AccountId: 011433970860
ContactId: 839260e9-5dc3-4a8a-b916-ed9fc1b7d7df
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1044250 ms
Total Talk Time (AGENT): 438191 ms
Total Talk Time (CUSTOMER): 320540 ms
Interruptions: 7
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/839260e9-5dc3-4a8a-b916-ed9fc1b7d7df_20250411T14:10_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], [PII] in [PII] again. How are you doing?
[AGENT][NEUTRAL] Hey, [PII], how are you today?
[CUSTOMER][POSITIVE] Doing great, doing great. I, um, hope all is well. I, I just had, if it's OK with you.
[AGENT][POSITIVE] Good.
[AGENT][NEUTRAL] Yes, it is. It's Friday.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Awesome, awesome. I'm glad to hear it. I know I'm happy this week's over. Uh, it's been a long one.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] It has.
[CUSTOMER][NEUTRAL] I'm just, I'm just trying to see if you can tell me two things about two separate claims. Um, I have everything ready for you whenever you're ready.
[AGENT][NEUTRAL] OK, [PII], so you're needing to check some information or status on 2 different claims for 2 different people or is it for the same person?
[CUSTOMER][POSITIVE] Yes ma'am, yes ma'am.
[AGENT][NEUTRAL] Different
[CUSTOMER][NEUTRAL] It's gonna be two separate people.
[AGENT][NEUTRAL] OK, sure, yes, I can help you with both [PII]. What is your callback number? [PII].
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. And what is the first patient's policy number?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] The first one is 23316667.
[AGENT][NEUTRAL] OK, thank you. One moment while I get the information pulled up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And by, as you know, any information that I provide would be a verification of benefits and not a guarantee of payment if you'll just go ahead and verify your email for me.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth on this policy?
[CUSTOMER][NEUTRAL] [PII] and it's [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Uh, one second, [PII].
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Alright, and what is the date of service and total bill amount for him, please?
[CUSTOMER][NEUTRAL] It should be the only claim on file. I think the date was probably 3-27-25.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so yes, I do see a claim that's on file for him for that data service and this claim was just processed, uh it went through nightly processing last night.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, are you just, what type, what are you needing to know on this one run?
[CUSTOMER][NEUTRAL] I need to know exactly what was paid and and and and what was the breakdown and was it ACH.
[AGENT][NEUTRAL] OK, so let's see.
[AGENT][NEUTRAL] OK, so the benefit paid on this claim was $1,725.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] And this claim does show that it is scheduled.
[AGENT][POSITIVE] As direct deposit, yes.
[AGENT][NEUTRAL] And on here.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK, so for 327 on code 99284, that charge, it looks like was 78,430 the benefit paid 300.
[AGENT][NEUTRAL] And that states that the maximum benefit, I mean, it's a long paragraph.
[AGENT][NEUTRAL] But the mark that shows the marks. Mhm.
[CUSTOMER][NEUTRAL] No, that's OK. No, basically I just need to know so it's.
[AGENT][NEUTRAL] Uh, then there was an 11.
[CUSTOMER][NEUTRAL] Just like for an example that
[AGENT][NEUTRAL] OK, go ahead. I'm sorry.
[CUSTOMER][NEUTRAL] I'm sorry, go ahead. Oh no, it's OK.
[CUSTOMER][NEUTRAL] So basically 300 ER 300 X-ray, I know there's a fracture benefit.
[AGENT][NEUTRAL] Yes, that was the 1125 $1,125. So that was paid. And then on the X-ray, that was a 1422.30 charge and there was a benefit paid on that one of $300.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] And that one does also state, uh, with the payment of this service line, this benefit is exhausted for this person for the plan year.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Alright, so 300 3 1125. That's how we came with the 1725, and that is direct deposited and that was processed overnight so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect, perfect, OK.
[AGENT][NEUTRAL] Yes, sir. Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] There's one more person that's, she's the.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The C uh COO I'm gonna pull up her real quick if that's OK.
[AGENT][NEUTRAL] That's fine. Do you need any additional information on um Mr. [PII]'s policy before I finish out my note on him?
[CUSTOMER][POSITIVE] No ma'am, that's good for now. I appreciate you.
[AGENT][NEUTRAL] OK. All right, well, you're very welcome. And typically, you know, [PII] will take 2 to 3 business days for that direct deposit. So because it was part, I mean, you know, I guess it's possible he might see it over the weekend, but it.
[AGENT][NEUTRAL] It might not be till Monday.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Or cheesy for him.
[AGENT][POSITIVE] And then you can just let me know when you're ready for the next one and I'm ready.
[AGENT][NEUTRAL] Whenever you are.
[CUSTOMER][NEUTRAL] Got it. I was just writing down this date of birth. I know y'all always ask for that, so I'm trying to got it, OK.
[AGENT][NEUTRAL] Yeah, we do. We have just certain things we need to verify.
[CUSTOMER][NEUTRAL] I get it. Let's see here, OK, um.
[AGENT][NEUTRAL] And I feel kind of silly asking you for your email because I've talked to you so much, but we still have to do that.
[AGENT][NEUTRAL] Even when I can clearly recognize you. Mhm.
[CUSTOMER][POSITIVE] No, I understand, and I always laugh.
[CUSTOMER][POSITIVE] And I've been doing this for 24 years, and I've been doing it with, I did it with Colonial for years and Allstate now APL the last 5 years. And I always laugh. I say, do, do you, I always used to joke around. I said, Do y'all really think that somebody off the street's gonna call in to try to help somebody with their claim information? Like, you know what I mean? Agents don't even want to do it, you know, like.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] I isn't that the truth?
[AGENT][NEGATIVE] Isn't that the truth, that it's hard enough to get a call back? No, they don't. And it's hard enough to get your own physician or physician's office to call you back these days.
[CUSTOMER][NEGATIVE] Yeah, nobody wants to help anybody anymore, you know.
[AGENT][NEUTRAL] I let someone else.
[CUSTOMER][NEUTRAL] Oh yeah, oh yeah.
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] I know. OK.
[CUSTOMER][NEUTRAL] OK. It's
[CUSTOMER][NEUTRAL] Yes ma'am, it's the actual um policy number is 233.
[CUSTOMER][NEUTRAL] 1679.
[AGENT][NEUTRAL] 79. OK, one moment.
[AGENT][NEUTRAL] OK, and then the uh same with this one, any information provided is verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII], [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And I normally track these claims for this one, it was done by someone else I believe so I was trying to make sure.
[CUSTOMER][NEUTRAL] What was actually, was she ever even paid?
[AGENT][NEUTRAL] OK, what's the data service, [PII] in total build amount on this one?
[AGENT][NEUTRAL] She has several claims on file.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Yeah, she's had, she's had some terrible luck the last couple of years. She's had some crazy things happen to her. Um, this is from [PII] [PII].
[AGENT][NEUTRAL] Oh well.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it does, let's see.
[AGENT][NEUTRAL] Well, OK, just one moment. I don't know what I've done here. Hold on.
[AGENT][NEUTRAL] OK, can you verify her address for me?
[CUSTOMER][NEUTRAL] Um, let me see here.
[AGENT][NEUTRAL] For Miss [PII].
[CUSTOMER][NEUTRAL] And she may have, I wanna say.
[CUSTOMER][NEUTRAL] That she moved recently.
[CUSTOMER][NEUTRAL] I believe I wanna say [PII] put this on the form. OK, yeah, I think, yeah, I think [PII] added in in red to update the address because she has moved to.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] But I wanna see we have her on ACH anyway.
[AGENT][NEUTRAL] Yeah, but I'm getting, um, I have a screen that I haven't.
[AGENT][NEUTRAL] That has come up that I've never seen before and it's asking me to verify that piece of information. So bear with me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] See here.
[CUSTOMER][NEGATIVE] Yeah, [PII].
[AGENT][NEUTRAL] OK, so this claim that we received for that data service at this point, [PII], it has not been approved.
[AGENT][NEUTRAL] Um, the claim number is 357-595-5.
[AGENT][NEUTRAL] The remark on here reads, receipt of your claim is acknowledged.
[AGENT][NEUTRAL] However, in order to provide further consideration of this loss under this policy, we will need supporting documentation to evidence the accident.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh let me see. And when it occurred, supporting documentation may include, but is not limited to office notes, hospital admission and discharge summaries, and or diagnostic testing results, and that is the remark on both line items on this claim.
[CUSTOMER][NEUTRAL] Let me go take a look at what was uploaded. I see the claim form. I see something from.
[CUSTOMER][NEUTRAL] Franciscan ministries of Our Lady.
[CUSTOMER][NEUTRAL] With the health system, it's.
[CUSTOMER][NEUTRAL] She went to Our Lady of the Lake Regional Medical Center.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] office outpatient visits.
[CUSTOMER][NEGATIVE] It says unsatisfied fracture of left patella, subsequent for closed fracture.
[CUSTOMER][NEUTRAL] What does that mean?
[CUSTOMER][NEUTRAL] OK, let's go see payment.
[CUSTOMER][NEUTRAL] Normally the bills are longer than these.
[CUSTOMER][NEUTRAL] 0 1219.
[CUSTOMER][NEUTRAL] So she does have some bills here. It just doesn't look like there's a lot of it looks like there's a charge for $85 and a charge for $41.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] Which normally the bill would be higher than that.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah, it looks like we're just needing, yeah, it looks like we're needing just additional information, more detailed information.
[CUSTOMER][NEUTRAL] But I, I'm, I'm trying to figure out what.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me read this again.
[CUSTOMER][NEUTRAL] So I was walking out the door, missed.
[AGENT][NEUTRAL] Supporting documentation.
[AGENT][NEUTRAL] It may include but it is not limited to office notes so we need the either the hospital admission and a discharge summary.
[AGENT][NEUTRAL] And or diagnostic test results.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. So basically, what she sent, they just need more information.
[AGENT][NEUTRAL] Right. Mhm.
[CUSTOMER][NEGATIVE] Because she does have diagnosis and some charges on here. It just doesn't seem like a complete bill.
[CUSTOMER][NEUTRAL] When at first glance.
[AGENT][NEUTRAL] Um, and I'm trying to.
[CUSTOMER][NEUTRAL] From what I can see because I look at claims all day every day and um.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh probably what the examiner is saying.
[AGENT][NEUTRAL] Yeah, there's
[CUSTOMER][NEGATIVE] See, we, on my side, you can't see EOBs. That's why I always have to call on these where with all the other companies we deal with, you just click on the EOB and it tells me what's missing or what's wrong or what was paid so I hate to have to call y'all all the time, um.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Right now if you all file it.
[CUSTOMER][NEUTRAL] They could just put it on my screen, you know.
[AGENT][NEUTRAL] Now excuse me but I'm sorry about that. I was thinking that if you all actually upload the information if y'all are the ones filing it under your broker access that you would have access to that.
[CUSTOMER][NEUTRAL] You would think, you would think, but when I actually talked to some other people at the home office, they thought, they thought we did, and then when I talked to someone else in broker services, they say it's actually not on there.
[AGENT][NEGATIVE] But no.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEGATIVE] The EOBs actually aren't available on my side. That's why we always have to call. They said they're working on it, but um it would just save a ton of time, you know.
[AGENT][NEUTRAL] Yeah, they are sure they uh they are working on some additional um functionality in the online service center. I do know that on all levels from individuals, you know, group to broker um but that, you know, that is just currently a work in progress, but it is something that that is being worked on.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, so yeah, this just, I just I'm kinda glancing, and this kinda looks like just a receipt basically that we received.
[CUSTOMER][POSITIVE] Good deal so
[AGENT][NEUTRAL] It's uh
[AGENT][NEUTRAL] It shows what she had done. Yeah, we don't have a diagnosis or anything. It's just a bill.
[AGENT][NEUTRAL] And it's not even a detailed bill, so I'm sure that's probably the same thing you're looking at because it does show Franciscan.
[AGENT][NEUTRAL] Missionaries, $41.
[AGENT][NEUTRAL] But yeah.
[CUSTOMER][NEUTRAL] And under the diagnosis, it actually does have diagnosis code, um.
[CUSTOMER][NEGATIVE] It just seems like a simplified bill that doesn't show everything, you know, because you see under service where it says 1224 it says procedure.
[AGENT][NEUTRAL] Let me
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Patient name, diagnosis, charge.
[AGENT][NEUTRAL] Yeah, see that's an um, but it doesn't, yeah, it.
[AGENT][NEUTRAL] Yeah, and they even highlighted that, but it just needs to be more, well, because this shows.
[AGENT][NEUTRAL] A subsequent.
[AGENT][NEUTRAL] Visit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So saying there's a visit before this kind of thing.
[AGENT][NEGATIVE] Not like initial.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well we're gonna find out. I'm gonna reach out to her and get some more information and we'll take it from there.
[AGENT][NEUTRAL] OK, [PII]. Well, is there anything else at the moment that I could help you with?
[CUSTOMER][NEUTRAL] But I
[CUSTOMER][POSITIVE] That's it. I appreciate your time today.
[AGENT][POSITIVE] Well, you are certainly very welcome. It's my pleasure as always. And so if that's all at the moment that I can help you with. Thank you for calling APO and I hope you and your family have a wonderful weekend.
[CUSTOMER][POSITIVE] You too. Have a great weekend. Thank you.
[AGENT][POSITIVE] Thank you. Yes, sir. You're welcome. You too.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][POSITIVE] Thank you bye bye.