AccountId: 011433970860
ContactId: 8e25f4e6-eab4-43c8-8a90-f33c71219f87
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 610260 ms
Total Talk Time (AGENT): 312001 ms
Total Talk Time (CUSTOMER): 187730 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/8e25f4e6-eab4-43c8-8a90-f33c71219f87_20250220T13:27_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] Yeah, my name is [PII], and I just got a notice of via the text that um some claims were taken care of, but I just need to know what.
[CUSTOMER][NEGATIVE] What was taken care of because I can't open it up on my computer.
[AGENT][NEUTRAL] OK, Mr. [PII], so you've received a text notification alert regarding a claim being processed, is that correct?
[CUSTOMER][NEUTRAL] Yeah, regarding a list of claims.
[AGENT][NEUTRAL] Yes, sir. I can help you with that. So you're wanting to see what the status is?
[CUSTOMER][NEUTRAL] Yeah and see where the money went.
[AGENT][POSITIVE] Yes sir I can help you
[CUSTOMER][NEUTRAL] If it went to to the provider if it's coming to me or or how it's being worked.
[AGENT][POSITIVE] Yes sir I can help you and what is your callback number please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And your policy number, please, Mr. [PII].
[CUSTOMER][NEUTRAL] Hold on 1 2nd.
[CUSTOMER][NEUTRAL] I got two policies, one's outpatient, one's inpatient. I don't know which one.
[AGENT][NEUTRAL] OK, the, the, OK, so if you'll know.
[CUSTOMER][NEUTRAL] 0184
[AGENT][NEUTRAL] OK, just a moment, Mr. [PII]. If you'll notice those two numbers, the beginning of each of them prior to the letters ML are exactly the same.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So that part, that is your actual policy number. The other, the rest of those numbers just indicate if you were admitted into the hospital as an inpatient or you had an outpatient service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you can give me either one.
[CUSTOMER][NEUTRAL] So it's 0184.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 1149
[AGENT][NEUTRAL] Thank you, one moment please while I get your information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And Mr. [PII], I will have to verify several things with you first for security and also any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, also your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number we have on file for you is the same as the one you gave me, so again that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you. And lastly your email address, please.
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So, yes, sir, um, you said that when you logged in, you could not yet see the explanation of benefits, is that correct?
[CUSTOMER][NEGATIVE] No, because I use my work computer and I can't download.
[AGENT][NEUTRAL] Uh, OK. All right. So, um, I just wanted to make sure they are viewable. You just weren't able to, to do that for some other reason.
[CUSTOMER][NEGATIVE] Well, I've never been able to view it because I can't, I can't download everything into my computer.
[AGENT][NEUTRAL] OK. You, OK, now I know you, OK, I understand.
[AGENT][NEUTRAL] OK, so yes, so we did process several claims last night and all of the payments were issued to providers.
[CUSTOMER][NEUTRAL] OK, who are the providers because I see a common $60 payment and I and I and that looks familiar because I already paid the $60.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] That's for
[AGENT][NEUTRAL] Yes sir, that was for Donner physical therapy.
[CUSTOMER][NEUTRAL] OK, yeah, they've already been paid.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So you would need to reach out to them because they filed the claim, so therefore payment was issued to them.
[CUSTOMER][NEUTRAL] OK, when did they file the claim because I haven't been to them since.
[AGENT][NEUTRAL] That was
[CUSTOMER][NEUTRAL] Since I don't know when.
[AGENT][NEUTRAL] They filed it. We received it on [PII]. So it appears that maybe um they did not know that you had this insurance at the time that you went for your services back in.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII] is one of these dates.
[CUSTOMER][NEUTRAL] Yeah, there's a whole list of them there. OK, I, I got how what how many $60 payments did you pay them?
[CUSTOMER][NEUTRAL] And then my next question is, I thought I would, I thought I was up, I thought I already um took, I thought I already used all my benefits.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] No sir.
[AGENT][NEUTRAL] Not for [PII].
[CUSTOMER][NEGATIVE] Cause I broke my leg last year and, and you paid out.
[CUSTOMER][NEUTRAL] You you paid out what you owed.
[AGENT][NEUTRAL] Yes, sir, but this policy.
[CUSTOMER][NEUTRAL] Obviously I'm not gonna argue. I'm obviously I'm not gonna argue with with payments but.
[CUSTOMER][NEGATIVE] But this was last year and I'm just a little bit confused.
[AGENT][MIXED] That is correct. First off, APL does not have a timely filing limit.
[AGENT][NEUTRAL] Give me just a moment to look at one claim.
[AGENT][NEUTRAL] OK, so let me, let me look at something.
[CUSTOMER][NEGATIVE] Because, because I called and asked about the one dated [PII] and because that was denied.
[CUSTOMER][NEGATIVE] Because, um, because of the, um, calendar year. But then they put it back through yesterday, and I haven't heard the result of that. That was the only one that I had a problem with the rest of them, I understood that they weren't covered because I exceeded my deductible.
[CUSTOMER][NEUTRAL] where I exceeded the benefit, I should say.
[AGENT][NEUTRAL] Maxim, let me look at a couple of things.
[AGENT][NEUTRAL] OK, so you have been admitted inpatient last year.
[AGENT][NEUTRAL] Is, is that when you had your surgery? OK, so that's what was meant.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and the outpatient wasn't.
[AGENT][NEUTRAL] Your inpatient benefit had not been met. No, sir. So with these claims, we were able to process them. That's what I was just checking.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, how many $60 claims were processed so I know how much to ask them for.
[CUSTOMER][NEUTRAL] They were all done at once.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, on here.
[CUSTOMER][NEUTRAL] I guess common sense would be 11 for each claim number that I was that was texting me just take $60 and multiply by the number of claims and that's probably the value, right?
[AGENT][NEUTRAL] I would have to look at each claim because.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There was one.
[AGENT][NEUTRAL] So the claim, claim number 356-5750, that was for data service 8-15-2024, there was a $60 benefit paid on that.
[AGENT][NEUTRAL] The next claim was 356-574-6. That was her data service 8-19-2024, and that was also a $60 benefit.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Claim number 356-5740. Yes sir, that was also a $60 benefit, and that was for data service 826.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim number 356-573-5.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Was for data service 828 2024 and that was also a $60 benefit.
[AGENT][NEUTRAL] And claim 356-5730 for data service 95 2024, that was a $60 benefit.
[AGENT][NEUTRAL] And claim 356-5718.
[AGENT][NEUTRAL] For data service 910 2024, that was also a $60 benefit.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I'm so sorry. Did that claim number that I just gave you end in 13?
[CUSTOMER][NEUTRAL] I don't know, but I got 1234567 claim numbers.
[AGENT][NEUTRAL] What was the last claim number I gave you?
[CUSTOMER][NEUTRAL] I don't know. I've just been writing a a dot next every time you read one off.
[CUSTOMER][NEUTRAL] Hold on, I can probably see it on my text. Hold on one second.
[AGENT][NEUTRAL] OK. The, the last claim ending in 30.
[CUSTOMER][NEUTRAL] Let me look.
[AGENT][NEUTRAL] That's OK. It's $60 also, and that was for data service 9-172024. So on a total of 12345678 claims, we paid a $60 benefit. Those 8 claims that you can see processed on 219 were all for $60 each.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Very good.
[AGENT][NEUTRAL] OK. Well, is there?
[CUSTOMER][POSITIVE] You made my, you yeah, you made, you made my day because it was just I didn't expect it.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] Oh well, then that's a good way to start the day then to, to know that something was paid and not some somebody wanting more money from you.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Right, exactly.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, thank you very much.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] Well, you're welcome and if that's all then, Miss [PII] that I can help you with, thank you again for calling APL. I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You do the same.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Bye.