AccountId: 011433970860
ContactId: 65f4f548-b8c2-47f7-9676-f066eb80eed9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 419149 ms
Total Talk Time (AGENT): 183894 ms
Total Talk Time (CUSTOMER): 156578 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/65f4f548-b8c2-47f7-9676-f066eb80eed9_20250131T16:39_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII] from Associated. I spoke to you earlier this morning on [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, now I need help with his son's claims.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, I'll be more than happy to help you. Hold on, let me go back to the, here we go.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Same policy number, right?
[CUSTOMER][NEUTRAL] You want me to give you his policy number? Yeah.
[AGENT][NEUTRAL] No, no, no, I haven't.
[CUSTOMER][NEUTRAL] It was for 2024. 0, OK, perfect. OK. So, we were told by um APL that there's claims for [PII].
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Or [PII], the dependent son [PII], this is the other son.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] that are pending EOBs from United Healthcare. I need to know what the dates of service are so that I can request the, the EOBs from United. Yeah.
[AGENT][NEUTRAL] DOB
[AGENT][NEUTRAL] OK. You said for [PII]?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] He's number 3. OK, so we don't have to verify anything because we already did that earlier and the ones that are requesting, you'll be.
[CUSTOMER][NEUTRAL] I was like, I'm hoping it's the same person.
[AGENT][POSITIVE] Yes, you got me.
[CUSTOMER][NEUTRAL] Woohoo.
[AGENT][NEUTRAL] Wait a minute.
[CUSTOMER][NEUTRAL] What?
[AGENT][NEUTRAL] For [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, wait, let me see if there's like multiple lines in this no.
[AGENT][NEUTRAL] Because
[AGENT][NEUTRAL] Unless it's unless they're duplicates, most of his claims were denied.
[AGENT][NEUTRAL] Because the primary provider, hold on, insured, primary insurance provided full benefits, so there's no benefits payable and then the other one.
[AGENT][NEUTRAL] DM 0, hold on one second.
[CUSTOMER][NEUTRAL] Yeah, I'll tell you what
[CUSTOMER][NEUTRAL] What um
[AGENT][NEUTRAL] Do you have the claim numbers?
[CUSTOMER][NEUTRAL] this
[CUSTOMER][NEUTRAL] No, so we reached out to um.
[CUSTOMER][NEUTRAL] Oh, to national, I can't remember the name of the [PII].
[CUSTOMER][POSITIVE] Oh, national. We got a response, I'm not gonna lie, from [PII], the supervisor of claims, and she told us, thank you for contacting us via email and [PII]. The EOBs for the outpatient speech therapy we received from the provider doesn't show an out of pocket expense limit.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Expense listed listed. Please submit the EOB's listing the amounts applied towards the deductible co-payment or co-insurance, and we will review the claims for benefits.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm. OK, so she, so the.
[CUSTOMER][NEUTRAL] Please see the
[AGENT][POSITIVE] Go ahead, you can read it if you want to, but I got it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah. Oh, OK, OK.
[AGENT][NEUTRAL] So, basically, yes, that's the same thing. So the provider, the primary insurance said they didn't show any charges there, so that's what they're asking for. So, um, so these are the claims. It's a different code if it's missing the explanation of benefits. That's what I was looking for.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh, OK, OK, OK.
[AGENT][NEUTRAL] Um, so hold on one second. So this one, is this the same claim now.
[AGENT][NEUTRAL] OK, so the first one.
[AGENT][NEUTRAL] I, you want me to give you the claim number and the date of service or just the data service?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, just the data service because when I call United I just give them the dates of service and they're gonna send me the EOBs and then we can submit them to you, right?
[AGENT][NEUTRAL] Mhm, you can.
[CUSTOMER][POSITIVE] To process. OK, yeah. OK, perfect.
[AGENT][NEUTRAL] OK, so [PII].
[CUSTOMER][NEUTRAL] 12, oops hold on my pen. 125, uh-huh, 24, yep.
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, that one was paid, that one was paid duplicate, duplicate paid. Hold on one second, duplicate.
[AGENT][NEUTRAL] OK, here goes one.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, [PII]. Sorry, I gotta go back and forth between the screens. I'm sorry. Um, OK, so that was [PII] and then [PII].
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 9901.
[AGENT][NEUTRAL] And then when I go back to the other page, it resets. I'm sorry.
[AGENT][NEUTRAL] Let me think, it's one more.
[CUSTOMER][NEUTRAL] No, and actually they, they said they're for February. You don't have any for [PII]? Cause that's when they're saying.
[AGENT][NEUTRAL] Oh, February. Hold on, let me scroll some more.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I don't need December. I need the February, sorry.
[AGENT][NEUTRAL] January.
[AGENT][NEUTRAL] Hold on one second January.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] January.
[AGENT][NEUTRAL] OK, here goes, February.
[AGENT][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But where is it? Sorry, it's like a block of them, so I got to go through each one to get the data services up. Just bear with me just a second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, January.
[AGENT][NEUTRAL] Alright, so [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so those are the claims that are pending in APL for EOBs.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, awesome. Thank you so much.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with, [PII]?
[CUSTOMER][NEUTRAL] And [PII]opefully I won't bother you anymore today.
[AGENT][POSITIVE] Oh, you're not a bother at all. You can call me and get ready.
[CUSTOMER][POSITIVE] All right. Thank you. Have a good one. Take care.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Thanks, bye.