AccountId: 011433970860
ContactId: 71a4d5be-185e-4b55-8f51-4559f1a29b80
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 352739 ms
Total Talk Time (AGENT): 139638 ms
Total Talk Time (CUSTOMER): 98911 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/71a4d5be-185e-4b55-8f51-4559f1a29b80_20250417T22:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I had some que I put in a claim online and um it's really weird like I don't know if like the the the website or the app or whatever is just not showing it properly, but I was just, it says the claim was completed but no other further information.
[AGENT][NEUTRAL] OK. Do you have your policy number?
[CUSTOMER][NEUTRAL] Uh, policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um or I can look it up by your last name or social.
[CUSTOMER][NEUTRAL] Uh, social security number is [PII].
[CUSTOMER][NEUTRAL] 063484
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] And what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah. Excuse me.
[AGENT][NEUTRAL] OK, [PII], when is your birthday? Excuse me.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][POSITIVE] And you have a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, just need two other pieces of information, your address?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And your email address.
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII] or it's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it looks like we've got your um claim on file. When it finalizes, it usually takes 24 hours before it'll load the actual explanation of benefits. So, um, let's see what it looks like you submitted a claim for [PII], is that correct?
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, it looks like we needed an explanation of benefits from your primary carrier along with an itemized bill.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, has your primary processed the claim?
[CUSTOMER][NEUTRAL] Um, my primary, um,
[CUSTOMER][NEUTRAL] What's the primary
[AGENT][NEUTRAL] Uh, your primary insurance, let me see if I can.
[AGENT][NEUTRAL] United Healthcare.
[CUSTOMER][NEUTRAL] Got it. I'm guessing no.
[AGENT][NEUTRAL] Yeah, so they, so the way this policy works, it's a secondary policy, so we have to see how did UnitedHealthcare process at first.
[AGENT][NEUTRAL] And then based on how they processed it, we potentially will pick up um additional charges.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, so I mean they, yes they did process it.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Because they paid X amount and then this was the balance of it.
[AGENT][NEUTRAL] Right, so we need um that explanation of benefits from United Healthcare and then basically like something showing what services were rendered, um, so, um, let me see what we received. Hold on just a second.
[AGENT][NEUTRAL] OK, let's see
[AGENT][NEUTRAL] OK, so let me see. So what we've received looks like, OK.
[AGENT][NEUTRAL] It looks like we just got a it's was like a statement from Lee Health um it just showed that the total paid 2761, so we actually need like an itemization of what kind of services they were, um, like a breakdown of services.
[AGENT][NEUTRAL] Was this like a hospital stay or ER or?
[CUSTOMER][POSITIVE] Yeah, I agree.
[AGENT][NEUTRAL] OK, yeah, so that's what we're looking for the United Healthcare explanation of benefits and then like an itemized bill that shows the date of service, what charges were and what you're seeing for.
[CUSTOMER][NEUTRAL] Got it, so I need to get an itemized bill from my health care provider first.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Um, and then got it and then send that to you.
[AGENT][NEUTRAL] Yes, and then you can upload that to our portal.
[CUSTOMER][POSITIVE] Excellent. All right, send that and then I need to get my United Healthcare to send you what?
[AGENT][NEUTRAL] The explanation of benefits showing how they process the claim.
[CUSTOMER][NEUTRAL] Got it, got it. Explanate and they'll know to do that or I'm guessing.
[AGENT][NEUTRAL] Um, you would need to request it from them, yes, and then give them our information.
[CUSTOMER][NEUTRAL] Got it. OK.
[CUSTOMER][POSITIVE] All [PII]. I appreciate it very much.
[AGENT][POSITIVE] OK, well thanks for calling APL have a good evening.
[CUSTOMER][POSITIVE] Thank you. Bye.