AccountId: 011433970860
ContactId: 6aaa07cb-ea2d-4f20-9e13-c07a94b2bb37
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 836599 ms
Total Talk Time (AGENT): 253066 ms
Total Talk Time (CUSTOMER): 305163 ms
Interruptions: 5
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/6aaa07cb-ea2d-4f20-9e13-c07a94b2bb37_20250103T23:22_UTC.wav
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[AGENT][NEUTRAL] Call APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] in the care team. I've got, um, hey, I've got [PII] on the phone, or, or [PII] to say, oh gosh, I don't even know if I'm saying that right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But his um policy number is 2518294.
[CUSTOMER][NEUTRAL] He's calling about
[CUSTOMER][NEUTRAL] Two claims um that we have for him. I gave him the remarks that were on the claim, and he said that there's information that we have.
[AGENT][NEUTRAL] For himself or part two?
[CUSTOMER][NEUTRAL] For part two, let me give you the claim numbers.
[AGENT][NEUTRAL] I have, it's only 2 planes.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Right, the one ending in 672 and the one ending in 963.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, he has, he needs further help pass the remarks that I've given him.
[CUSTOMER][POSITIVE] So I'm gonna transfer him on over to you and I hope you have a good weekend.
[AGENT][POSITIVE] All righty.
[AGENT][NEUTRAL] You can send them over.
[AGENT][POSITIVE] Thank you and you do the same. Goodbye.
[CUSTOMER][NEUTRAL] OK, bye bye.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes, hello?
[AGENT][NEUTRAL] Hello, I'm [PII]. I'm gonna be assisting you. So you're calling in regards to the claims for your dependent for data service [PII], [PII], and the [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, there's one more day, the [PII].
[AGENT][NEUTRAL] That this is the first claim that you're calling about, so that's the only dates on this kind of claim.
[CUSTOMER][NEUTRAL] Yeah, um, I, um, I updated, I updated the all of the claims at once, so there was, um, if you check claim number 3541672, you'll see that, um, all four of those claims are on there, but then I received a different claim for the check date [PII]. There's only 3 claims.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] T 3 clients requesting the diagnosis code.
[AGENT][NEUTRAL] For the date of service [PII], the [PII], and the [PII].
[CUSTOMER][NEUTRAL] Yeah, but they should be.
[CUSTOMER][NEUTRAL] Yeah, um, look at claim number 3541672.
[AGENT][NEUTRAL] Which was sent prior to this claim being processed.
[CUSTOMER][NEUTRAL] Exactly with which had 4.
[AGENT][NEUTRAL] Right, it had date of service [PII], the [PII], the [PII], and the [PII].
[AGENT][NEGATIVE] But it looked like there was not enough information submitted.
[CUSTOMER][NEUTRAL] Yeah, so.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um, prior on the [PII], there was, there was the same amount of information.
[AGENT][NEUTRAL] Let me look at it and verify.
[AGENT][NEUTRAL] Oh, I want my computer.
[AGENT][NEGATIVE] Can't be right.
[AGENT][NEUTRAL] 14.
[CUSTOMER][NEUTRAL] And if you look at the.
[CUSTOMER][NEGATIVE] The remarks on that one, that's, that's just not true.
[AGENT][NEUTRAL] Since the patient is not covered dependent under the policy. The patient is not a cover dependent under the policy. The patient is no longer eligible dependent under the policy.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] Yeah, that, that wasn't true.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] And then I verified it with my employer. um, I think they sent over something to you guys and then on this check date one of the claims is missing. I know the, the remarks for this one I have to get some stuff for the from from my insurance and then get all the, get all the diagnosis for those dates, but I just wanna make sure it's 4 claims, not 3.
[AGENT][NEUTRAL] 412.
[AGENT][NEUTRAL] It
[CUSTOMER][NEUTRAL] You get what I'm saying, man?
[AGENT][NEUTRAL] Yeah, I'm I'm trying to look at it for you if you don't mind, could you give me a moment? May I place you on a brief hold?
[CUSTOMER][POSITIVE] No problem.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 1214 24 2.
[AGENT][NEUTRAL] I know, I'm not tripping.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] So.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I'm on the phone.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding. So I looked through the claims information that you sent over. You sent those 9 pages.
[AGENT][NEUTRAL] We need the
[AGENT][NEUTRAL] Explanation of benefits for this claim from your primary insurance company.
[AGENT][NEUTRAL] And we need the diagnosis codes from your, the facility that the where you receive the services from.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, that's no problem. I just wanna make sure there's one more claim that's added on there. It's not just 3 claims.
[AGENT][NEUTRAL] No, so there's, it's two separate claims, sir. So the one for 1214, 24?
[CUSTOMER][NEUTRAL] I understand I have to get.
[AGENT][NEUTRAL] The one ending in um 1672, that's 4 dates of services. However, on the second claim, there's only 3 dates of services on that information that was submitted to us.
[CUSTOMER][NEUTRAL] Yeah, but, um, the first one, they're all the same.
[AGENT][NEUTRAL] Right, however, on the, we can only process the information that we have and as of right now, there were 4 dates of services you sent 4 receipts for dates of service, the [PII], the [PII], [PII], and [PII].
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] The [PII].
[AGENT][NEUTRAL] The name, right, that's for the very first claim of 1672 ending in 1672. So on the second claim it's not 4 dates of services.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, but if you, um,
[CUSTOMER][NEUTRAL] If you get the, the, the dates, they're all the same. What I'm saying in the [PII].
[AGENT][NEUTRAL] Right, however, but you didn't send us information for one of those dates of services, sir. You didn't send us the date of service of [PII] on the second one.
[CUSTOMER][NEUTRAL] They, they're just the [PII].
[CUSTOMER][NEGATIVE] You're, you're not understanding. Listen.
[CUSTOMER][NEUTRAL] I understand. Listen, you're not understanding what I'm saying. The same claims on the [PII], the [PII], and the [PII], which is only three claims on the [PII], it's the same claim as on the [PII]. They're all the same claim, the same date, same everything.
[CUSTOMER][NEUTRAL] I just wanna make sure that on the [PII] there should be 4 claims, not just 3, even though on the first claim 1672 that's 4, but all everything is one.
[AGENT][NEUTRAL] Right, I get that, but did you send in all the information for 4 dates of services the second time? Because as I just stated, I'm not seeing it.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] No, this is, this is what happened when I contacted my employer, they must have resend it again, so you guys are assuming it's a different claim.
[AGENT][NEUTRAL] No, we're not assuming that it's a different claim.
[CUSTOMER][NEUTRAL] Which to you guys.
[AGENT][NEUTRAL] Could you, could you hold? Let me transfer you to a supervisor that can better explain this to you because I don't know how else to explain it to you other than what I just provided you the information with, sir, because there's only 3 days of services for the the claim ending in 4963. I can't make up something that's not in the system. I can only verify what's in the system.
[CUSTOMER][NEUTRAL] No, no. I'm not saying, I'm not saying you're making it up. I'm saying the 1672 that has 4 claims is the same as the 4963.
[AGENT][NEUTRAL] Right, but you still have not submitted the information that is needed to process the claim.
[CUSTOMER][NEUTRAL] I know, I know what I'm saying is I don't want it just to be for 3 claims. I want it to be for 4 claims, so.
[AGENT][NEUTRAL] Right, you send in all the information for all 4 of them. If you send in the information that we need.
[CUSTOMER][NEUTRAL] Let me ask you, let me ask you this question before you transfer me. So once, once I submitted those um insurance and then the diagnosis.
[AGENT][NEUTRAL] The EOB
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It'll be 4 how many planes.
[AGENT][NEUTRAL] You have to submit it for each date of service. If you got all those data services, you need to contact your primary, your primary physician, your primary insurance company. As for data service [PII], [PII], [PII], and [PII], which is on the original claim.
[CUSTOMER][NEUTRAL] OK, so how many days?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And then I gotta go to the um pediatricso um pediatric where I got the service to get the diagnosis code, right? Is that what you said?
[AGENT][POSITIVE] Mhm. That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so for my insurance, um, just if you could repeat, um, exactly what I need to ask of them.
[AGENT][NEUTRAL] You need the EOB the explanation of benefits for all of those dates of services.
[CUSTOMER][NEUTRAL] Explanation of benefits, so meaning like just so I can prove that my son is under my insurance, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, that's not for proof to show that your son is under your insurance. It's for proof that they made a payment and something went towards your deductible.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Co-pay or co-insurance.
[CUSTOMER][NEUTRAL] I understand.
[AGENT][NEUTRAL] We're not affiliated with your primary.
[CUSTOMER][NEUTRAL] I understand.
[AGENT][NEUTRAL] 7 because this is your gap insurance. Um, is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] No problem, I understand.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][POSITIVE] Um, no, that's all. I just, um, thank you for your help.
[AGENT][POSITIVE] Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Bye.