AccountId: 011433970860
ContactId: 8f3ab062-ccc6-4323-a290-98b5d8035dca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 925119 ms
Total Talk Time (AGENT): 207580 ms
Total Talk Time (CUSTOMER): 407384 ms
Interruptions: 4
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/8f3ab062-ccc6-4323-a290-98b5d8035dca_20250519T13:49_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good Morning. Thank you for calling. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Maybe.
[CUSTOMER][NEUTRAL] Hi, yes, my name is [PII]. I'm trying to get an update on my claim status, please.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And may I have the policy number?
[CUSTOMER][NEUTRAL] Oh, it's 770896-9845.
[AGENT][NEUTRAL] That's the policy number or that's the phone number?
[CUSTOMER][NEUTRAL] Oh, the policy. I don't know the policy number. I'm traveling. It's, I know it's 736. Can you look it up by my social?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, sure. Bear with me just a second. Let me pull another system where I can use your social, OK?
[CUSTOMER][NEUTRAL] I am sorry.
[AGENT][NEUTRAL] It's OK.
[AGENT][POSITIVE] All right. Go ahead, I'm ready for it.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And Miss [PII] for security, may I have your mailing address, email address on file?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, what's the email address on file?
[CUSTOMER][NEUTRAL] The [PII].
[AGENT][NEUTRAL] OK, thank you. All right, let me look at the claims, one moment.
[CUSTOMER][NEUTRAL] 4 average not high spot and so big or supervisor doctor should use to identify.
[CUSTOMER][NEUTRAL] Not scared of anything, but with this and see I hit everything.
[CUSTOMER][POSITIVE] You showed me it was possible to smile again all within my budget. You feel like family. My mother got to see my new smile before she passed, and I know our days are happy.
[AGENT][NEUTRAL] OK. Let me uh look at the paperwork. Let me look at this claim. Do you mind holding for me, Ms. [PII]?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's OK, sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Miss [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, uh-huh.
[AGENT][NEUTRAL] OK, so it looks like uh we're waiting on the explanation of benefits from the primary insurance um for the radiation benefits.
[CUSTOMER][NEUTRAL] Oh my goodness, they have sent, I don't know what is it that they're looking for. First of all,
[CUSTOMER][NEUTRAL] I sent in all that they received me, all that, um, on my statement explaining everything. I called the insurance company with one of your girls in your office. Her name is [PII]. They were asking for the UMB or UBO whatever, something like that statement that your insurance company would need.
[CUSTOMER][NEUTRAL] I called about 3 or 4 days later to see if it was received. They confirmed that they received that. They told me that that's what they need. It gives all the code. It gives everything for the for them to decide. They said that they got it and now they're still waiting. What is it that they need? I really would like to know. I mean, I called the insurance my, my, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] My insurance company, I'll do everything I can, but it's like I am sending information. I am calling and and the right thing is not going to your insurance company. So what is it that they really need?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] If I could talk to somebody so they can truly explain and I will work with work on it.
[AGENT][NEUTRAL] OK. Well, right now, that's what we need. Um, if you need to speak to an examiner, which is the person who processed the claim, I can go ahead and get you to one so they can let you know exactly why they're asking for that and all that. Yeah, the instructions are gonna be on the claim forms. Um, whenever you send a claim on the instructions is in the first page, and it does ask for that if you have any chemo or radiation therapy benefits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, but you know.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I understand. I called before I send anything to your insurance. I called them and asked them. I did radiation. Tell me what I need to send you. They said they need a statement from the hospital giving the codes. It has to give the codes of the treatment so they can determine what it is. I.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sent it to them. They said they didn't want that from because the statement was to me it was showing my name, so they said they want it directly from them, from the um from my uh from the hospital to them, not to me. I'm like, OK, so [PII] was on the phone. It's called.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] UMB or UBO something like that statement. The insurance company understood and I call again your insurance company to confirm, did you get the UMB? They said yes and now they're still so transfer me to somebody cause I don't know what they need. I really don't know.
[AGENT][NEUTRAL] Yeah. Mhm. Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] It's OK. One moment. OK, yes, yes, one moment. OK, you're welcome. One moment while I transfer you.
[CUSTOMER][POSITIVE] So transfer me to somebody. Sure, thank you so much.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] Deferring.
[CUSTOMER][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, [PII], how are you? This is [PII].
[CUSTOMER][NEUTRAL] Fine. How are you?
[AGENT][NEUTRAL] I'm good, I'm good. Um, I have a member on the line she's a little upset about her claim. She's just saying that we keep asking for everything and she wants to make sure that that's all we need, um, which I, yeah, it's 736-888.
[CUSTOMER][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And what claim is it on?
[AGENT][NEUTRAL] The most recent one, the one we're asking for the EOB for the radiation therapy, which I did explain to her that we need that to process any chemotherapy, radiation therapy, um, but she still says, she said she spoke to [PII] a few.
[AGENT][NEGATIVE] Weeks ago and that she didn't tell her about that. So basically she's just calling back when she said I, I was not aware and I just wanna make sure that's all you need. I don't need to be sending you stuff and then, you know, it's not what we, what you need and it's just that sad, basically. It's on the 3602587.
[CUSTOMER][NEUTRAL] OK. What's the claim number?
[CUSTOMER][NEUTRAL] See what we got.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][NEUTRAL] Right on this is not letting me pull up the document.
[AGENT][NEUTRAL] Oh boy.
[AGENT][NEUTRAL] That'll be Monday.
[CUSTOMER][NEGATIVE] He was trying to pull it up, then I got an error.
[AGENT][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] There's any issue rendering the document, OK.
[CUSTOMER][NEUTRAL] Let me try this again.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] I know Friday I had a lot of trouble with my system.
[AGENT][POSITIVE] No, it seems to be working better for me, yeah.
[CUSTOMER][NEUTRAL] Oh, OK, I see she sent the itemized billing.
[AGENT][NEUTRAL] Mhm. Mhm.
[CUSTOMER][NEUTRAL] So yeah, we would need the explanation of benefits for this coverage because the policy is based on actual charges.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah. And she did not send any, uh any on the past documents. She didn't send any EOB, did she?
[CUSTOMER][NEUTRAL] She didn't. OK, let me find this real quick.
[AGENT][NEUTRAL] I don't think she did. I, I don't, I don't think she did, but yeah, just in case.
[CUSTOMER][NEUTRAL] Let me see what we what we paid in if we paid radiation in the past, let's see.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] No, we haven't paid radiation. We haven't paid any radiation.
[AGENT][NEUTRAL] OK. OK dokey. OK, so if you're ready for her, I did verify all the information, so all the information is correct in the system, OK?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, let me put her in. Have a good day.
[CUSTOMER][NEUTRAL] Mm, you too.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you for holding and being patient for you, Ms. [PII]. I got Miss [PII] on the line. She's in the claims department and she will assist you from here.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][POSITIVE] Thank you so much. Hello, hello Miss. [PII].
[CUSTOMER][NEUTRAL] Hi, [PII], how are you doing? I am fine. How are you?
[CUSTOMER][NEUTRAL] OK, um, fine, Ms. [PII], I'm many questions in regards to your, your radiation.
[CUSTOMER][NEUTRAL] Yeah, so it looks like on the most recent claims we processed for the for the dates of [PII] you receive radiation. We have requested the explanation of benefits.
[CUSTOMER][NEUTRAL] OK. I'm not sure what to give you. The reason why I'm saying that.
[CUSTOMER][NEUTRAL] I first called and I asked before I sent him anything. I said tell me and I wrote them down, tell me everything that you need to process the claim.
[CUSTOMER][NEUTRAL] They told me one of the main things they need, the statement from the hospital with the codes, telling exactly the treatment that I got. I, I, I, I called the hospital, they sent it to me twice. I sent in that information. Then the girl told me it's your office. That's not what they're looking for. They're looking for, and I may not call it right, the UMB or UBO whatever.
[CUSTOMER][NEUTRAL] Whatever that from the hospital from the hospital. [PII] was the name of the girl. We called together. We spoke with the people. They're gonna say they're gonna, they would not send it to me. The hospital do not send that to me. They said it has to go to my insurance company. So [PII] was on the phone, gave them the fax number and everything. They faxed it to you. I called about 3 or 4 days later to confirm that you got it.
[CUSTOMER][NEUTRAL] The girl said yes we got it and we're going to process the claim now you're telling me that you don't have whatever you need. I am just totally confused, ma'am, to be honest, what must I do here? Let let me take a look, give me one moment.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] To try and get some sort of leverage.
[CUSTOMER][NEUTRAL] after the.
[CUSTOMER][NEUTRAL] Alright, the White House thank you very very much. OK, I'm gonna take a look at the documents. I'm gonna put you on a brief hold. Give me one.