AccountId: 011433970860
ContactId: 9dd8bad5-c1f5-4c3e-b5ab-76ecad091e7a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 508380 ms
Total Talk Time (AGENT): 184288 ms
Total Talk Time (CUSTOMER): 137960 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/9dd8bad5-c1f5-4c3e-b5ab-76ecad091e7a_20250314T18:10_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I'm trying to understand what claim was sent to you on the [PII].
[CUSTOMER][NEUTRAL] On the [PII] for myself.
[AGENT][POSITIVE] OK, I'm happy to check on a claim. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yeah, 255-7208.
[AGENT][NEUTRAL] And then if I
[CUSTOMER][POSITIVE] And there's go ahead, I'm sorry.
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[AGENT][NEUTRAL] Can I have the name on the policy and date of birth, please?
[CUSTOMER][NEUTRAL] Uh, [PII], [PII] and [PII].
[AGENT][NEUTRAL] Thank you. And then I just need to verify the address as well, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And so do we have a claim number that we're inquiring on specifically or a data service?
[CUSTOMER][NEUTRAL] Yeah, it was the [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I believe there's 3 charges.
[CUSTOMER][NEUTRAL] I just don't know what was submitted to you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Like what they were for.
[AGENT][NEUTRAL] Let me just pull this up here one second.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Are they X-rays?
[AGENT][NEUTRAL] So there were 2 from an elite imaging, so that would, um, yeah, lend to believe it was an X-ray imaging place.
[CUSTOMER][NEUTRAL] Oh, yeah, that's what it is. But what was the claim they filed? Cause there were tests done that was going through insurance that day and there was a self-pay. So I'm trying to understand and make sure that they didn't submit at all.
[AGENT][NEUTRAL] So yeah, it looks like that's the only claims that we have is from Elite Imaging for that date of service. Let me see if I can.
[CUSTOMER][NEUTRAL] But what are they, you're right, what is the bill for?
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] I'm just trying to pull up the explanation of benefits here and see what was submitted. I appreciate your patience.
[CUSTOMER][NEUTRAL] Yeah, I have the procedure codes if they help.
[AGENT][NEUTRAL] Yeah, I mean, we don't have a way unfortunately I don't have a way to look at their procedure codes.
[CUSTOMER][NEUTRAL] Oh, I didn't know if you could, well, procedure codes are procedure codes. You know, it doesn't matter whether it's them or the guy down the block or somebody next door. A numbers, you know.
[AGENT][NEUTRAL] So it looks like one claim shows the procedure code 73502 and 773,130.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] So those two were submitted.
[CUSTOMER][NEUTRAL] I understand. Were they X-rays? Were they a scan? Um, that's what I'm trying to find out. What are you paying for?
[AGENT][NEGATIVE] I don't have any way to search the codes, ma'am, unfortunately.
[CUSTOMER][NEUTRAL] You can't see what claim they submitted to you and yet your company just paid?
[AGENT][NEUTRAL] I'm not a claims examiner. I can get somebody on the phone to go over this with you. I'm not familiar. OK.
[CUSTOMER][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Is the [PII] number a good call back number if anything happens on the train?
[CUSTOMER][NEGATIVE] No, it is not. No, it is not.
[CUSTOMER][NEUTRAL] The number should be [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you so much. One moment, please.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey, [PII], this is [PII] in customer care. How are you?
[CUSTOMER][NEUTRAL] Fine. How are you?
[AGENT][NEUTRAL] I'm OK. I have an insured on the line who needs some help with a claim. Um, I offered her a call back. She wants to speak to somebody about some claims. Can you help her with that?
[CUSTOMER][NEUTRAL] What's the policy number?
[AGENT][NEUTRAL] 02557208
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] Yeah, [PII], I think it's [PII] is her last name.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So she's flustered because she says that she's getting bills from I guess this elite imaging and the last two claims that I see on there, she's wondering if any claims were submitted for [PII], and I told her that yeah I did see a couple claims. She wants to know what they're billing us for and I'm like.
[AGENT][NEUTRAL] You know, it looks like it was, it would have been for X-rays, and she's like, yeah, but for what? Like a CT scan, a blah blah blah. She's like, can you not tell me what these procedure codes are? I'm not familiar with that kind of stuff.
[CUSTOMER][NEUTRAL] Let me take a look. He says for the [PII] claim.
[AGENT][NEGATIVE] Yeah, and there were 2, and she's like getting frustrated with me because she's like, well, you guys paid claims and you don't even know what it was for, and I'm like,
[CUSTOMER][NEUTRAL] Find, let me see.
[CUSTOMER][NEUTRAL] Yeah, all three of them was just X-rays.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's what the imaging was X-rays.
[AGENT][NEGATIVE] Would you mind just going over those couple with her because like she's frustrated with me.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, thank you. Do you want her callback number?
[CUSTOMER][NEUTRAL] Sure, what's that number?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And what are you calling her by her first name or her last name? Her last name is [PII] you said?
[AGENT][NEUTRAL] Yeah, so I was calling her Miss [PII] cause yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Thank you, I appreciate you. Here she comes.
[CUSTOMER][POSITIVE] Uh-huh. You're welcome.
[CUSTOMER][NEUTRAL] Clas department, this is [PII].
[CUSTOMER][NEUTRAL] Yes.