AccountId: 011433970860
ContactId: 62233f23-e0ee-4839-a2b0-b0e995b24f9b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 962440 ms
Total Talk Time (AGENT): 316606 ms
Total Talk Time (CUSTOMER): 316242 ms
Interruptions: 5
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/62233f23-e0ee-4839-a2b0-b0e995b24f9b_20250317T21:46_UTC.wav
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[CUSTOMER][NEUTRAL] Hello.
[AGENT][POSITIVE] Thank
[AGENT][NEUTRAL] [PII], this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey To [PII] with [PII] at Benefit Services. How are you?
[AGENT][POSITIVE] Hey, I'm doing good, sir. How are you doing today?
[CUSTOMER][POSITIVE] Uh, uh, in [PII], yay for me, works.
[CUSTOMER][NEUTRAL] So I have a client that we submitted a claim for, and I forgot I submitted, I resubmitted it today, but I have a claim number. It's 35585006 [PII] with Townsend Management.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, all right, and what is the group number, [PII]?
[CUSTOMER][POSITIVE] Oh God, um, that's, that's a good question.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 000.
[CUSTOMER][NEUTRAL] And I
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] 26569
[AGENT][NEUTRAL] OK, let me pull up that group real quick.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, and I'm just gonna need for you to please verify the group for me although I've talked to you many times, I know this is your voice, but I still have to do it.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, you're fine.
[AGENT][NEUTRAL] OK, so can you please verify the physical address for me?
[CUSTOMER][NEGATIVE] Oh yeah, shit, let me go to down.
[CUSTOMER][NEUTRAL] organization they got several. so, um, townston match will be [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then can you please give me your call back number and verify your email address for me?
[CUSTOMER][NEUTRAL] [PII]. You're gonna have [PII] at RJ Blanchettbenefits. agency or request at RJblanchettbenefits. agency.
[AGENT][NEUTRAL] I've got [PII]. OK, thank you. I appreciate you verifying the group for me, sir. Alright, and do you know Ms. [PII]'s um policy number?
[CUSTOMER][NEUTRAL] Yup.
[CUSTOMER][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] Yep, uh, let's see, that's [PII]'s policy number.
[CUSTOMER][NEUTRAL] They go back into it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] [PII], we keep everything at ease. We keep everything.
[CUSTOMER][NEUTRAL] We have a policy here.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Her policy number ma'am is uh
[CUSTOMER][NEUTRAL] Well, certificate number is 0251.
[CUSTOMER][NEUTRAL] 2643.
[CUSTOMER][NEUTRAL] Because they have the group number it's the policy number in there so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Let me pull up her.
[AGENT][POSITIVE] Policy number real quick.
[AGENT][NEUTRAL] And you're looking for claim status, is that right?
[CUSTOMER][NEUTRAL] It was
[CUSTOMER][NEUTRAL] Yes, ma'am. So, um, I thought, I thought it was an inpatient, but she was, but she was, it was an outpatient surgery, so I resubmitted it with the billing for it.
[AGENT][NEUTRAL] OK. Now, I do see that um there was a claim reported on [PII] that is in progress right now.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yeah, yeah, so I resubmitted it. That's and I think that's what I did. So there's another one too that's there and I gave you the um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I gave you a claim number on that one.
[CUSTOMER][NEUTRAL] 35585006 is the claim, uh-huh.
[AGENT][NEUTRAL] The 558-506. OK.
[AGENT][NEUTRAL] OK, let me see this one has a remark on it. Let me see what it says.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, this one needs a diagnosis code for the date of service.
[AGENT][NEUTRAL] And then it also.
[CUSTOMER][NEUTRAL] OK, I wish they would uh.
[CUSTOMER][NEUTRAL] Alright, what else it says?
[AGENT][NEUTRAL] And it's also stating that need an itemized statement of services provided listing the charges, diagnosis code and procedure codes.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEGATIVE] I sent that though, I sent, I sent the detailed billing that I resent with the new one.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] But see, here, here's my problem, and this is what I'm gonna say. I'm gonna say it again. I'm about to go back to [PII] with this.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] We handle claims. We have HIPAAs for every last person. If I'm not getting this information sent to me by claims, then my clients are getting mad, and then they get their boss involved and they want to move it. And I don't want to move there.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, we've had a long conversation about this already.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And we, we have to know that because it makes us look stupid. It makes us look stupid.
[AGENT][NEUTRAL] Would you
[AGENT][NEUTRAL] Mhm. Yes, I understand that. Would you like for me to go ahead and transfer you on over to Broker Resources so we can let them know again that this has happened again?
[CUSTOMER][NEUTRAL] Yup. And I mean, you need, I, I, I, I need to have this in writing so I can let her know. Uh, and, you know, on that, hold on, let me look at something real quick. Give me one minute. I think on this detailed billing, it's gonna have a diagnosis on it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] I think, I think, I think.
[CUSTOMER][NEUTRAL] You have the last person that's that bought home.
[CUSTOMER][NEUTRAL] Going from [PII].
[CUSTOMER][NEUTRAL] AC anesthesia.
[CUSTOMER][POSITIVE] Gros HD, yup, it's got codes on this one, I think.
[CUSTOMER][POSITIVE] I think, I think you're gonna have what you need, I think anyway.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] I think I'm not sure.
[CUSTOMER][NEUTRAL] She did go on the anesthesia. She had gastro services, yep, 433-29 and yep, 432259. So yeah.
[AGENT][NEUTRAL] And you did send that uh with the claim that you sent it today, OK, OK, alright, well they should.
[CUSTOMER][NEUTRAL] I sent that in a new claim. Yeah. Yes, ma'am.
[CUSTOMER][NEGATIVE] But yeah, we need to talk to broker services again, because this is, I, I, I don't, you know, if I don't have a status, then they're calling me, well, I, I thought you handled our claims. Yeah, we do. But if, you know, like I've already had to tell Aflac, cause, you know, one of my girls works at Doug [PII]. She's Aflac religious. I told them the same thing. You can't send me a status, we're not using you. Not, not that I'm gonna do that to y'all, but
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] You know, but I, I, because we got a lot, we got a lot invested with y'all now. And I don't, I, I don't want people getting mad and saying, hey, you said this and you're not doing it, so now we're gonna go somewhere else.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right, I understand. I do. And I, and I've
[AGENT][NEGATIVE] I feel your concern too, and I don't want them to go anywhere else either. Um.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] So I'm gonna go ahead and transfer you on over to broker resources um that way they you can let them know that it's happened again.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you know, what can we do to fix it, OK?
[CUSTOMER][NEUTRAL] Yup.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][POSITIVE] All right. You're welcome, [PII]. You have a good rest of your day. You're so welcome.
[CUSTOMER][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] All right. You take care, sir. Bye-bye.
[CUSTOMER][NEUTRAL] Uh-huh. Bye-bye.
[CUSTOMER][NEUTRAL] Bring
[CUSTOMER][NEUTRAL] Thank you for calling APL this is [PII].
[AGENT][NEUTRAL] Hi, [PII], this is [PII] in the care team. I've got, um, hey, I've got um [PII] on the phone.
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And he is calling because he wanted to check on claim status for [PII], um, which is policy number 2512643, which we did.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I, um, gave him the
[AGENT][NEUTRAL] Um, remarks that was on the claim, and he immediately said, I've already asked for claim status to be sent to me for my insured's claims because if we can't have claim status sent, then my insureds are wanting to go other places. So he needs to talk to somebody about that.
[CUSTOMER][NEGATIVE] About going to other places or about the claim status because I, I won't have access to the claim status.
[AGENT][NEUTRAL] Right, I gave him the claim status, but he wants to this is broker resources, right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes.
[AGENT][NEUTRAL] OK, he wants to talk to somebody about how can he get claim status when he files claims for his insured.
[CUSTOMER][NEUTRAL] Um, I am not sure on that. Um, have you asked the claims department by chance?
[AGENT][NEUTRAL] No, this is gonna be through broker resources he said he's tried to talk to [PII] about it already.
[AGENT][NEUTRAL] He's
[CUSTOMER][NEUTRAL] OK, let me, yes, yes, I get that. Um, let me put you on hold for a brief moment, OK?
[AGENT][NEUTRAL] He's a broker.
[AGENT][POSITIVE] OK, OK, and I'm gonna go back to him, love, no, I haven't forgot him.
[CUSTOMER][POSITIVE] OK, sounds good.
[AGENT][NEUTRAL] OK, all right
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Hey, I just wanna let you know I had forgot about you um I've got [PII] on the other line but I think she's trying to get us some further help but I wanted to come back and let you know that I hadn't forgot you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, ma'am.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] Hi [PII], it's [PII].
[CUSTOMER][NEUTRAL] Hey, hey, [PII].
[AGENT][NEUTRAL] We're both still on hold. I wanted to see if you wanted to continue to hold or if you want me to have somebody call you back or what you would like to do.
[CUSTOMER][NEGATIVE] Have someone call me back. Have someone call me back that way we're not holding. Just have him call my cell phone.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK, and that's the [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] OK, I'll make sure somebody calls you back.
[CUSTOMER][POSITIVE] Thank you, ma'am.
[AGENT][POSITIVE] You're very welcome. You take care, [PII].
[CUSTOMER][POSITIVE] You too, [PII]. Have a great one.
[AGENT][NEUTRAL] You too, sir. Bye-bye.
[CUSTOMER][NEUTRAL] Uh bye bye.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello, is this [PII]?
[AGENT][NEUTRAL] Hey, he hung up. He said to have somebody calling back, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I, I did talk to some people on our team and they said that that would be going to the claims department, um, just because we don't have access to any of the claims.
[AGENT][NEUTRAL] Let me give you
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] All right. um, trying to see. I think this is.
[AGENT][NEUTRAL] [PII], did, did you talk to [PII]?
[CUSTOMER][NEUTRAL] No, [PII] is, um, she's not a part of Broker Resources. She's, um, a little bit different.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Maybe I just need to send an email to [PII] with his concerns and get [PII] to call him back because he said this is something that he's talked to her about before and that she was supposed to be working something out for him so I'm gonna go ahead and do that that way um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, that's
[AGENT][POSITIVE] That way I know that we're getting the person that he wanted to talk to also, so, and, and he'll feel happy about that.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] OK, sounds good. And, and if he does call back, um, I think [PII] might be off at [PII], so if he doesn't get a response today I'm sure he'll go in tomorrow.
[AGENT][POSITIVE] OK, I'm just gonna send her an email and hopefully she'll get that and she can call him back at her convenience.
[CUSTOMER][POSITIVE] Perfect. Perfect. That sounds good.
[AGENT][POSITIVE] OK. All right, [PII]. Well, thank you so much for checking for me.
[CUSTOMER][POSITIVE] Absolutely you have a great rest of your day.
[AGENT][NEUTRAL] You too ma'am bye bye.
[CUSTOMER][NEUTRAL] Bye bye.