnity. I uh.
[AGENT][NEUTRAL] All right, let's look at this.
[CUSTOMER][NEUTRAL] I think, not quite sure to be honest.
[AGENT][NEUTRAL] Right, let's look at this one. Let me pull that up real quick.
[AGENT][NEUTRAL] OK, well I'm gonna pull it up and we'll look real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, Ms. [PII], can you verify your date of birth for me?
[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] Um,
[CUSTOMER][NEUTRAL] My address should be [PII]. Did my birthday?
[AGENT][NEUTRAL] Uh, no, ma'am, your, um, email address and phone number that we have on file.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Yeah, that's go.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And then the email should be [PII] my last name [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you so much. Alright, so, um, and the claim was for yourself, is that correct?
[CUSTOMER][NEUTRAL] Mhm. Right.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, now I do show that a claim was uh sent in by the provider on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let's see. It's already been processed. It was for, uh,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Day of service was [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][POSITIVE] Yep, that sounds about right.
[AGENT][NEUTRAL] OK, and what was the name of the facility you went to?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It was US Health in Jacksonville, US Health Emergency room.
[AGENT][NEUTRAL] OK, thank you. All right, so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We do have one.
[AGENT][NEUTRAL] Part of the claim that was paid.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look and see where that check went to.
[AGENT][NEUTRAL] Let me look up that check number real quick.
[AGENT][NEUTRAL] Yes, it was paid to the University of Florida of Jackson, um, $50 and that was mailed out on [PII] and then we have some uh denial codes, um, some remarks on some of the claim, and I can read those to you.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] The maximum benefit for the date of service was met. So after that 50, that maximum benefit was met and that's the um
[CUSTOMER][NEUTRAL] Yeah, let's just that.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yep, that's all we have on it, but it has been processed and paid.
[CUSTOMER][NEUTRAL] OK, so I can't, I can't redact it since then since it's been processed and paid.
[AGENT][NEUTRAL] No, ma'am. Yeah, right. Check's already been sent out.
[CUSTOMER][NEUTRAL] No, OK.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][POSITIVE] Yeah, no worries.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I want to double check. It was cheaper for us if we paid out of pocket and there was clearly just a miscommunication while I was getting all my stuff done, so no worries.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] All right. Well, is there anything else that I can help you with before we go?
[CUSTOMER][POSITIVE] No, ma'am, that was it. Thank you so much. You've been very helpful.
[AGENT][POSITIVE] You're, you're very welcome. I hope you have a wonderful weekend and we thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you. You as well.
[AGENT][POSITIVE] Oh, you're welcome. Bye-bye, ma'am.
[CUSTOMER][NEUTRAL] Bye bye.