AccountId: 011433970860
ContactId: 789dfb03-38b4-4572-85c6-94c36fe07f2d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 350600 ms
Total Talk Time (AGENT): 124906 ms
Total Talk Time (CUSTOMER): 163671 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/789dfb03-38b4-4572-85c6-94c36fe07f2d_20250416T16:54_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII]. I'm calling with World Insurance. We're the broker for a group that is with APL. Am I able to get like uh ask a couple claims questions with you or a member?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, yeah, I can check on some claims for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] OK, thank you and then uh what was that group number please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The group number is one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] X
[CUSTOMER][NEUTRAL] Group number is my system is slow. It is 266-07.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That uh Goldman Property management?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was the name of the broker's office that you're with?
[CUSTOMER][NEUTRAL] World Insurance Associates.
[AGENT][NEUTRAL] Got it. OK, thank you so much for verifying that. Um, what was the policy number for this claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, let's see if it's on. I have a claim number.
[AGENT][POSITIVE] Oh, that works, yeah.
[CUSTOMER][NEUTRAL] Oh, the policy numbers I have I have both of them, um, which one do you prefer?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, we could go ahead and just do the claim number, that's fine.
[CUSTOMER][NEUTRAL] Claim number is 357.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 1594.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, and then if you would, what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Sure, hold on that up for you. So the first name is [PII], last name [PII], and that date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect thank you so much for verifying that [PII]. OK, well we just needing uh some clarification regarding this claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, so I have like a whole bunch of a list of claims to go over with the member and the client, so I just wanted to make sure I get uh all the information. I see that they paid $85 for the total bill of $1,165. Was that because the other codes were not um.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That covered?
[AGENT][NEUTRAL] So only one of the codes was not covered um that was uh office visits are not covered under this policy that's uh the 99213. All of the other codes that we did not pay on uh per the information we received their primary insurance had paid those benefits in full, so there was nothing additional for us to pay.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] Got it. And uh other benefits, perfect.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, and then.
[CUSTOMER][NEUTRAL] I had sent an email to [PII], but since I have you on the line, I submitted another claim um for this member.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] On the portal and I just wanted to see if it was received if there's a status and I have the confirmation number of the claim submission or I have the the uh I guess the information for the claim whatever works.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, let's do, um, what was that confirmation number? We can try that.
[CUSTOMER][NEUTRAL] OK, so the submission confirmation number is.
[CUSTOMER][NEUTRAL] O as in Oscar, S as in Sam, C as in Charlie, 96446.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Was this for the date of service of [PII]?
[CUSTOMER][NEUTRAL] Uh, let me open this one second.
[AGENT][NEUTRAL] Looks like $1,212.
[CUSTOMER][POSITIVE] Uh, yes, that is correct.
[AGENT][NEUTRAL] OK. Alrighty, let's take a look here.
[AGENT][NEUTRAL] OK, so this one is missing some information, so it does state that we've received the primary explanation of benefits. However, the explanation of benefits we received does not list the amounts that were applied to deductible, co-pay or co-insurance, so we need a more detailed explanation of benefits showing those amounts.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][MIXED] OK, then deductible.
[CUSTOMER][NEUTRAL] Co-pay, uh.
[AGENT][NEUTRAL] And I've got that claim number if you'd like.
[CUSTOMER][NEUTRAL] Oh sure.
[AGENT][NEUTRAL] OK, that is uh 35.
[CUSTOMER][NEUTRAL] I'll take it.
[AGENT][NEUTRAL] 88
[AGENT][NEUTRAL] 980.
[CUSTOMER][NEUTRAL] OK, and then let me just take a look at it maybe I missed something.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Um, the EOB, oh, I don't even.
[CUSTOMER][NEUTRAL] OK, so just uh the EOB was missing the deductible that was applied, um, in the co-pay, correct?
[AGENT][NEUTRAL] It was missing any of those amounts, yeah, co-pay, deductible or coinsurance we need those amounts that they pay towards.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, I will let them know. OK, I think that was all.
[AGENT][NEUTRAL] OK, there wasn't anything else I can help you with?
[CUSTOMER][POSITIVE] I appreciate it.
[CUSTOMER][NEUTRAL] No, that'll be it.
[AGENT][POSITIVE] Alright, well thanks for calling APL Erica. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you you as well bye.
[AGENT][POSITIVE] Thank you, bye bye