AccountId: 011433970860
ContactId: 9d922320-28d8-4f29-bfef-3fba29f013d1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 444970 ms
Total Talk Time (AGENT): 156728 ms
Total Talk Time (CUSTOMER): 181207 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/9d922320-28d8-4f29-bfef-3fba29f013d1_20250408T16:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], um, I'm calling because I gave my information, my APL information to a physician, and they are saying that that your response was that you couldn't find me, so I just want to make sure that we have all the correct information for them.
[AGENT][NEUTRAL] OK, can I get your name?
[CUSTOMER][NEUTRAL] [PII]. It should be under my husband [PII]. He's the actual insured person and I'm the claimant.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Policy number is 02552057.
[AGENT][NEUTRAL] OK, let's see
[AGENT][NEUTRAL] And it looks like the policy terminated [PII].
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, it was this for a date prior to that?
[CUSTOMER][NEUTRAL] And these these are services uh for dates prior, yeah, let's see the date on that.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] This, this would be [PII], [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, and here's another one for [PII].
[AGENT][NEUTRAL] Did they say they submitted the claims or?
[CUSTOMER][NEGATIVE] Yeah, they said that they, you know, because I gave them the information and they said um that when you responded, you said you, you couldn't find me as a customer.
[AGENT][NEUTRAL] OK, and what provider was that?
[CUSTOMER][NEUTRAL] Um, this is Team Health.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Which underneath their name it says based on HM.
[AGENT][NEUTRAL] Can I get it.
[AGENT][NEUTRAL] Uh, let me get a good callback number from you just in case I lose you.
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] OK, and can you verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And then your address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, yeah, so I have, OK, you said 12:10.
[AGENT][NEUTRAL] I've got one claim on file for that.
[CUSTOMER][NEUTRAL] And 12 7.
[AGENT][NEUTRAL] OK, let's see what we
[CUSTOMER][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] And I have one claim from Eastside Hospitalist.
[AGENT][NEUTRAL] Um, it was for.
[CUSTOMER][NEUTRAL] From what?
[AGENT][NEUTRAL] East Side Hospitalist. It looks like they're physicians, um.
[AGENT][NEUTRAL] Were you inpatient in the hospital?
[CUSTOMER][NEUTRAL] I was
[AGENT][NEUTRAL] OK, looks like physician charges for that date. um, let me see what the bill charges were.
[AGENT][NEUTRAL] I I billed a total of $278.
[AGENT][NEUTRAL] Looks like we paid.
[AGENT][NEUTRAL] 6654.
[AGENT][NEUTRAL] That was to the provider.
[AGENT][NEUTRAL] What? and then you said 12 7, is that correct?
[CUSTOMER][NEUTRAL] Uh, yeah, this would be at Memorial Hospital West.
[CUSTOMER][NEUTRAL] And it would be for a physician, but I'm not seeing numbers like what you're talking about, so I don't know if we're talking about the same thing.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And when I spoke with them directly, they said that they were not able to get any information from you, which means that you didn't pay anything out to this particular guy.
[CUSTOMER][NEUTRAL] Maybe you paid out something for that, but I don't know if it's for team health.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Because they're saying they didn't receive anything from you.
[AGENT][NEUTRAL] Yeah, so the only thing I have for 1210 is the one I just mentioned, so that was for $278 and we paid out $66.
[AGENT][NEUTRAL] I don't have anything for 127.
[AGENT][NEUTRAL] Um, no claim on file for that date.
[CUSTOMER][NEUTRAL] OK, so let's, let's verify, let's verify information so that I, I know that I'm giving them the right information I have for claims. Is it [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, OK, so that's the right address, and then, um, the policy number, I don't know if I have to include the ML 8 at the end, but on your paperwork it says policy 02552057 with nothing after it, but the card did have an like ML 8 or something after it. Does it matter if it has that last part or not?
[AGENT][NEUTRAL] It doesn't matter yeah we we'll be able to identify either way so um I I don't know why. Let me look in the notes and see. Do you, do you know who you spoke to at the provider's office?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII] was her name.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I don't see, let's see.
[AGENT][NEUTRAL] Looking through our notes to see we, we note every call that we take so.
[AGENT][NEUTRAL] I'm not seeing anything regarding uh [PII] from the provider's office.
[AGENT][NEUTRAL] So I'm not sure if maybe they called a different number that yeah so because we if we had that information we would verify that you were covered during those days of service and then you know give them the claims information to get that sent in, etc. so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I know. And do you have the group number? Can you share the group number with me? It was on the card, but.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEGATIVE] I'll be damned if I know where that card is now.
[AGENT][POSITIVE] Right, that's how it always works.
[AGENT][NEUTRAL] Um, let's see. Uh, the group number is 21042.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so I'm, I'm going to assume that whoever filed a claim with you.
[CUSTOMER][NEUTRAL] Did not give you the right information because I have all the right information and they gave me the group number 21042. I recognized the number, so I, you know, I said, yeah, that's the number. I wasn't sure because I didn't have it on the paper, but, uh, maybe somebody thought that they, maybe they got distracted while they were in the middle of contacting you and didn't actually contact you. I don't know, but I'll call them back and tell them to resubmit a claim now that we've verified all the information.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Yeah.
[AGENT][NEUTRAL] OK, yeah, take, um, do you have our fax number as well because sometimes they like to fax it's easier, so.
[CUSTOMER][NEUTRAL] Oh, OK, go ahead, what's the fax number?
[AGENT][NEUTRAL] Fax number is [PII], and they can fax claims on that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][POSITIVE] I will let them know thank you so much for helping me.
[AGENT][POSITIVE] OK, well thank you and thank you for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] Thanks you too.
[AGENT][POSITIVE] Thanks you too. Bye.
[CUSTOMER][NEUTRAL] Bye.