AccountId: 011433970860
ContactId: 9fecfc88-6adb-4d9c-9521-1526ca607036
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 616320 ms
Total Talk Time (AGENT): 257482 ms
Total Talk Time (CUSTOMER): 166671 ms
Interruptions: 3
Overall Sentiment: AGENT=1.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/9fecfc88-6adb-4d9c-9521-1526ca607036_20250404T16:58_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], this is [PII] in [PII]. How are you doing?
[AGENT][POSITIVE] I'm good, [PII]. How are you doing today?
[CUSTOMER][POSITIVE] I'm doing great. I'm doing great. I'm just calling to, I got, I got a little, I'm on a bridge that's 24 miles long, so I got a little bit of a hike on my hands, but I wanted to see if I could check on two claims while I'm driving.
[AGENT][POSITIVE] Good. Well, how can I help you?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, [PII]. So you have 2 claims that you're wanting to check status on?
[CUSTOMER][POSITIVE] Yes ma'am for for two of our customers.
[AGENT][NEUTRAL] At
[AGENT][NEUTRAL] Yes, so it's for two different members. Is that right, [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And [PII], um, any information provided on these claims would be a verification of benefits and not a guarantee of payment. Uh, do you have the first patient's policy number?
[CUSTOMER][NEUTRAL] Yes ma'am, it is 26051.
[CUSTOMER][NEUTRAL] 49
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK. And [PII], what is your, the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and it's [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And if you will verify your email address for me?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] OK, thank you and the name of the group that she's with.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Ho Homa Thibodau rehab and Spa.
[AGENT][POSITIVE] OK. All right, thank you.
[AGENT][NEUTRAL] And what is the data service fun and total bill amount for her?
[CUSTOMER][NEUTRAL] To be honest, there's like 10 things on the on the site, so I can't really tell. I know she had one accident. She filed it under both plans, and I know we gave her the $50 twice on the hospital, I believe.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And on the accident plan I remember they gave her 350. They the first check was $300 for the X-ray and 50 for the first visit, but after that I don't know what she received that.
[AGENT][NEUTRAL] Mm OK. So give me a moment because we're, I'm looking at the ac. OK. All right.
[CUSTOMER][NEUTRAL] Sorry, I'm just reading from my notes on here.
[AGENT][NEUTRAL] I just
[CUSTOMER][NEUTRAL] She sent a bunch of follow up visits to the chiropractor I believe.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it's technically all one claim technically.
[AGENT][NEUTRAL] Yeah. Alright. So give me just a second to look at a couple of things.
[AGENT][NEUTRAL] OK, so I do see that there was a claim. The most recent claim was processed on 41 for her.
[AGENT][NEUTRAL] Um, and this does have multiple dates of service on it, and this does show a benefit of $150.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On the total for this claim that was paid to her and that was via direct deposit.
[CUSTOMER][NEUTRAL] OK, I believe there may have been a check in between that one and the 350 check, but I'm not 100%.
[AGENT][NEUTRAL] OK. So let me look on this policy just to see um
[AGENT][NEUTRAL] What else there is.
[AGENT][NEUTRAL] OK, so on the accident policy prior to that, there was another claim that was processed. It was also direct deposit. That was a $50 benefit.
[AGENT][NEUTRAL] Mm, again, that was direct deposit.
[AGENT][NEUTRAL] And again, I am only looking at her accident policy.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And then there was one more claim.
[AGENT][NEUTRAL] That was processed on [PII] and that was also a direct deposit, and that one was for $350.
[AGENT][NEUTRAL] Now, I don't know if you're able to write down the claim numbers. Yeah, if you want to write down the claim numbers, I can give you that, but you're driving, so.
[CUSTOMER][NEUTRAL] Got it, so she got 350 to.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] That's OK. I pretty much got it memorize. She's, she's got the 350, the 50, then the 150, so that maxes out her chiropractic visits, I believe, um, because you only get 5 of those, I think so.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's 12345, so OK, so you've got.
[CUSTOMER][NEUTRAL] 150 200 $250 in chiropractic visits, $300 for the X-ray. So she got $550 for the accident and I believe under the hospital plan she did get $50 twice.
[AGENT][NEUTRAL] Yes, because it does show that with this, this, on this claim that was just processed the other day, um, it does say that this benefit is exhausted for the cover for this state of service. Yes.
[CUSTOMER][POSITIVE] Got it, got it.
[CUSTOMER][NEUTRAL] know too much about these claims and policies.
[AGENT][NEUTRAL] Yeah, there's the accident policies are pretty complicated, to be honest with you, for somebody who works with them, they're complicated.
[CUSTOMER][NEUTRAL] It's crazy.
[CUSTOMER][NEUTRAL] They, they
[CUSTOMER][POSITIVE] Yeah there's a lot of benefits involved, you know, um, OK, awesome, well I, I greatly appreciate you on that, um, whenever you're ready I'll.
[AGENT][POSITIVE] That's exactly right, yes.
[AGENT][NEUTRAL] OK, was there anything else on her policy from this one that you needed? OK, all right, so just a second.
[CUSTOMER][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] OK, and what is the next policy number [PII]?
[CUSTOMER][NEUTRAL] OK, next policy number is 219.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 9714.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And the patient's name and date of birth on this one?
[CUSTOMER][NEUTRAL] It's [PII] [PII].
[AGENT][POSITIVE] Alright, and what is the date of service? Uh, well, first off, I'm sorry you, you did give me your date of birth. I'm sorry, [PII]. Well, it's Friday, so glad to love my job, but I'm glad it's Friday.
[AGENT][NEUTRAL] What's the data service and total bill amount for her, for [PII]?
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes, ma'am.
[CUSTOMER][NEGATIVE] I'm not, I'm not 100%. I know it was sent in last week. I believe it was sent in about 1 week ago, and I know it's processed already.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] All right, so we did, OK, so we received a claim. The most recent one we received was received on [PII]. Yes, it processed on [PII].
[AGENT][NEUTRAL] Uh,
[AGENT][POSITIVE] And on this one, there was a benefit paid in the amount of $600 even.
[AGENT][NEUTRAL] And that was also paid via direct deposit.
[AGENT][NEUTRAL] And that looks like that's for data service 104.
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEUTRAL] And 1021.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] On that one claim, it had 2 dates of service.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so that was, I'm thinking if it's 600 on the hospital, they must have gave her 100 for something and then 500 for like a doctor's office surgery.
[AGENT][NEUTRAL] OK, so let's see. So there was the surgery, that was, that was 500.
[AGENT][NEUTRAL] And then there was a
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] $50.02 separate $50 payments, one for the 1021 data service.
[AGENT][NEUTRAL] And yes, that would have been for the physician's office and then for 104.
[AGENT][NEUTRAL] The surgery, $500 on 104, and uh, and also a $50 for the office.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And then for data service.
[AGENT][NEUTRAL] Of $102,150 for a total of $600.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] Got it, got it, thank you very much for your time I appreciate it.
[AGENT][POSITIVE] Well, you are certainly so welcome. Is there anything else I can help you with today, [PII]?
[CUSTOMER][POSITIVE] That's it. Have a great day.
[AGENT][POSITIVE] OK. Well, I hope you have a great day too, and a great weekend and it was nice speaking to you.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Uh yes, sir. Thank you for calling APL.
[CUSTOMER][NEUTRAL] Yes ma'am bye bye.
[AGENT][NEUTRAL] Bye-bye.