AccountId: 011433970860
ContactId: 80e53844-cdcb-4bd5-85b0-a2fcd9ac3b63
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 485320 ms
Total Talk Time (AGENT): 185143 ms
Total Talk Time (CUSTOMER): 130522 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/80e53844-cdcb-4bd5-85b0-a2fcd9ac3b63_20250410T16:14_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, so, it's [PII]. How are you?
[AGENT][POSITIVE] Hey, I'm good and you?
[CUSTOMER][POSITIVE] I'm good. It's weird calling y'all for a change.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I, I have a, uh, provider on the line. Um, she's saying she's needing to check some claims that were paid, um.
[AGENT][NEUTRAL] How can I help you?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] She said that we paid claims basically as if we were the primary, so she's wanting to take a look at those claims. Can you help her?
[AGENT][NEUTRAL] Oh, sure. Mhm. Yes. And what's her name?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Her name is [PII] and she is with Synergy Well-being.
[CUSTOMER][NEUTRAL] And her call back number?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] OK, and has she provided a policy?
[CUSTOMER][NEUTRAL] Yes, it is 238-9029.
[CUSTOMER][NEUTRAL] And I also had her verify the name and date of birth of the patient for [PII].
[AGENT][POSITIVE] OK dokey. I'm ready for [PII].
[CUSTOMER][POSITIVE] All right, here she comes. Thank you.
[AGENT][POSITIVE] Mm. You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] Good morning, Ms. [PII]. This is on the care team and he was transferred over to us to assist you with claims.
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] Hi. All right. So, um Miss [PII] was telling me that um you're looking for some claims, some, for some clarification of some claims.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, so it looks like you guys paid like your primary insurance and um you should have paid like your secondary.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] I can check and see what type of product is it and then um we can go ahead and check and see why it was pay like that. All right. um and what is the date of service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Uh, well, let me look at the checks here it says.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] All right, let me.
[CUSTOMER][NEUTRAL] I have a whole bunch of them.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] All right. All right, let me look at that.
[AGENT][NEUTRAL] Claim itself um.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And I'm waiting on the documents to pull up, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Alright, let me try to make this a little bit bigger. It's really tinyar with me.
[AGENT][NEUTRAL] I.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah. OK. So based on the explanation of benefits we received, uh, there is, um,
[AGENT][NEUTRAL] So there were 75 applied towards the co-insurance.
[AGENT][NEUTRAL] And it looks like there was $35 paid towards the deductible.
[AGENT][NEUTRAL] So that's $110.93.
[CUSTOMER][POSITIVE] OK, that's correct.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh sorry. All right. I just need to make sure.
[AGENT][NEUTRAL] All right, do you need me to check on another one just to make sure that the other one is correct?
[CUSTOMER][NEUTRAL] I'm sorry, you're cutting out a little bit. I didn't understand what you said.
[AGENT][NEUTRAL] You said you have another one, another data service?
[CUSTOMER][NEUTRAL] Oh, they're all the same.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see
[CUSTOMER][NEUTRAL] 4:19.
[AGENT][NEUTRAL] 4
[AGENT][NEUTRAL] That's 2024. OK, let me pull that image on this one. I just wanna make sure I'm looking at it correctly because it was really hard to read that one and that one was like really small. I had to make it really big, um, but let me see if this one has the same information.
[CUSTOMER][NEUTRAL] I, I think I see what you're saying why we.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Why we thought it was different, but I see.
[CUSTOMER][NEUTRAL] Um, how you got your number.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mm OK.
[AGENT][NEUTRAL] And I'm just gonna take a quick look on this one.
[AGENT][NEUTRAL] If it's the same, we'll leave it like that.
[AGENT][NEUTRAL] But it looks like that was and um let's see do do do do do.
[AGENT][NEUTRAL] The waiting on the documents taking a little bit.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Just you can move way faster than a computer.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I think.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh, come here.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] 673.
[AGENT][NEUTRAL] Yeah, it looks like that's, that's, that's the reason we are paying $110.93. Yeah, there's $35 applied towards the deductible.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right. Well, thank you for your help. I appreciate it.
[AGENT][POSITIVE] You're welcome and thank you for calling ATO. Have a good day [PII].
[CUSTOMER][NEUTRAL] OK, ma'am.
[AGENT][NEUTRAL] Yeah, uh-huh.
[CUSTOMER][NEUTRAL] Ma'am.
[AGENT][NEUTRAL] Go ahead. Yes, I'm still here.
[CUSTOMER][NEUTRAL] I'm sorry, can I get your name?
[AGENT][NEUTRAL] Oh, sure, yes. My name is [PII]. That's [PII]. Last initial is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I is there anything else I'm gonna help you with today, Miss [PII]?
[CUSTOMER][POSITIVE] That'll be all. Thank you.
[AGENT][POSITIVE] You're welcome. Have a good day. Good afternoon.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] You can do that