AccountId: 011433970860
ContactId: 8b7b911d-d992-48eb-be1b-08c08cc04d31
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 563880 ms
Total Talk Time (AGENT): 170300 ms
Total Talk Time (CUSTOMER): 217196 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/8b7b911d-d992-48eb-be1b-08c08cc04d31_20250617T16:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. I am calling from Multicare Tacoma General Elmore Hospital, and I have a question on a claim that um has not processed, and it looks like you've sent us a form stating you cannot find the policy.
[AGENT][NEUTRAL] OK. Um, do you have the claim number?
[CUSTOMER][NEUTRAL] Let's see if it's printed on the letter, just a second here.
[CUSTOMER][NEUTRAL] Um, it's not printed on the letter, I don't think. Let me see.
[CUSTOMER][NEUTRAL] If uh I have it anywhere else.
[CUSTOMER][NEUTRAL] Just a second here.
[AGENT][NEUTRAL] I can try to look up the last name and or the, do you have the social for the member?
[CUSTOMER][NEUTRAL] Um, OK, let me get over to that screen. So the, um, I have the member number or the social, whichever you'd like.
[AGENT][NEUTRAL] Uh, let's try the social.
[CUSTOMER][NEUTRAL] OK. That's [PII].
[AGENT][NEUTRAL] And [PII], do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what was the patient's first and last name?
[CUSTOMER][NEUTRAL] Um, oh my gosh, I don't know if I can say it. Uh, [PII], which I can spell, [PII], goes by [PII]. Would you like me to spell that first name?
[AGENT][POSITIVE] Yeah, that'd be great.
[CUSTOMER][NEUTRAL] OK. [PII]
[AGENT][NEUTRAL] OK, last name was [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Well, I'm not finding that in our system. Um, do you have a group number by chance? or group name?
[CUSTOMER][NEUTRAL] Let me check here. Um, group number is V E R S T L uh oh I think I did it wrong. V E R S T E L A.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Is that V E R S T E L A? Is that what you said?
[CUSTOMER][NEUTRAL] Uh yeah, V E R S T E L A.
[AGENT][NEUTRAL] OK, let me see 7007.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Maybe.
[AGENT][NEUTRAL] OK, I found the group number. Um, let me see.
[AGENT][NEUTRAL] Yeah, I don't show anybody located with that name or information under that group number.
[AGENT][NEUTRAL] So you might
[CUSTOMER][NEUTRAL] OK. Let me look and see if, if she has um a spouse that carries
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Let's see here, um, subscriber name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, let me see if I've got anybody under that.
[AGENT][NEUTRAL] And I'm not showing him in the system either. Um.
[CUSTOMER][NEUTRAL] Isn't that just odd that, uh, what, um,
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] So then,
[CUSTOMER][NEUTRAL] Let me just, I don't think there's any other thing I can try to do. I can.
[CUSTOMER][NEUTRAL] And can we look by the subscriber ID just to see if that comes up?
[AGENT][NEUTRAL] Uh, sure. What's that?
[CUSTOMER][NEUTRAL] OK. 0256500007.
[AGENT][NEUTRAL] OK, that's weird. This is under a different let's see.
[AGENT][NEUTRAL] How strange.
[AGENT][NEUTRAL] Oh, OK, these policies are, it's term, that's why I only showed active. Um, this policy, it looks like it termed 3 16-25.
[AGENT][POSITIVE] That is the right
[CUSTOMER][NEUTRAL] OK, let me see what my data.
[CUSTOMER][NEUTRAL] OK, 3 1625, so this data service was prior to that.
[AGENT][NEUTRAL] Um, what date of service was that for?
[CUSTOMER][NEUTRAL] um
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what was the uh bill charges?
[CUSTOMER][NEUTRAL] And that was, let me just get over to the right page here.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] Goodness gracious, it's being.
[CUSTOMER][NEUTRAL] Picky today.
[CUSTOMER][NEUTRAL] So it looks like the bill charges were 39,400.
[AGENT][NEUTRAL] Yeah, I don't show the claim on file, and that's the right policy number, so,
[AGENT][NEUTRAL] Um, let's see, we've got her name [PII]. I do have her name, [PII], and we've got [PII] as the insured, um [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I will say this is a very limited hospital indemnity plan, so it's got a, it's got very limited coverage, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] Is there a plan for that same date or period?
[CUSTOMER][NEUTRAL] For $17,079 it looks like we had rebuilt it with a different amount.
[AGENT][NEUTRAL] Uh, no, I don't. I only have some really, um, some imaging charges that are, uh, low dollar amounts. I don't have any. Is this for a claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry, the phone cut out. What was that question again?
[AGENT][NEUTRAL] Is this for a facility claim like a UBO4?
[CUSTOMER][NEUTRAL] Yes, it is.
[AGENT][NEUTRAL] OK, yeah.
[CUSTOMER][NEGATIVE] Is there any way I can fax the claim in since we're having trouble getting it looks like we've rebuilt it several times and we did get this letter back stating they couldn't find it.
[CUSTOMER][NEUTRAL] The policy
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yeah, absolutely. Um, our fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That goes directly to claims.
[CUSTOMER][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] OK. Should I put um this, we've received this letter um asking, you know, for all of the information on here. I don't have the patient, the spouse's social security number.
[CUSTOMER][NEUTRAL] Which the form ask should I return that to or not to worry about it?
[AGENT][NEUTRAL] No, with that policy number, um, the 256-50007, it, it should be fine. We we we'll be able to locate the insured and um patient and get that uh claim processed.
[CUSTOMER][NEUTRAL] OK. OK, then I will get that um faxed over right away then. And are you showing that you are the primary insurance or the secondary?
[AGENT][NEUTRAL] Um, I don't show, let me see, probably don't have any other insurance on file. Let me double check. Yeah, I don't show any other insurance on file, and like I said, this is like a supplemental policy, so it's, it has very limited coverage, um, so it's not like a major, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, well, I'll get that faxed over and I appreciate your help today.
[AGENT][NEUTRAL] OK, well, anything else I can help with, [PII]?
[CUSTOMER][POSITIVE] Uh, no, that should be good.
[AGENT][POSITIVE] OK, well, thank you for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thanks. Bye bye.