AccountId: 011433970860
ContactId: 821032b2-eac9-4302-b192-a55f3dc1cd08
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 855219 ms
Total Talk Time (AGENT): 392504 ms
Total Talk Time (CUSTOMER): 233730 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/821032b2-eac9-4302-b192-a55f3dc1cd08_20250519T22:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah [PII], hi, this is [PII] online and I'm checking on the status of claim.
[CUSTOMER][NEUTRAL] And the last time I talked with someone, they told me I needed to get estimations of benefits.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] But I forgot what else they said.
[AGENT][NEUTRAL] OK, all right. I.
[CUSTOMER][NEUTRAL] So maybe you can look it up and tell me.
[AGENT][POSITIVE] Yes, ma'am. I can help you. What is your, your name and your callback number?
[CUSTOMER][NEUTRAL] My name is [PII] My callback number is area code [PII].
[AGENT][NEUTRAL] OK, thank you, Ms. [PII]. And then may I also get your policy number?
[CUSTOMER][NEUTRAL] Oh, I don't know that. He's my social security number [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me see if I can find you real quick.
[AGENT][NEUTRAL] OK, Ms. [PII], uh, uh, what kind of claim were you filing? Was it for cancer, accident, medical?
[CUSTOMER][NEUTRAL] It's accident.
[AGENT][NEUTRAL] Accident, OK.
[CUSTOMER][NEUTRAL] It's for therapy.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, thank you. And then can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, ma'am.
[AGENT][NEUTRAL] And then I'm also going to need you for security reasons, can you give me your address, a phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] Uh, the email, I think it should be [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what else you need?
[AGENT][NEUTRAL] I'm showing it's a uh work email address for the school district.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][POSITIVE] [PII].
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes ma'am, that's correct. OK and when did you file the claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh Lord. Uh, let's see. I think about a month or so ago.
[AGENT][NEUTRAL] OK, let me check to see.
[AGENT][NEUTRAL] And, and was it for yourself?
[CUSTOMER][NEUTRAL] For my
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you happen to get a claim number when they asked you to send additional information?
[CUSTOMER][NEUTRAL] Uh, let me see. I got a paper here and I don't know.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] If it is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 3591614
[AGENT][NEUTRAL] 3591614. OK, let me look up that claim real quick.
[AGENT][NEUTRAL] OK, I do see the claim and it's gonna be under let me give you this policy number 237-533-3. That will be your policy number when you call to check about this claim.
[CUSTOMER][NEUTRAL] OK. 237 what?
[AGENT][NEUTRAL] 5333.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I do show.
[AGENT][NEUTRAL] A couple of remarks they did pay on the claim and it says that the calendar year maximum for this benefit has been exhausted with this payment.
[AGENT][NEUTRAL] And then you've got another remark says the diagnostic and prevention benefit has been exhausted for.
[AGENT][NEUTRAL] This calendar year, no further benefits are available. That was for the diagnostic and preventive and then you've got one says the charges submitted are not covered by the policy contract, but with that being said, let me tell you what was paid.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] An amount of $50 was paid.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] With
[AGENT][NEUTRAL] Let me get
[AGENT][NEUTRAL] Let me see when that was paid 3591614.
[AGENT][NEUTRAL] Give me just a minute. I've got to get to another screen.
[AGENT][NEUTRAL] OK, so that was actually done on um.
[AGENT][NEUTRAL] [PII] and was sent direct deposit in the amount of $50.
[CUSTOMER][NEUTRAL] OK, yeah, I got that, but it's another one I'm supposed to get for therapy.
[CUSTOMER][NEGATIVE] I think it's like 4 days of therapy, and she told me, when I talked to the representative, she told me they didn't pay for it yet. It's because they needed the explanation benefits.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] I'm trying to find out what company where I can call the company and get the explanation of benefits. I wrote that down. I wrote down all of.
[AGENT][NEUTRAL] Who you had your
[AGENT][NEUTRAL] Oh, OK, OK, so you're wanting to find out who you had your primary insurance through so that you can contact them?
[CUSTOMER][NEUTRAL] No, I know who I had that to, but it's two different companies that I used for physical therapy.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I wanna know which company.
[AGENT][NEUTRAL] Let me see if I can find.
[CUSTOMER][NEGATIVE] That I, I wrote all of this information down and I lost it.
[AGENT][NEUTRAL] OK, that's OK. Let me look on here real quick because it'll tell us.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm showing this claim number you gave me was through Houston Methodist. Let me see if there's another claim close to this time.
[AGENT][NEUTRAL] That has a different, different provider. Um, community health, um, Beaumont surgical affiliates.
[CUSTOMER][NEUTRAL] Yeah, it should be.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, those the names are coming up. Let me see if there's enough.
[CUSTOMER][NEUTRAL] It should be a therapy place.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm looking at all your claims that have been submitted.
[AGENT][NEUTRAL] To see if I can find.
[AGENT][NEUTRAL] One, not.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There please.
[AGENT][NEUTRAL] No, not on this one, not on this policy, let's see.
[AGENT][NEUTRAL] Yeah, on this policy number you gave me, those are the only providers that I have that have claim information on them.
[CUSTOMER][NEUTRAL] Oh shoot, it's a therapy place. I know one of them is home health care therapy.
[CUSTOMER][NEUTRAL] But it's another place that I use.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, I can't think of the name of the other place that I live.
[AGENT][NEUTRAL] Yeah, there hasn't been.
[AGENT][NEUTRAL] A claim. Now, let me look on your other policies.
[CUSTOMER][NEUTRAL] I just talked to the lady.
[AGENT][NEUTRAL] OK, that's OK. I might be on the, it might be on a different policy than this one. Let's see.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Oh, OK, we've got a policy here that has a bunch on them, um, let me see.
[AGENT][NEGATIVE] And it was denied because you needed the explanation of benefits from that provider.
[AGENT][NEUTRAL] OK, we've got Jefferson County Home Health rehab.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] That's what's showing up. Jefferson County Home Health Rehab.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, is that the one?
[CUSTOMER][NEGATIVE] That they couldn't pay because they need explanation of benefits.
[AGENT][NEUTRAL] Let me look at the remarks.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, they're gonna need itemized bills with diagnosis codes, super bills.
[AGENT][NEUTRAL] These are all things that can be sent in the itemized bill with diagnosis and procedure codes, um.
[AGENT][NEUTRAL] And explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] In order for them to pay.
[AGENT][NEUTRAL] Right, or you can even get a super bill from the office.
[AGENT][NEUTRAL] It does mention that.
[CUSTOMER][NEUTRAL] What's a super bill?
[AGENT][NEUTRAL] Super Bill is, um, you know, when you go to the.
[AGENT][NEUTRAL] Office and they hand you that copy of your bill. It has all those codes and stuff and they mark on it what they did and put your total at the bottom. That's, yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Now,
[CUSTOMER][NEUTRAL] It is, it is the company Jefferson County.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, cause I had another.
[CUSTOMER][NEUTRAL] One that I did therapy with. So how would I know which one? I, well.
[CUSTOMER][NEUTRAL] They're saying this one need that, right?
[AGENT][NEUTRAL] Right, um.
[AGENT][NEUTRAL] From [PII].
[AGENT][NEUTRAL] Rehab.
[AGENT][NEUTRAL] Then you have, let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see if we can find some other ones, if there's anything else.
[AGENT][NEUTRAL] No, ma'am, that's the only thing I'm seeing that's close to.
[AGENT][NEUTRAL] Jefferson County Home Health rehab.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Do you know what date is on there?
[AGENT][NEUTRAL] Uh, it, the date of
[CUSTOMER][NEUTRAL] Yeah, on the Jefferson County bill.
[AGENT][NEUTRAL] Data service
[AGENT][NEUTRAL] Yes, ma'am. The data service is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, OK, can you check, OK, I got all this, but can you check and see if I, the other place where I had therapy at.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] What I might go ahead and do.
[CUSTOMER][NEUTRAL] It should have been like [PII].
[AGENT][NEUTRAL] Yeah, I'm gonna probably have to go in and um transfer you on over to a claims specialist so that they can dig up the paperwork because I can't see the paperwork myself and there's so many on here that we we're gonna be here for a long time going through each one by hand so I wanna make sure yeah.
[CUSTOMER][NEUTRAL] Oh, OK, OK, but this is the last, this is the last one, right?
[AGENT][NEUTRAL] Yeah, this one was reported on [PII] and it was processed on [PII].
[CUSTOMER][NEUTRAL] OK, so we don't need to go any further, this is the one.
[AGENT][NEUTRAL] Are you sure? OK, all right.
[CUSTOMER][NEUTRAL] I would just
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, it was
[AGENT][NEUTRAL] Yeah, that's the only one that I'm finding that has remarks on it of things that you need to send in of anything that needs to be sent in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, it's a I know it's another one that I did.
[CUSTOMER][POSITIVE] And I'll, I won't worry about that right, OK, alrighty, thank you.
[AGENT][NEUTRAL] You know that, that the [PII] may have like in your medical records, maybe notes where you've done other rehab at.
[AGENT][NEUTRAL] It's just a thought.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They may have notes on that, OK.
[CUSTOMER][POSITIVE] OK. All righty.
[CUSTOMER][POSITIVE] OK, alrighty. I thank you so much.
[AGENT][POSITIVE] Well, you're so very welcome, Ms. [PII]. I, I hope you have a blessed night and thank you for calling APL.
[CUSTOMER][POSITIVE] Appreciate it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. I feel like I should check.
[AGENT][NEUTRAL] Bye-bye, ma'am.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Yes, ma'am.