AccountId: 011433970860
ContactId: 6ab9d279-3aea-450d-8f5f-127af6f59ddd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1697199 ms
Total Talk Time (AGENT): 501270 ms
Total Talk Time (CUSTOMER): 330660 ms
Interruptions: 6
Overall Sentiment: AGENT=0.7, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/6ab9d279-3aea-450d-8f5f-127af6f59ddd_20250327T18:34_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] in Berker Resources. How are you?
[AGENT][POSITIVE] [PII]. I'm good. How are you today?
[CUSTOMER][NEUTRAL] Good, good. So can you do, do you do, does the care team do claim status for for broker's office that are OK. I've got a broker named [PII] on the phone.
[AGENT][NEUTRAL] I do.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, um, what is, so she's, and have you verified all of the information of make sure I can speak to her they filed the claim.
[CUSTOMER][NEUTRAL] She's
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, she's with us that the, yeah, she's with, oh, I didn't ask her that part. She just went, she's calling for data service. She date service on this lady to see if we have the claims.
[CUSTOMER][NEGATIVE] Why they haven't been paid. I don't know what all's procedure is on that, so I apologize.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That's OK. What's her last name?
[CUSTOMER][NEUTRAL] Uh her name is [PII]. I don't have her last name. She's with the broker's office, FD National, sorry, I've got her callback number.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] SB National.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] [PII], [PII], I believe that's what that's the national, yes, yes.
[AGENT][NEUTRAL] FD National.
[AGENT][NEUTRAL] OK, and what's your number?
[CUSTOMER][NEUTRAL] OK. It is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you, Policy number please ma'am?
[CUSTOMER][NEUTRAL] And let me see, so let's let's see, it is 1071583.
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] Give me one second, [PII]. I'm still trying to pull them.
[CUSTOMER][POSITIVE] They're fine. They're fine.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and did you verify any information about the insured or the broker?
[CUSTOMER][NEUTRAL] I did not. No, I didn't know it's claim status after we got into it, she gave me that information and my screens are a little different than y'all, so sorry.
[AGENT][NEUTRAL] Yeah, OK.
[AGENT][POSITIVE] Oh, you're fine. I just want to know what I needed to um to verify with her, so, you know, instead of redundancy, but anyway, but yeah, I'll be happy to talk to her.
[CUSTOMER][POSITIVE] Yeah, exactly, right.
[CUSTOMER][NEUTRAL] Absolutely I know. OK, she gave me the dates of service at [PII] and [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, wait. [PII]. And what is the other one?
[CUSTOMER][NEUTRAL] Mhm. [PII].
[AGENT][POSITIVE] OK. I will certainly help her. I can do that. I, yes, ma'am.
[CUSTOMER][POSITIVE] Ready? OK, I'll, I'll join her in. Thank you so much here. Hang on a second.
[AGENT][POSITIVE] OK. You're welcome. All right.
[CUSTOMER][NEUTRAL] Hi [PII].
[CUSTOMER][NEUTRAL] Hi, yes, I'm still here. Hi, I've got I've got [PII] on the line and she's gonna help you with that claim status, OK?
[CUSTOMER][POSITIVE] OK, thank you. OK, thank you for calling APO you have a great day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][NEUTRAL] Hi, [PII]. This is [PII]. How are you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. I'm doing OK. How are you?
[AGENT][NEUTRAL] I'm doing fine, thank you. So [PII] said that you were needing to check claim status uh for this Ms. [PII], is that correct?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, yes, but um
[AGENT][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, [PII] is the insured. The, the, the, the patient was actually the spouse, which is [PII].
[AGENT][NEUTRAL] OK, so I can help you with that as well, but I will need to verify some pieces of information with you first. Um, so first off, if you could please verify the name of the group.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] That they were with.
[CUSTOMER][NEUTRAL] Sure, it's La Food Service Corporation.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Thank you. And the agent's name?
[CUSTOMER][NEUTRAL] The agent's name?
[AGENT][NEUTRAL] Uh-huh, yes, ma'am.
[CUSTOMER][NEUTRAL] Sorry, which agent?
[AGENT][NEUTRAL] The agent for the group, the broker.
[CUSTOMER][NEUTRAL] Oh, financial design, sorry.
[AGENT][NEUTRAL] Uh, and who is the agent for the group?
[CUSTOMER][NEUTRAL] Uh, let me check for you, just a moment.
[AGENT][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] Uh, hold on.
[CUSTOMER][POSITIVE] Thank you. Sorry.
[AGENT][POSITIVE] No, you're, no worries.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Sorry, I'm still here.
[AGENT][NEUTRAL] Oh, no, you're fine. Mm mm, you're fine.
[AGENT][NEUTRAL] It's taken me a long time all day to do most tasks today.
[AGENT][NEGATIVE] I've had some technical issues that this morning I thought, oh maybe I should have even come to work today.
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][POSITIVE] Maybe I should just try to start this all over. So yes, no worries. Take your time. I've been having to ask people to be patient with me all day today.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK. No, this is not moving.
[CUSTOMER][NEUTRAL] OK. Just one moment, OK?
[AGENT][NEUTRAL] Sure. Yes, ma'am.
[CUSTOMER][NEUTRAL] I'll be right back.
[AGENT][NEUTRAL] Uh-huh, that'll be fine.
[CUSTOMER][NEUTRAL] Sorry, I'm still here. I'm just making one quick call.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And you said you needed the agent's name for the, for lace.
[AGENT][NEUTRAL] I need an agent's name for the, for this, uh-huh, for this group, and then also the email address.
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] OK, and then the email that would be on file for this group and for the agent?
[CUSTOMER][NEUTRAL] OK, let me get the email for you. Sorry, I've never been asked these questions.
[AGENT][NEUTRAL] OK, thank you. You, yeah, right, and yes, and it's part of, there's certain things that we are supposed to verify and I'm sorry if this seems inconvenient, but for security purposes, it should be be being verified. Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, that's OK. No, that's OK. I understand.
[CUSTOMER][POSITIVE] Yeah, I totally get it.
[CUSTOMER][NEUTRAL] OK. So it's [PII].
[AGENT][POSITIVE] OK, thank you very much. OK.
[CUSTOMER][NEUTRAL] You're welcome, [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Alright, so you said that the claims were for.
[AGENT][NEUTRAL] Part two, correct, the spouse. Is that right?
[CUSTOMER][NEUTRAL] Yes, for [PII].
[AGENT][NEUTRAL] Not the primary.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And if you could please verify his date of birth for me?
[CUSTOMER][NEUTRAL] Sure. His date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and what is the first date of service and total bill amount for him?
[CUSTOMER][NEUTRAL] Yes, let me tell you.
[CUSTOMER][NEUTRAL] It's, uh, uh, let me go back. It's [PII].
[AGENT][NEUTRAL] 8
[AGENT][NEUTRAL] 818.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And total charge is $960.
[AGENT][NEUTRAL] OK, so let me check that one first. There was [PII] indicated there was more than one data service, is that right?
[CUSTOMER][NEUTRAL] Yes, the other, yes, there are only 2.
[AGENT][NEUTRAL] OK. Don't give it to me yet. OK. All right, we'll do this one.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Well, they, this we're gonna have to do it one at a time.
[AGENT][NEUTRAL] And then [PII], what is your last name? I didn't get that either.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII]. OK, thank you. And then what is your email address, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sure. That would be [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] [PII], sorry.
[AGENT][NEUTRAL] Oh, [PII] [PII], OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, that's [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And [PII], your callback number that [PII] gave me was [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, let's see for $960 is for the claim, is that correct?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] Alright, it's gonna take me just a couple moments. It looks like we've received this claim multiple times. It was denied as a duplicate as of most recent, um, I mean the last two times to just let me locate the original one.
[CUSTOMER][POSITIVE] OK, take your time.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Bear with me
[CUSTOMER][POSITIVE] That's OK. Take your time. You're just bearing with me.
[AGENT][POSITIVE] And I appreciate you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] I'm trying to, OK.
[AGENT][NEUTRAL] On this policy, I should, the total claim, do you have the total billed amount for the total claim received?
[AGENT][NEUTRAL] Because it wasn't 9, yeah, it's.
[CUSTOMER][NEUTRAL] Let me go back.
[CUSTOMER][NEUTRAL] Uh, hold on, 1000.
[AGENT][NEUTRAL] That's
[CUSTOMER][NEUTRAL] I'm showing 1000 as the total charge. Um, there was a balance for 2745.
[AGENT][NEUTRAL] $27.45.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so on the
[AGENT][NEUTRAL] Mhm
[AGENT][NEGATIVE] I honestly don't understand.
[CUSTOMER][NEUTRAL] Let me double check.
[CUSTOMER][NEUTRAL] Let me double check to ensure I'm correct.
[AGENT][NEUTRAL] Sure, yeah, you're fine.
[AGENT][NEUTRAL] Because I'm
[AGENT][NEUTRAL] Let me just see if I can look at what was actually received because.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm still trying to determine.
[AGENT][NEUTRAL] Are you still there, [PII]?
[CUSTOMER][POSITIVE] Yeah, I'm still here with you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK and I'm gonna have to send a request to have someone to look into this and call you. I was trying to look at the actual claim information, but it is not um it, it will not pull in for me to be able to look at it to see.
[AGENT][NEUTRAL] So I'm not sure if this.
[AGENT][NEUTRAL] I can see where 960 was apparently it looks like denied as a duplicate of a larger claim was received the same thing with the 1000, but I cannot differentiate in what I can, I can see.
[AGENT][NEUTRAL] As to if that was paid or not. Now I know there's a physician's benefit on this policy of max of, it's $25.
[CUSTOMER][NEUTRAL] Mhm. Because, um,
[AGENT][NEUTRAL] And it looks like that was paid.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Because the $960 so it's the same data service but um two different balances. So, the first total charge is $960 and the other one is $1000.
[AGENT][NEUTRAL] And of that, that's what I'm um.
[AGENT][NEUTRAL] Let me try one other way to look up this.
[AGENT][NEUTRAL] Particular
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then it's not, I have to have some, I'll just have to send a request. I'm trying to avoid having to do that to give you a call back.
[AGENT][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, I will because I I can't pull that claims information for whatever reason it won't show me the original claim that this was.
[AGENT][NEUTRAL] Reviewed under?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, I can't differentiate. I can just see that we received a claim that it appears we paid $25 on for that data service, which would have been the maximum benefit.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] For that date.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] But that's all I can tell.
[AGENT][NEUTRAL] And I tell you what, instead of having someone, yeah, yeah.
[CUSTOMER][NEUTRAL] OK, so only.
[AGENT][NEUTRAL] No, go ahead, [PII].
[CUSTOMER][NEUTRAL] Oh sorry, I was saying, so you're only seeing $25 payment was made.
[AGENT][NEUTRAL] Right, because that would be the maximum under this policy.
[CUSTOMER][NEUTRAL] OK. Are you able to take a look at the other one?
[AGENT][POSITIVE] Sure, I'll certainly try.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the other data service?
[CUSTOMER][NEUTRAL] OK. This one was [PII], and total charge is $260.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 260. OK, let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on the, on this data service, I can see this claim. The claim was received [PII] and it was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There was a benefit paid in the amount of $25.
[AGENT][NEUTRAL] And that claim number is 353-9444.
[AGENT][NEUTRAL] And with this,
[CUSTOMER][NEUTRAL] 353-944-444
[AGENT][NEUTRAL] Mhm. And with this payment, the maximum benefit amount for services provided during this office visit is exhausted.
[CUSTOMER][NEUTRAL] OK. So that's why only $225 was paid.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] And I believe that it's gonna be the same as with the other data service because I can see that that benefit was paid. I'm just not able.
[AGENT][NEUTRAL] If you have time, I'd like to try to get back to look at that 11 more time, the first data service.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So just save a call back if that's if you do have time if not then I can put a request in.
[AGENT][NEUTRAL] Uh, and I may still have to do that anyway, but.
[CUSTOMER][NEUTRAL] No, it's OK.
[CUSTOMER][NEUTRAL] It's OK. You can, if, um if you're able to take a look at it, you can look at it. But if you need to escalate it and give me a callback, then that's OK as well.
[CUSTOMER][NEUTRAL] Um, you might be seeing the provider's name as [PII] for that one, the one that you couldn't access.
[AGENT][NEUTRAL] Mm, it also shows it's under cardiovascular.
[AGENT][NEUTRAL] Medicine associates. Mhm. And again, um.
[CUSTOMER][NEUTRAL] OK. OK. That's.
[CUSTOMER][NEUTRAL] Yes, that's
[AGENT][NEUTRAL] I'm gonna try one more time to
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] I'm only able to see the explanation of benefits.
[AGENT][NEUTRAL] Regardless, let's see.
[AGENT][NEUTRAL] Yeah, and then I can't.
[AGENT][NEUTRAL] Yeah, yeah, I'm sorry. I will have to have um.
[AGENT][NEUTRAL] I'll have to send a request to have them call you on this one because I just can't see the claim form so I can't tell you for certain what the claim number is on that one for that charge for the 960.
[AGENT][NEUTRAL] The only one I can see which shows denied is a duplicate, but like the original claim that it would.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I guess it was on, I can't access that information.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I just tried it again. Mhm.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK. OK. That's OK, [PII], you tried. Uh, for the, the $25 that one, was it paid to the provider?
[AGENT][NEUTRAL] It was, yes.
[CUSTOMER][NEUTRAL] OK. OK. Thank you, [PII].
[AGENT][POSITIVE] It was paid. You are certainly very welcome. So is there anything else that I can help you with at the moment? And again, someone should call you [PII] within 24 hours.
[CUSTOMER][POSITIVE] OK. Thank you. No, that was all, [PII]. I hope you have a lovely day, OK?
[AGENT][POSITIVE] OK, well I hope you do too, [PII], and thank you again for calling APL.
[CUSTOMER][POSITIVE] OK, thank you. Bye-bye.
[AGENT][NEUTRAL] All right. Bye-bye.