AccountId: 011433970860
ContactId: 59ca222c-6af3-4085-8e57-9a90495a264a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 681450 ms
Total Talk Time (AGENT): 308004 ms
Total Talk Time (CUSTOMER): 180656 ms
Interruptions: 3
Overall Sentiment: AGENT=1.6, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/59ca222c-6af3-4085-8e57-9a90495a264a_20250611T21:10_UTC.wav
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[CUSTOMER][NEUTRAL] Well.
[AGENT][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, how are you?
[AGENT][POSITIVE] I'm doing well how are you?
[CUSTOMER][POSITIVE] Good, good. I just finished talking to the to the gastro.
[CUSTOMER][NEUTRAL] Um, and they told me that you need to call them.
[AGENT][NEUTRAL] I'm sorry, they told you what?
[CUSTOMER][NEUTRAL] To pay my, my bill.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] OK, you want me to give you the claim number?
[AGENT][NEUTRAL] Uh, sure, I can take a look at that claim for you.
[CUSTOMER][NEUTRAL] 35 76 86.
[AGENT][NEUTRAL] OK, that was 35 76 86?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah, on the end instead of 86.
[CUSTOMER][NEUTRAL] 806.
[AGENT][POSITIVE] Oh, I see. OK, got it. And I'm so sorry, what was your name, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your last name [PII]?
[CUSTOMER][NEUTRAL] All right.
[AGENT][POSITIVE] OK, thank you one moment please.
[AGENT][NEUTRAL] OK, so I did find that claim. [PII] just gonna verify some information really quick. Uh, can I get your date of birth please?
[CUSTOMER][NEUTRAL] Well, this is this claim you guys gave it to me is 35 76806.
[AGENT][NEUTRAL] Yes, I've got the claim pulled up. I just need to verify your information before I can disclose any of the information. Can I get your date of birth please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Perfect. The last thing I need is the email address that we've got on file for you. It looks like it's an MSN account.
[CUSTOMER][NEUTRAL] No, no, I don't have one.
[AGENT][NEUTRAL] I do have an email address on file.
[CUSTOMER][NEUTRAL] Oh [PII], [PII].
[AGENT][NEUTRAL] Yes, that's it.
[AGENT][POSITIVE] Got it. OK, thank you so much for verifying all of that. OK, so for this claim, [PII], we did pay a benefit of $65 for the other.
[AGENT][NEUTRAL] It does state that your the way that this policy works is your major medical does have to contribute anything towards co-pay deductible coinsurance before this policy can pay. So based off of the information that we received, they did not pay for one of the items on this claim. So let's see that was for $1500. So if they did, then we need that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, and they say, they say.
[CUSTOMER][NEGATIVE] They say you guys didn't wanna pay because uh the, the, the treatments since I'm on the [PII] old, that's why you guys did not pay. That's what they just told me.
[AGENT][NEUTRAL] No sir, that is not no sir that is not correct and if you'd like I can send you a copy of this explanation of benefits that does show in detail why we could not pay this benefit.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Correct. Correct. Uh, that's what I told them because I just finished talking to them and, and I, and I kind of scream at them and they said, oh no, that, that's not what I said. I said, are you finish talking to them last week.
[AGENT][POSITIVE] Oh goodness.
[CUSTOMER][NEUTRAL] And they say, oh, can you tell them to, OK, and they just told me, oh, can you tell them to call me?
[AGENT][NEGATIVE] Oh, no.
[AGENT][NEUTRAL] Oh my goodness, OK, so they should have this information um we don't typically reach out to providers other than to send them a copy of this explanation of benefits which is again if you would like this I can send you this copy as well.
[CUSTOMER][NEUTRAL] OK, cause I
[CUSTOMER][NEGATIVE] Yes, I told them, I told them they, they need to send the bill again with explanation benefit and they say, oh, I cannot send, I cannot send, uh, BO bill or something OP something. I don't know why it's don't let us they they say.
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] Sure, OK, so from this point, [PII], you do have a couple of different options. I understand they're making it a bit difficult and I do apologize for that. So again I can send you this information just so you do have it for your record as to why we could not pay that amount, um, so you can try reaching back out.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] To them and tell them that uh it sounds like you already did they are more than welcome to give us a call if there's any confusion or you can ask for the um primary explanation of benefits for yourself um they do have to give that to you if you ask and then you can simply send that to us.
[CUSTOMER][NEUTRAL] Yes,
[CUSTOMER][NEUTRAL] OK, I said, I told, I asked them and they said no, that I need to call my insurance.
[AGENT][POSITIVE] Uh, they should have that. I mean, if it's easier, it does sound like they're being a bit difficult with you, um, so if it's easier, you can reach out to your major medical, whoever you have as your primary, you can if they're easier to deal with. I apologize they're being like this. I'm so sorry.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEGATIVE] I know. And, and, and I and I and I got so mad I said, you know what, you send the night, you're not gonna hang up. And I guess when I try to do like, like, like a 3 way.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] I, I lost him.
[AGENT][NEUTRAL] Oh gosh, OK, yeah, well again we don't reach out to providers like that again we send them this information they do have it um they can reach out to us if they need clarification, but at this point, um, if they're being difficult with you I would just go to your major medical, whoever you have as your primary and request it. um I can give you this date of service if you need it if that's easier and then again I can send this to you if you'd like do you want me to email you this EOB?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Please.
[AGENT][NEUTRAL] OK, do you want me to send it to this MSN account that we call it?
[CUSTOMER][NEUTRAL] Please
[AGENT][POSITIVE] OK, sure, I'll go ahead and send that to you now uh you should be getting that shortly and I'm sure sorry you're having to go through all of this was, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Uh, I, I
[CUSTOMER][NEUTRAL] Uh, I'm, I'm gonna, I'm gonna, I'm gonna stay on the line, so can you please send it?
[AGENT][POSITIVE] Oh sure yeah definitely give me just a moment I'll let you know when that sends.
[AGENT][NEUTRAL] Bear with me just a moment.
[CUSTOMER][NEGATIVE] And I told him, I've been dealing with this almost, almost 1 year or 6 months, and you know, this is insane.
[AGENT][NEGATIVE] It is especially for them to give you that misinformation like that. I don't know why in the world they told you that.
[AGENT][NEUTRAL] Especially as let's see, hang on, let me see when this claim actually finished processing give me just a moment.
[AGENT][NEUTRAL] That was, oh goodness I've got a different one pulled up here.
[AGENT][NEUTRAL] I'm just gonna go ahead and send this to you. Hang on just a moment.
[AGENT][POSITIVE] Alright, I sure appreciate your patience. I did just go ahead and send that, um, let's see, I'll let you know what it actually sends.
[AGENT][POSITIVE] OK, there we go it did just send so you should be getting that shortly.
[CUSTOMER][NEUTRAL] You send it already?
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Did it go out?
[AGENT][NEUTRAL] Uh yes, I do show that it's sent.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is is that coming from which email account?
[AGENT][NEUTRAL] Um, it should say [PII].
[CUSTOMER][NEUTRAL] He says what?
[AGENT][NEUTRAL] Uh, [PII]. Did you get it?
[CUSTOMER][NEUTRAL] Hold on, OK.
[CUSTOMER][NEUTRAL] Yeah, OK, right.
[AGENT][NEUTRAL] Yes, [PII]
[CUSTOMER][NEUTRAL] Yeah, hold on.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] No, I haven't got it yet.
[AGENT][NEUTRAL] OK, um, just for good measure, would you mind checking your, um, your spam folder? OK.
[CUSTOMER][NEUTRAL] I, I'm in my spam emails.
[CUSTOMER][NEUTRAL] I'm in, I'm in my spam.
[AGENT][NEUTRAL] OK, let me verify the spelling.
[CUSTOMER][NEUTRAL] The email is
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] The is [PII].
[AGENT][NEUTRAL] Yes, that's [PII].
[CUSTOMER][NEUTRAL] Yes, hold on.
[AGENT][NEUTRAL] OK, yes, I did send that. I mean, maybe it just needs, needs a few minutes.
[CUSTOMER][NEUTRAL] OK, uh, [PII].
[AGENT][NEUTRAL] That's it. Yes, sir.
[CUSTOMER][POSITIVE] Hold on, yeah, I got it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me see if he's trying to open.
[CUSTOMER][NEUTRAL] For some reason I kinda open it it's like loading.
[AGENT][NEUTRAL] It is as a PDF so I'm not quite sure it might depend on what you're trying to open it with.
[CUSTOMER][NEUTRAL] OK, at least I got it, so I'm gonna wait later on to see if it finished loading. If not, I, I, I give you a call later on or tomorrow.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Sure it might be easier if you have access to a uh desktop or a laptop computer it might be easier to view it on there.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Alright, well again I apologize for the confusion. Did you have any other questions for me or anything else I can help you with?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, I'll see.
[AGENT][POSITIVE] Alright, well thanks for giving us a call, [PII]. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.