AccountId: 011433970860
ContactId: 8fbd1625-9dc6-4e6b-88d1-6206b427c944
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 277359 ms
Total Talk Time (AGENT): 152423 ms
Total Talk Time (CUSTOMER): 110513 ms
Interruptions: 6
Overall Sentiment: AGENT=0.8, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/8fbd1625-9dc6-4e6b-88d1-6206b427c944_20250214T15:23_UTC.wav
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[AGENT][POSITIVE] Thank you for calling. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], how are you today?
[AGENT][POSITIVE] Good how are you?
[CUSTOMER][POSITIVE] Good thank you I've got a quick question for you about one of our groups.
[AGENT][NEUTRAL] OK, who am I speaking with?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, alright, and let's see, and do you have the group number that you're calling in regards to?
[CUSTOMER][NEUTRAL] Yes, it's 21042.
[AGENT][NEUTRAL] Alright, let me pull that up. Give me just one second.
[AGENT][NEUTRAL] For Exotech Incorporated.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, how can I help you?
[CUSTOMER][NEUTRAL] Um, I am trying to find out, um, if a claim was filed for a member.
[AGENT][NEUTRAL] Oh, OK. OK.
[CUSTOMER][NEUTRAL] Back in December, um, he doesn't know.
[AGENT][NEUTRAL] Oh, OK, I understand that. I understand that completely, not a problem. What's the name? Mhm.
[CUSTOMER][NEUTRAL] Yeah, so I mean I don't what I don't know what is the protocol for the doctor's office to file the claim? I don't know.
[AGENT][NEUTRAL] Well, I just need and the doctor's office can file if they gave them their information and they're willing to do so, um, because we, they can assign benefits and we can pay whatever is due to them, um, that the, you know, as long as anything outside of that would go to the insured, but, um, they can file it themselves or that it doesn't it doesn't really matter um what.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] OK, yeah, I don't know, and he, he didn't when I asked that question, the, the answer that he gave me in the email didn't make any sense. So I do, I have the bill and I know that it was paid by United Healthcare under the terms of the policy, so all that was left was the $500.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Co-pay for the service. It was during the time because I know the the the policy is canceled, but the date of service was in December, so it's under the policy. I just don't know if he, I, and we're gonna go back and forth all day unless I just bite, bite the bullet and call and ask you if it was it was fine.
[AGENT][NEUTRAL] Ah, OK.
[AGENT][NEUTRAL] Yeah, yeah, OK.
[AGENT][NEUTRAL] What's his, what's the, yeah I can yeah I can call over to claims and see as well too. What's the um what's the name of the gentleman that you're referring to?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] His last name is, why is his name not on here? Patient [PII]? Oh, that's helpful.
[AGENT][NEUTRAL] I can do it by first name. That's OK.
[CUSTOMER][NEUTRAL] It's [PII]. It's [PII] Yeah, and the date of service was [PII].
[AGENT][NEUTRAL] [PII], yeah, found him. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it would have been a $500 co-pay that he had to make, um, and it's Reyes radiology.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For MRI there's an an MRI code and an injection code they go together.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright, let's see. OK, let me, um, I'm gonna have to get claims on the line because I can't see it, so I'll probably just, did you have any other questions outside of that? OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] No, that's it. I just need to know about that, um.
[AGENT][NEUTRAL] OK, well, I'm gonna have one of our claims people help you with that. Is your callback number in case we get disconnected between me transferring is that [PII]?
[CUSTOMER][POSITIVE] Uh, yes, that's correct.
[AGENT][POSITIVE] OK, OK, let me get someone to help you. Bear with me just one second. Mhm, you're most welcome.
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII] in Broker Resources. I have [PII] uh with our one of our broker's offices calling to see if this gentleman has filed a claim. I guess he gave her a claim document because he doesn't know if it was filed with us, and I told her I can't see the claims and I would get someone from claims to help her. Um, let me give you the policy number. Let me know when you're ready.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK, it's 2457924.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And she said the date of service, she says it's, let's see, I wrote down December, but I guess I didn't write down the date. Um, it's [PII], OK, it's [PII] radiology. Her callback number is [PII].
[CUSTOMER][NEUTRAL] That's fine.
[AGENT][NEUTRAL] [PII] and I'll pull her on the line when you're ready.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, hold on one second.
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Hi, I have [PII] from our claims department on the line and she's gonna help you with that, OK? Have a great day. Thanks, bye bye.
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][POSITIVE] Great, appreciate it. mhm thanks you too.