AccountId: 011433970860
ContactId: 7ac5ef07-4bc8-4644-b21e-2581ac7ddf4e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 676919 ms
Total Talk Time (AGENT): 215439 ms
Total Talk Time (CUSTOMER): 259340 ms
Interruptions: 4
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/7ac5ef07-4bc8-4644-b21e-2581ac7ddf4e_20250228T17:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, I had a question about a bill that I received.
[AGENT][NEUTRAL] OK, sir.
[CUSTOMER][NEGATIVE] That was not uh paid it was denied. Mhm. What kind of info do you need?
[AGENT][NEUTRAL] OK, for a claim
[AGENT][NEUTRAL] Yes, sir. May I get your name and your policy number and I can help you with the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, my name is [PII].
[CUSTOMER][NEUTRAL] And uh policy number is 02351096.
[AGENT][NEUTRAL] OK, and let me pull that policy up real quick, sir.
[AGENT][NEUTRAL] OK, Mr. [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, sir. And then all for security reasons, can you give me your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Address is [PII].
[CUSTOMER][NEUTRAL] Uh, did you say phone number?
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Yeah, [PII] and uh I'm not sure which email address it's. I think you changed it to. It might be yeah [PII].
[AGENT][NEUTRAL] It looks like it's [PII].
[AGENT][NEUTRAL] Thank you, sir. And then I also have a PO box number for you. Is that going to be the correct?
[CUSTOMER][NEUTRAL] That's my, uh, yeah, that's my, uh, I'm using that, uh, for all my mail [PII].
[AGENT][NEUTRAL] Address?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes sir, thank you so much and on.
[CUSTOMER][NEUTRAL] My, my, I'm gonna, I'm gonna put my wife [PII] on here because she's uh more familiar with insurance stuff and uh I basically don't know much about it and if you don't mind it if she could uh speak with you and OK, OK, here you go, hold on.
[AGENT][POSITIVE] Yes sir, yes sir.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK. No, I don't mind.
[AGENT][NEUTRAL] I don't mind at all. And what's your name, sir?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] [PII], thank you so much.
[CUSTOMER][NEUTRAL] Yeah, my wife [PII] OK.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][POSITIVE] Hi, Ms. [PII], this is [PII] with [PII]. It's nice to meet you. um, so Mr.
[CUSTOMER][NEUTRAL] OK, yeah, me too.
[AGENT][NEGATIVE] Mr. [PII] stated that um there you guys received a bill for a claim that should have been paid, you're saying, but it was not.
[CUSTOMER][NEUTRAL] Right, um, so we first received that explanation of benefits, um, and they've got it like in 3 parts, and then we went online and saw that part of it was being paid, part of it, I guess is under review, and then one part was all coded on the information of benefits is out of network, but she's in network and this is all one and the same.
[CUSTOMER][NEUTRAL] Uh, uh, you know, office that this procedure was done at. Basically, he saw, you know, a couple of spots on his body that, you know, colored that he hadn't seen before, went in, they, you know, biopsied and whatever, took the little sample, sent them out, found that they were cancerous, and then cut them out.
[AGENT][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] So it doesn't make, you know what I'm saying, it doesn't make sense that saying this is she's out of the network, but these other two doctors are in and some of it's getting paid and then she's sending us a bill and so we're just trying to get this resolved.
[AGENT][NEUTRAL] OK, what is the date of service?
[CUSTOMER][NEUTRAL] Um, what was the date of service is this it? Well, on here they've got I guess [PII].
[CUSTOMER][NEUTRAL] Yes. And then he went back on the.
[CUSTOMER][NEUTRAL] OK, well they have something on here dated [PII], but oh, OK, that may have been pathology that's all pending review and then [PII] is when he had the procedure which not the [PII] date isn't showing on this explanation benefit.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] OK, so I am looking at the claim for [PII].
[AGENT][NEUTRAL] And I'm showing that claim was paid $125 with check number 2028037.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, that's what I'm saying. Some of it online is showing stuff is paid, but OK, so going back to the claims for [PII].
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] OK, let me see if I can find.
[CUSTOMER][NEUTRAL] NYERS she's being coded as uh network but I can't be because this is all in network and it shows up on the list of uh in network providers.
[CUSTOMER][NEGATIVE] She's the one that we've gotten a bill. We haven't gotten any other bills.
[AGENT][NEUTRAL] OK, let me look at your claims.
[AGENT][NEUTRAL] OK, the only claim that I show for the year of [PII] that's been submitted to us is the one from.
[AGENT][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] With dermatology associates.
[AGENT][NEUTRAL] And this is on [PII], is that correct?
[CUSTOMER][NEUTRAL] Right. And what are you showing then that that procedure was?
[AGENT][NEUTRAL] Yeah, that's the only
[AGENT][NEUTRAL] 11602.
[AGENT][NEUTRAL] 17262.
[AGENT][NEUTRAL] And 12032.
[CUSTOMER][NEUTRAL] I don't know what those numbers are.
[CUSTOMER][NEGATIVE] None of that matching what's on this.
[AGENT][NEUTRAL] That's the procedures.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] And this is the one that was paid $125 and the remarks on the claim after the $125 was paid was the maximum benefit payable this date of service was met after that $125 was paid.
[AGENT][NEUTRAL] And that's, that's the [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Prior to that, the last claim that we received was uh [PII].
[CUSTOMER][NEUTRAL] Well, how come when we go online we see all this other stuff and it's on this explanation of benefits.
[CUSTOMER][NEUTRAL] But you're only showing something from [PII] and nothing else prior to that in the year.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Right, I'm showing there was a claim submitted on reported on [PII]. I show there's a claim that was reported on [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] No, we're not, yeah, we're not talking about December. You didn't go back in December. No, it was, you went in January and that's all it's showing online when we pull up our claims.
[CUSTOMER][NEGATIVE] What we show online is matching what we received in the mail for this explanation of benefits, but what you're telling me is all totally different.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so what I'm going to do, we're gonna get you further help, um, I'm gonna get somebody from the claims department and examiner to call you back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] That way you guys can go over everything that you have compared to what we have here and then we'll make sure we get you some good answers, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm gonna put you on a brief hold while.
[CUSTOMER][NEUTRAL] OK, yeah, you, OK.
[AGENT][NEUTRAL] I'm gonna put this request in for somebody to give you a call back and I'm gonna put you on a brief hold while I get requests together and I'll be right back.
[CUSTOMER][POSITIVE] OK. All right, thanks.
[AGENT][POSITIVE] Thank you so much, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 322
[AGENT][NEUTRAL] Alright Ms. [PII] I've got that request in for claims to give you guys a call back at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, yeah, sounds good.
[AGENT][POSITIVE] Alright thank you so much you guys have a blessed weekend and thanks for calling APL.
[CUSTOMER][POSITIVE] Alright, thank you.
[CUSTOMER][POSITIVE] OK, you too. Alrighty, bye bye.
[AGENT][NEUTRAL] Mhm. Bye-bye, ma'am.