AccountId: 011433970860
ContactId: 715a6dc9-3a23-497f-8981-e58e2cf46333
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 272299 ms
Total Talk Time (AGENT): 82867 ms
Total Talk Time (CUSTOMER): 152380 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/715a6dc9-3a23-497f-8981-e58e2cf46333_20250501T17:58_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, yes, uh, good afternoon. My name is [PII]. I'm an agent and I'm following up regarding a claim that we had submitted. It was missing the itemized, uh, bill or diagnosis codes, and the policy number is 15.
[CUSTOMER][NEUTRAL] 66,010
[CUSTOMER][NEUTRAL] And the member's first name is [PII]. Oh, my first name is [PII]. Last name is [PII]. I'm the agent.
[AGENT][NEUTRAL] And what was your name?
[AGENT][NEUTRAL] You spell your name [PII]?
[CUSTOMER][NEUTRAL] Uh yep, and the last name [PII]
[AGENT][NEUTRAL] Thank you. And what is the member's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, his first name is [PII].
[CUSTOMER][NEUTRAL] Last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] Uh area code [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're calling to check the status of a claim for what date of service?
[CUSTOMER][NEGATIVE] Uh, the data service is [PII], so we had submit the first time, uh, and it went on [PII]. It was missing the itemized, uh, information.
[CUSTOMER][NEUTRAL] So we had uh submitted that on [PII] and then we needed diagnosis codes and then that was uploaded on [PII].
[AGENT][NEUTRAL] For the ER visit?
[CUSTOMER][NEUTRAL] Yeah, well, it's actually, uh, uh, inpatient or outpatient. I, I, I, I guess you would say it's um.
[CUSTOMER][NEUTRAL] Yeah, he had, he went through the ER and then he was hospitalized.
[CUSTOMER][NEGATIVE] And unfortunately he passed away.
[AGENT][NEGATIVE] Oh wow, it don't even look like they sent the updated information because I do see an ER visit for [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, [PII], [PII].
[AGENT][NEUTRAL] Oh [PII].
[AGENT][NEUTRAL] Yeah, um, [PII] ER [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Yeah, and then we've got the major portion of the hospital bill of 1240.
[CUSTOMER][NEUTRAL] And that's where they were requesting the itemized.
[AGENT][NEUTRAL] up the claim because it looked like someone processed it as outpatient instead trying to make sure that all the information was sent in.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I guess outpatient would be correct because since he didn't stay the night.
[AGENT][NEGATIVE] Oh, he didn't stay the night.
[CUSTOMER][NEGATIVE] No, no, because he, he, he passed away. He passed away while he was, uh, while he was admitted into the hospital. He had a massive heart attack. So they brought him in through the ER and then he died.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Got you. OK, so it will be considered as outpatient if it wasn't over 18 hours. It looked like there was a payment of $500 made on this claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, OK, so that that's exactly what we're trying to get them, OK, and then, uh, is there a benefit for the ambulance side of it?
[AGENT][NEUTRAL] So his policy is per occurrence.
[CUSTOMER][NEUTRAL] On the ER is it just.
[AGENT][NEUTRAL] This policy is based on a per per occurrence. So when the, the payment went towards the ER visit, so the ambulance, the benefits were maxed out for that per occurrence for occurrence.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Max
[CUSTOMER][NEUTRAL] Got it. OK, OK.
[CUSTOMER][NEUTRAL] OK, so the $500 check will then be sent to them. I'll let you know, I'll let the wife know.
[CUSTOMER][NEUTRAL] That the claim was processed then.
[AGENT][NEUTRAL] Yeah, it looks like it's, yup, it was processed on the [PII].
[CUSTOMER][POSITIVE] OK, yep, so just like OK, just last week, OK, perfect.
[CUSTOMER][POSITIVE] Perfect. I greatly appreciate your help on this. No, no, no, that'll be it. Thank you so much.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today, [PII]?
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. You have a great day.
[CUSTOMER][POSITIVE] You do the same. Thank you, bye bye.
[AGENT][POSITIVE] Thanks, goodbye.