AccountId: 011433970860
ContactId: 6b694bb4-459a-488b-a8cf-553889015033
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 689900 ms
Total Talk Time (AGENT): 305420 ms
Total Talk Time (CUSTOMER): 270006 ms
Interruptions: 2
Overall Sentiment: AGENT=2.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/6b694bb4-459a-488b-a8cf-553889015033_20250414T16:25_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling about um information I got back on a claim. Can I give you a claim number to get started?
[AGENT][POSITIVE] That would be wonderful. What is that claim number?
[CUSTOMER][NEUTRAL] It's 358-425-5.
[AGENT][POSITIVE] Thank you and what is your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, Ms. [PII]. And what is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you. And this, so this claim is for you. Let me take a look real quick.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And while I'm looking at this, do you mind verifying your current mailing address?
[CUSTOMER][NEUTRAL] Uh, sure. [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] OK, so I do have the claim pulled up.
[AGENT][NEUTRAL] And I'm looking at everything.
[CUSTOMER][NEUTRAL] OK. One of my main questions, yeah.
[CUSTOMER][NEUTRAL] Are you looking at it now on the information I sent?
[AGENT][NEUTRAL] I am.
[CUSTOMER][NEUTRAL] OK, it asks for an itemized billing from the provider's office, so showing codes and charge amounts.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Do you not have a copy of the women's hospital bill?
[CUSTOMER][NEUTRAL] Which is where my surgeon is located and where the surgery was done.
[CUSTOMER][NEUTRAL] It's got codes all over the place.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm looking. Let's see what we've got.
[CUSTOMER][NEGATIVE] I don't, I don't understand.
[CUSTOMER][NEGATIVE] Yeah, I just don't understand what you're looking for.
[AGENT][NEUTRAL] All right, let's see if we can.
[AGENT][NEUTRAL] It just, it just takes a minute to pull everything up.
[CUSTOMER][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Are you enjoying this drier, warmer weather?
[CUSTOMER][POSITIVE] Yes, I am, and I'm enjoying the fact that it's gonna stay dry until [PII] and we can have our crawfish ball, not in the rain.
[AGENT][POSITIVE] 00, OK. So, yeah, I would be excited about that too.
[CUSTOMER][NEGATIVE] Oh yeah, come on, are you in [PII]?
[AGENT][NEUTRAL] I'm in [PII], right next door.
[CUSTOMER][NEUTRAL] Oh, you're in [PII] you're next door.
[AGENT][POSITIVE] That's right. I'm next door neighbor.
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] Oh my God.
[CUSTOMER][POSITIVE] Oh yeah, we're looking forward to a beautiful week.
[AGENT][POSITIVE] Yes, it is a it is interesting that [PII] is.
[AGENT][POSITIVE] You know, the, the weather is usually beautiful. I think that's interesting.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] It usually is.
[AGENT][NEUTRAL] I think that says a lot.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] I'm still going through your documents, so hang on just a second.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][NEUTRAL] Now, has the crawfish season been this good uh good this year? Cause I thought I had read something where there was a little.
[AGENT][NEUTRAL] Off this year
[CUSTOMER][NEUTRAL] Um, actually, no, it seems that the cold weather put it back a little bit, but they're selling crawfish everywhere right now, so they're expensive, but that's, that's how it is.
[AGENT][POSITIVE] Oh, that's good.
[AGENT][NEUTRAL] Yeah, what didn't.
[AGENT][POSITIVE] We have a little town here and every year they do a, a crawfish 5K run and have a big crawfish bowl after it, and it's always so much fun.
[CUSTOMER][NEUTRAL] Uh
[AGENT][POSITIVE] It's so good.
[CUSTOMER][NEUTRAL] Oh yeah, that.
[AGENT][POSITIVE] I'll always look forward to that.
[AGENT][NEUTRAL] You know what, Mr [PII].
[CUSTOMER][NEUTRAL] Well, that's just
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] No, no, I was just gonna say that's our tradition. That's what we do every Easter Sunday.
[AGENT][POSITIVE] I think that's awesome. I love tradition.
[CUSTOMER][NEUTRAL] And as, as much of the family comes in as they can, you know.
[AGENT][NEUTRAL] Do you have the big garbage cans out and the tables with the holes in them and all that fun stuff?
[CUSTOMER][NEUTRAL] Oh no, we don't have that we just have tables, just regular tables.
[AGENT][NEUTRAL] I remember I was in [PII] one year and they had a crawfish bowl and they, they put out all the big tables and just covered them with the plastic stuff and you just put everything on that table and then
[AGENT][NEUTRAL] At the end, they just roll it up.
[CUSTOMER][NEUTRAL] That's it. That's.
[CUSTOMER][NEUTRAL] Roll it up and put it in the can.
[AGENT][NEUTRAL] I wish we could do everything that way.
[CUSTOMER][NEUTRAL] I know, isn't that the truth?
[AGENT][NEUTRAL] I just haven't got to where I can suck the heads yet, but I'm working on it.
[CUSTOMER][NEGATIVE] OK, OK, that's fine. I'm not going anywhere.
[AGENT][NEUTRAL] Yeah, let's see what I need to do, Miss [PII], let me get you to uh one of our claims specialists to look at this because.
[AGENT][NEUTRAL] I mean I do see the procedure codes.
[CUSTOMER][NEUTRAL] Their procedure codes and uh whatever the REV code is I don't know what that is.
[AGENT][NEUTRAL] But that was for.
[AGENT][NEUTRAL] The hospital.
[AGENT][NEUTRAL] Yeah, the revenue code is gonna be a hospital code that's something that they put in their building, their billing.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] So that doesn't apply to us.
[AGENT][NEUTRAL] But let me get you to them and it may be for that date of service of [PII]. Now I do see in the hospital bill.
[AGENT][NEUTRAL] That they
[CUSTOMER][NEUTRAL] Right, on [PII]?
[AGENT][NEUTRAL] That's what it's showing [PII].
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] [PII], [PII] for radiation.
[CUSTOMER][NEUTRAL] No, I was in the hospital.
[CUSTOMER][NEUTRAL] No, that was radiation, right, but I'm looking at the hospital bill, [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Now, it looks like the hospital bill, let's see.
[AGENT][POSITIVE] Yeah, let me get you to them and see what else is needed and they can.
[AGENT][POSITIVE] Help you further with that information if that's all right.
[CUSTOMER][NEUTRAL] Oh sure that's fine. Like I said, I just, I thought I had what I needed.
[AGENT][NEUTRAL] Yeah, well, they can.
[CUSTOMER][NEGATIVE] And so far they've paid me $100 you know, it's like, OK, come on.
[AGENT][POSITIVE] Yeah, it's just that that they're needing specific information and they can kinda get tell you specifically what to ask for if you don't mind holding just a minute let's see if we can get this paid for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, that's
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] That way you can buy some more crawfish.
[CUSTOMER][NEUTRAL] There you go.
[AGENT][POSITIVE] Give me just one moment, Mrs. [PII], and I hope you have a lovely day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEGATIVE] Deferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How may I help you?
[AGENT][POSITIVE] Hi [PII], it's [PII]. Happy Monday.
[CUSTOMER][NEUTRAL] Hello [PII] how are you?
[AGENT][POSITIVE] I'm doing well, thank you. I have policy number 85303.
[AGENT][NEUTRAL] I have Ms. [PII] on the line, verified all of her information.
[AGENT][NEUTRAL] And she is calling regarding her claims.
[AGENT][NEUTRAL] Now she said that she thought that she had sent over everything and the only thing that's been paid so far is $110.
[CUSTOMER][NEUTRAL] OK, just give me one second let me pull that up.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So I
[AGENT][NEUTRAL] Just need some she needs some further assistance pulling up the documents and seeing what all she needs.
[CUSTOMER][NEUTRAL] 853-03.
[CUSTOMER][POSITIVE] And it's for uh [PII] you said I'm sorry.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] And everything's been verified.
[AGENT][NEUTRAL] Everything has been verified.
[AGENT][NEUTRAL] And your phone number is the number on file, but I can give it to you if you'd like.
[CUSTOMER][NEUTRAL] OK and.
[CUSTOMER][NEUTRAL] OK, the number is showing [PII]?
[AGENT][NEUTRAL] It is.
[AGENT][POSITIVE] You got it, girl.
[CUSTOMER][NEUTRAL] OK, and she's just needing further clarification of what's needed for her claim, is that right?
[AGENT][NEUTRAL] Right, cause she said she'd send in uh documents with codes. Now, we did talk about the revenue codes and that being a hospital code that they use.
[AGENT][NEUTRAL] But that's not a code that we use, right?
[CUSTOMER][NEUTRAL] Um, I'd have to look at it the.
[CUSTOMER][NEUTRAL] Is that the latest claim, the 422 and in 4225 she's speaking of?
[AGENT][NEUTRAL] Yeah, and I was looking so.
[AGENT][NEUTRAL] It looks like they're needing something for the hospital, the women's hospital charges.
[AGENT][NEUTRAL] And I think that that was what she was mainly referencing other than what else is needed for her radiation.
[CUSTOMER][NEUTRAL] OK, yeah, I'm looking at I pulled up the document from that previous claim and then I'll pull up the newest ones and see exactly what we're missing but you can go ahead and um transfer her when you're ready.
[AGENT][POSITIVE] All right. Thank you, [PII]. It's always a pleasure to talk to you. I hope you have a great day.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] You too, [PII] thank you so much.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Ms. [PII], thank you for your patience. I have a claims specialist on the line, uh, [PII], and she is looking at your documents as well and going to assist you further as to what's needed, OK?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, thank you very much.
[AGENT][POSITIVE] And thank you for calling APL MC. You have a happy Easter week and weekend. Enjoy that crawfish bowl. Now, take care. Thank you. Bye-bye.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Uh huh thank you [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Hi Ms. [PII], my name is [PII]. I'm in the claim support team and so I'm looking over your documents now. It looks like we're, we were asking for some additional information. So right now I'm reviewing uh that previous claim that we, um, initially requested it looks like we were requesting some um additional information regarding the surgery that you had on [PII].
[CUSTOMER][NEUTRAL] For surgery and anesthesia. OK, so I'm gonna look over those documents first and then we'll move on to that last uh information received.
[CUSTOMER][NEUTRAL] Yeah, I just, I just don't quite understand. I thought I had what you needed.
[CUSTOMER][NEGATIVE] Apparently not.
[CUSTOMER][NEUTRAL] Understood, so let me just take a look here.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So