AccountId: 011433970860
ContactId: 833ed79e-b4fe-4645-90b8-92d87c5f90e6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 556549 ms
Total Talk Time (AGENT): 170781 ms
Total Talk Time (CUSTOMER): 163999 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/833ed79e-b4fe-4645-90b8-92d87c5f90e6_20250212T16:30_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey [PII], it's [PII]. I have a quick question for you.
[AGENT][POSITIVE] Hey [PII], how are you doing?
[CUSTOMER][NEUTRAL] I'm here. I'm hungry. I wait for lunch time. I need to eat.
[CUSTOMER][NEUTRAL] But, um, under the, well, under the gap, or well gap, Metlink policy as far as sleep apnea, the insured is saying that uh they would have a machine taken home and want to know if that's covered. And for one understand, like taking a machine home, that is not covered, but taking it back to the doctor's office for review could be covered under lab benefits, but they don't have a lab writer. So I just want to double check and see if that's covered or not.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] That smell like strawberries.
[AGENT][NEUTRAL] I don't think it's covered, but I don't wanna lie to you. What's the policy number, [PII]?
[CUSTOMER][NEUTRAL] 1685558.
[AGENT][NEGATIVE] I don't know, cause let me ask Ms [PII] because I had processed the claim. I had one was at home and I think I denied it.
[AGENT][NEUTRAL] And she told me I was supposed to, but let me make sure because I don't wanna lie to you.
[CUSTOMER][NEUTRAL] Yeah, cause I, I couldn't remember. I know [PII] had told me something before, but.
[CUSTOMER][NEUTRAL] I forget.
[AGENT][NEUTRAL] Hold on, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I didn't get anybody, but um.
[AGENT][NEUTRAL] I, I don't wanna tell you yes and I don't wanna tell you no, then we process the claim and it's not processed, but I'm trying to reach out to they know [PII] to verify if it's covered or not.
[AGENT][NEUTRAL] But um the the policy, I'm looking at it, don't.
[AGENT][NEUTRAL] It says that it's covered in like the facility itself, but.
[AGENT][NEUTRAL] I wonder, would it be at home? Like home should be covered if it's covered under the outpatient facility charges.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] For home health?
[AGENT][NEUTRAL] And they have it.
[AGENT][NEGATIVE] Not for home health for sleep apnea. Home health is not covered for sleep apnea.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, yeah, I mean.
[CUSTOMER][NEUTRAL] I couldn't see anything in the policy as far as sleep apnea. I don't know. I just think it wouldn't covered cause it's not covered place of service. And I know I wrote a note cause I thought that like if they have a machine, they do sleep apnea machine at home and then go back to the doctor's office for a review, then it could be covered if they had a lab benefit.
[AGENT][NEUTRAL] Is at home.
[CUSTOMER][NEGATIVE] But this insured doesn't have a lab benefit.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh, these people need to stop having sleep apnea.
[AGENT][NEUTRAL] No, why they send it home though? They just, I don't know.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm texting um [PII].
[CUSTOMER][NEUTRAL] Is she here today?
[AGENT][NEUTRAL] Uh-huh, but it looks, she red though.
[AGENT][POSITIVE] That's that's a good moment.
[AGENT][NEUTRAL] Um
[AGENT][NEGATIVE] Then the caller called back after we received the claim and it was denied.
[CUSTOMER][NEUTRAL] No, there was no claim. He said that the provider tried to call us uh to verify benefits. They just got, uh, there was no answer and he was like, well, I called and I got it on the first ring. I was thinking just, and he, I think he want us to call them.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] What?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I was like, uh
[AGENT][NEUTRAL] Did they call the right number? Do we don't call people? Well, we can call them on the call. I do let them call them on a conference call to verify their benefits. I do do that.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] Like if it doesn't work the first time.
[CUSTOMER][NEUTRAL] Call again.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] I don't think they called cause there's too many people on the phone.
[AGENT][NEUTRAL] So, this week.
[CUSTOMER][NEUTRAL] They said she's ringing now.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] You said she's green now? Yup, she's good.
[CUSTOMER][NEUTRAL] Yeah, it's showing green.
[AGENT][NEUTRAL] But I text her, I text [PII] and I text [PII] to make sure. Look, somebody gotta give me the answer.
[AGENT][NEUTRAL] This is why you, look, this make you miss Ms. [PII].
[CUSTOMER][NEUTRAL] Why?
[AGENT][NEUTRAL] Because of course.
[CUSTOMER][NEUTRAL] Because she went.
[AGENT][NEUTRAL] She would have knew, she would have known.
[CUSTOMER][NEUTRAL] And that's the 2nd time this week someone mentioned about Ms. [PII].
[AGENT][NEUTRAL] Just me, do you have a policy number?
[CUSTOMER][POSITIVE] Had a pro or I call web TPA and they was like, oh, I miss Ms. [PII]. I said, oh, she retired. She said, oh, she just was the sweetest person.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] She was.
[AGENT][NEUTRAL] I told her that the policy doesn't have the lab writer. She asked what the policy number was.
[CUSTOMER][NEUTRAL] Who, [PII]?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Cause I don't think it's covered.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] That way, I'm glad you called me so I can help you because I'm processing the self-insured claim with multiple pages.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEGATIVE] It's a hate process and insured it, uh, submitted claims. They never submit all what we need.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Mm, never. And they have submit.
[AGENT][NEGATIVE] Stuff and want us to pay it and be upset about it.
[AGENT][NEUTRAL] She takes it back.
[AGENT][NEUTRAL] Oh, it's not covered. [PII] said it's not covered.
[CUSTOMER][NEUTRAL] I don't think so. What did [PII] say?
[AGENT][NEUTRAL] No, Miss [PII]'s texting, she must be texting me something long.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Do they have a lay rider? No, ma'am. That's what [PII] ask about the lay rider.
[CUSTOMER][NEUTRAL] So I don't think it's covered. I'll, I'll tell him.
[AGENT][NEUTRAL] Yeah, it's not covered if they don't have the lari.
[CUSTOMER][POSITIVE] All right. Well, I appreciate you so much.
[AGENT][NEUTRAL] Oh, it took so long, cause I don't know.
[CUSTOMER][NEUTRAL] No, no, you're good. I need to know, um, just in case you get another call cause that sleep apnea is kind of tricky.
[AGENT][POSITIVE] OK. Well, have a good day. Get you something to eat.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] I am trying to figure out maybe [PII]'s or something. All right.
[AGENT][NEUTRAL] Talk to you later.
[CUSTOMER][NEUTRAL] Alright bye.