AccountId: 011433970860
ContactId: 6bd1889f-6355-45e7-8f5b-038065e5dbdd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 352149 ms
Total Talk Time (AGENT): 64518 ms
Total Talk Time (CUSTOMER): 193378 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/6bd1889f-6355-45e7-8f5b-038065e5dbdd_20250506T17:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, how you doing [PII]?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][NEUTRAL] I'm great thanks for asking. This is [PII] in the claims department. I have an insured on the phone who's calling in regards to her online account. She's called, she called to check the status of a claim which I was able to assist her with that. However, she said that she wanted to view the claim online through her online account, and when she do click on the claim, it says an error has occurred, please contact customer service. I contact the customer service and they told me that this should go to the care team instead.
[AGENT][NEUTRAL] OK. Uh, do you have the policy number?
[CUSTOMER][NEUTRAL] It is 1221549.
[AGENT][NEUTRAL] OK, and who are you speaking with?
[CUSTOMER][NEUTRAL] I'm speaking with [PII], however, [PII], the spouse who's the policyholder, did give me permission to speak with [PII] on his behalf, which is his spouse.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK, I can talk to her.
[CUSTOMER][NEUTRAL] And their callback number is the [PII] number, do you see it?
[AGENT][NEUTRAL] Uh yes, I see that.
[CUSTOMER][POSITIVE] Alright, so let me transfer him over to you thank you have a good day.
[AGENT][POSITIVE] Thank you so much. Thank you.
[AGENT][NEUTRAL] Hello, this is [PII].
[CUSTOMER][POSITIVE] Hello [PII]. I have someone on the phone who's gonna better assist you in the care team. Well, thanks for calling APL and have a good day.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, [PII] and um can you give me what was that date of service?
[CUSTOMER][NEUTRAL] Um, it was [PII].
[AGENT][NEUTRAL] And this was for your spouse, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And it was for um professionals Clark and Coa Casa um for North American partners and anesthesia.
[AGENT][NEUTRAL] OK, um, let me get this pulled up.
[AGENT][NEUTRAL] Did it have a claim number by it on the website?
[CUSTOMER][NEUTRAL] She gave um uh uh [PII] gave me the claim numbers.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is that the 357-1306357-1313.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And you said it won't let you see it on the online portal?
[CUSTOMER][NEUTRAL] Right, when we click on it, it doesn't, um, we can't see it but not that now that we have the information it's not that it really matters anymore but we what uh [PII] explained to me is all you guys were requesting was the EOB in order to make payments so we have um the different the two claims that we printed out from Humana and she said that we could submit them so that you guys would have them and just attach the claim numbers to the submission. So how would we go about doing that?
[AGENT][NEUTRAL] Um, you should be able to upload file.
[AGENT][NEUTRAL] Um, on the portal on your dashboard.
[CUSTOMER][NEGATIVE] I can't open those.
[CUSTOMER][NEUTRAL] Oh, he said he can't, he can't open it, he said to do that.
[CUSTOMER][NEUTRAL] Go to dashboard bib.
[CUSTOMER][NEUTRAL] He's he, he can hear you. He's across the room from me. You're on speaker so upload, upload file you said?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, yeah, it should be upload documents.
[CUSTOMER][NEUTRAL] Under the dashboard
[AGENT][NEUTRAL] Under my claims?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I can do it there.
[CUSTOMER][NEUTRAL] So do you have any other questions? You got everything? Uh, the details which is just the number, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The document
[CUSTOMER][NEUTRAL] Yes, OK.
[CUSTOMER][NEUTRAL] So do you have it under control? do we need to?
[CUSTOMER][NEUTRAL] Any additional assistance?
[CUSTOMER][NEUTRAL] Hold, he said, hold on.
[CUSTOMER][NEUTRAL] We've been dealing with this since last since last November December.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh select file, OK.
[CUSTOMER][NEUTRAL] The craziness of this is, is, um, he had an outpatient procedure with an in-network hospital at an internet network in-network hospital with an in-network provider surgeon.
[CUSTOMER][NEUTRAL] And now the anesthesiology is saying that they were out of network.
[CUSTOMER][NEGATIVE] And then we owe them and I'm like this is insanity like I didn't choose you like what.
[AGENT][NEUTRAL] Yeah, that's it sometimes. ER and anesthesia some typically can be out of network for some reason. I don't know why.
[CUSTOMER][NEUTRAL] You know this is
[CUSTOMER][NEUTRAL] Like how is that cool? Like, and this is not an insignificant bill. This is like almost $700 like $650. I'm like.
[CUSTOMER][NEGATIVE] That's just, that's not, you know, that's not cool like.
[AGENT][NEUTRAL] Did your primary apply it to your uh deductible?
[CUSTOMER][NEUTRAL] Yeah, but we only have a deductible if it's out of network we don't have a deductible in network.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you guys cover it if it because they're calling it a deductible do you our policy covers deductible?
[AGENT][NEUTRAL] Yeah, it potentially covers deductible, co-pay, co-insurance, yes.
[CUSTOMER][NEUTRAL] That's what I thought, OK.
[CUSTOMER][NEUTRAL] You got it under control be or?
[CUSTOMER][NEGATIVE] Yeah that's my problem.
[CUSTOMER][NEUTRAL] So can we let her continue with her day? OK.
[CUSTOMER][NEUTRAL] I guess he's got it under control, he says.
[AGENT][POSITIVE] OK, well, thank you for calling [PII]. I hope you all have a great day.
[CUSTOMER][POSITIVE] Thank you for your help.
[AGENT][POSITIVE] Thank you. Bye-bye.