AccountId: 011433970860
ContactId: 6bb18ef8-f5c5-4a3c-ab2f-530fd1a93d29
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 413709 ms
Total Talk Time (AGENT): 141614 ms
Total Talk Time (CUSTOMER): 147315 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/2025/06/12/6bb18ef8-f5c5-4a3c-ab2f-530fd1a93d29_20250612T19:04_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good morning. Uh, I'm sorry, good afternoon. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Yes, hi. I'm calling to find out if um you have received claims from one of my insureds.
[AGENT][NEUTRAL] OK, I can verify claim status for you and your name is?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] With associated
[AGENT][NEUTRAL] OK, and Miss [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] The policy number is 025.
[CUSTOMER][NEUTRAL] 83472.
[AGENT][NEUTRAL] OK, thank you, ma'am. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] and his date of birth is [PII].
[AGENT][NEUTRAL] OK, and what is the data service and amount of the charge?
[CUSTOMER][NEUTRAL] Uh, um, [PII] $120.
[AGENT][POSITIVE] OK, thank you ma'am, give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh no, actually the, the
[CUSTOMER][NEUTRAL] That was his responsibility because it was subject to deductible.
[AGENT][NEUTRAL] Let's see, and you said the date of service was [PII]?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Um, I don't show that claim has been received. Uh, can you verify the address it was submitted to?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Well, give me one second. It looks like some was recently submitted. Give me one moment, please. I'm sorry.
[CUSTOMER][NEUTRAL] Uh, well,
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] January, let's see, I'm sorry, it's gonna take a minute.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] There was actually there, I mean, I don't know if you can just do a general overview and see if there were any claims for him at all, but between the month of January.
[CUSTOMER][NEUTRAL] Um, [PII] and.
[CUSTOMER][NEGATIVE] Before there should have been 30 claims submitted.
[CUSTOMER][NEUTRAL] He's autistic.
[CUSTOMER][NEUTRAL] So he has um therapy visits.
[CUSTOMER][NEGATIVE] And the provider was supposed to submit the claims to you guys.
[AGENT][NEUTRAL] 01 moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, looking at the claims that recently received, I don't show that it's been, uh, can you verify the mailing address it was submitted to?
[CUSTOMER][NEUTRAL] No, I don't know where the provider sent them, to be honest.
[CUSTOMER][NEUTRAL] We're the broker, or the insurance broker, so I don't know where they sent them before I called them and asked them to submit them, I wanted to make sure they weren't submitted already.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] I understand that's why I was looking um because there are some recent claims they were submitted. I'm just checking them to see if it was for this date, but I do show some claims have been received for them, but um not for that date of service.
[CUSTOMER][NEUTRAL] Because they're billing my.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] But not for 24, not for any, for [PII], no.
[AGENT][NEUTRAL] No, no, we received from [PII], just not specifically for that date.
[CUSTOMER][NEUTRAL] Yeah, because I have like [PII], January [PII], January [PII], [PII], [PII].
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Cause I said he goes to therapy, so.
[AGENT][NEUTRAL] And I say that let me give me one moment to check one more thing.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you say you're calling from broker's office?
[CUSTOMER][NEUTRAL] Yeah, associated financial consultants or the broker.
[AGENT][NEUTRAL] Well, not from the previous claims, um.
[AGENT][NEGATIVE] Come on, this computer's so slow. We're just waiting for the weekend. Give me one moment.
[CUSTOMER][NEUTRAL] Exactly, I was gonna say is it's almost Friday.
[AGENT][NEUTRAL] For some reason on Monday and close to Friday, that's when everything is like, well, we're just gonna go really slow.
[CUSTOMER][NEUTRAL] It's slow, right?
[AGENT][NEUTRAL] Yes, ma'am. I don't.
[CUSTOMER][NEUTRAL] Oh, how about when you guys got that new system?
[AGENT][POSITIVE] Oh yeah, it's like, yay, new system is coming out.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Well,
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] Hopefully it should get back on track.
[AGENT][NEUTRAL] No, ma'am, I don't show any claims for [PII].
[CUSTOMER][NEUTRAL] For Lucas?
[AGENT][NEUTRAL] For Lucas, yes ma'am.
[CUSTOMER][NEUTRAL] Wow, so they haven't submitted any claims for Lucas for [PII].
[AGENT][NEUTRAL] Uh, no, ma'am.
[CUSTOMER][NEUTRAL] OK, so I'm gonna call the provider and the only way they can submit the claims is mailing them, correct? I know I go on the portal and I submit it.
[AGENT][NEUTRAL] Uh, they can.
[AGENT][NEUTRAL] Uh, they can fax the claim.
[CUSTOMER][NEUTRAL] Oh, they can go on the portal.
[CUSTOMER][NEUTRAL] OK, I have the fax number [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. OK, so no claims have been submitted for Lucas for [PII].
[AGENT][POSITIVE] Correct, yes, ma'am.
[CUSTOMER][POSITIVE] OK. All righty. OK, thank you.
[AGENT][POSITIVE] You are welcome, Ms. [PII], and is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Nope, that's it for today. Have a great day.
[AGENT][POSITIVE] Oh you too and thank you so much for calling APL.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Bye.