AccountId: 011433970860
ContactId: 605992b4-c171-4ed9-b808-a2301d9e43e4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 594400 ms
Total Talk Time (AGENT): 188018 ms
Total Talk Time (CUSTOMER): 160732 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/605992b4-c171-4ed9-b808-a2301d9e43e4_20250409T15:16_UTC.wav
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[AGENT][NEUTRAL] Morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey, this is [PII] with the Affordable employee benefits. I was checking on a claim to make sure or to see if y'all have it and how y'all processed.
[AGENT][NEUTRAL] OK, I'm sure.
[CUSTOMER][NEUTRAL] Um, I've got a policy number.
[AGENT][NEUTRAL] Let me have a callback number just in case we get disconnected first.
[CUSTOMER][NEUTRAL] The phone number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and Miss [PII], this is a provider's office or you're calling from a group or?
[CUSTOMER][NEUTRAL] Broker.
[AGENT][NEUTRAL] Yeah, OK. OK. All right. And um what is the policy number?
[CUSTOMER][NEUTRAL] Alright, policy number is 00982081.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] What's the name and date of birth of the member?
[CUSTOMER][NEUTRAL] Um, I've got, let's see.
[CUSTOMER][NEUTRAL] [PII] is her name and can I give you her address that's what I have.
[CUSTOMER][NEUTRAL] In front of me.
[AGENT][NEUTRAL] OK, um, so you don't have her date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I mean I could look it up but it's gonna take me a minute, but I've got her date of birth here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you said [PII] or [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] Start from [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the date of service for the claim?
[CUSTOMER][NEUTRAL] Alright, so there's a few on here. They're all Baptist, um, this one is [PII] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] And total charge was 45,000.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] $35.95.
[AGENT][POSITIVE] Thank you, Ms. [PII], one moment.
[CUSTOMER][NEUTRAL] 1517.
[AGENT][NEUTRAL] Just a minute.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] There is.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I'm trying to going as fast as I can, but, uh, Miss [PII].
[AGENT][NEUTRAL] I'm trying to locate you to verify you, but I don't see anything um.
[AGENT][NEUTRAL] What's your email address?
[CUSTOMER][NEUTRAL] Or the broker's affordable employee benefits.
[AGENT][NEUTRAL] OK. And, and what is your email address?
[CUSTOMER][NEUTRAL] Claims at [PII].
[AGENT][NEUTRAL] And you submitted these claims for the member, Ms. [PII], or no, no.
[CUSTOMER][NEGATIVE] No, the provider didn't.
[AGENT][NEUTRAL] And you just need to know if they're um processed or you need detailed information.
[CUSTOMER][NEUTRAL] Right, it makes
[CUSTOMER][NEUTRAL] Right, and making sure you have the claim and if you do how are y'all processed.
[AGENT][NEUTRAL] Because usually for security we don't really give this information out unless the um.
[CUSTOMER][NEUTRAL] Yeah I do. I mean, I talk to you all the time. I just talked to my, I can't think of her name. I talked to her yesterday. I had another one.
[CUSTOMER][NEUTRAL] I mean I can hang up and call.
[AGENT][NEUTRAL] No, it's fine. I just wanna make sure I follow protocol because um
[CUSTOMER][NEUTRAL] Back, um,
[CUSTOMER][NEUTRAL] I can tell you the member I talked to yesterday and who I talked to. I can't think of her name, um but I mean this is what we do because we're the broker's office.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] I understand, yeah, I, I have handled broker's office before. I just need to usually we verify, we give information out from the claims, but it mostly is whenever they send me the claim.
[CUSTOMER][NEUTRAL] What do you need else to verify me because.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, the one I talked to, let's see.
[CUSTOMER][NEUTRAL] Alright, let's see
[CUSTOMER][NEUTRAL] Policy number.
[CUSTOMER][NEUTRAL] 02307669
[CUSTOMER][NEUTRAL] And it was on [PII].
[CUSTOMER][NEUTRAL] The lady I spoke to, that's who I used to talk to all the time.
[AGENT][NEUTRAL] OK. I'm just gonna go ahead and look at the notes, OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] 8571.
[AGENT][NEUTRAL] OK so it's an issue.
[CUSTOMER][NEUTRAL] 1
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the date of service was [PII] for $45,0035.95 correct?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it looks like it was denied. So let me go ahead go ahead.
[CUSTOMER][NEUTRAL] After
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The Blue Cross left 3,22619.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Are y'all missing that EOB or
[AGENT][NEUTRAL] Um, let me check and see what's the denial reason on this one.
[AGENT][NEUTRAL] OK, I'm waiting on the EOB to pull up.
[AGENT][NEUTRAL] OK, so it looks like this one was for um either chemotherapy, radiation therapy, um.
[AGENT][NEUTRAL] In a physician's office or outpatient facility, but there's no benefits payable for chemotherapy or radiation therapy under this policy based on the denial of the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Even if it was in the hospital?
[AGENT][NEUTRAL] It says in a physician's office or outpatient facility.
[AGENT][NEGATIVE] Um, there's just no benefits, outpatient benefits for chemotherapy or radiation therapy.
[CUSTOMER][POSITIVE] OK, alright, I'll get that checked out thank you.
[AGENT][NEUTRAL] You're welcome do you need the claim number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] You can give it to me. I also have one more while I got you.
[AGENT][NEUTRAL] OK, sure. Yes, right, the claim number is 3556232.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, and then the other data services for her it's 1:30 25.
[AGENT][NEUTRAL] 1325. OK and OK, so it's gonna be the same denial reason.
[AGENT][NEUTRAL] Do you need the claim number on this one? Yes, the same denial.
[CUSTOMER][NEUTRAL] See.
[CUSTOMER][NEUTRAL] OK, what's that claim number?
[AGENT][NEUTRAL] 356-596-3.
[CUSTOMER][POSITIVE] OK all right thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] That is it, thank you.
[AGENT][NEUTRAL] And I'm sorry, I just need to follow the protocols to make sure I can get this information out, OK? You're welcome.
[CUSTOMER][NEUTRAL] That, that's fine, thanks.
[AGENT][POSITIVE] OK. Have a good day. Bye-bye.