AccountId: 011433970860
ContactId: a29d68c6-6267-457e-8a30-5bca34a14e39
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 473179 ms
Total Talk Time (AGENT): 231639 ms
Total Talk Time (CUSTOMER): 138379 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/a29d68c6-6267-457e-8a30-5bca34a14e39_20250204T21:30_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] Yes, ma'am. I just have a question over a claim that my insurance company sent over to y'all yesterday, and I wanted to see if y'all received it. It's from my uh health insurance company. They sent it for me since we've been having some problems getting it taken care of.
[AGENT][NEUTRAL] OK, so you're wanting to just verify if we received something that was supposed to have been sent to us for a claim yesterday?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, they sent an EOB yeah.
[AGENT][POSITIVE] Yes ma'am, I can help you.
[AGENT][NEUTRAL] Yes ma'am, I can check that for you um and who am I speaking with?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] Thank you and Miss [PII], what is a good call back number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] Oh, I do not have it with me. I need to pull it up. Hang on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I need to start pulling it up before I call.
[AGENT][POSITIVE] You're OK.
[CUSTOMER][MIXED] OK, slowly but surely open it.
[CUSTOMER][NEUTRAL] OK, my policy number is 1775159.
[AGENT][NEUTRAL] 1775159. Is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So what I'll need to do first, um, once I get your policy information pulled up, Miss [PII] is to verify several things with you first for security.
[AGENT][NEUTRAL] And any information that I do provide for you would be a verification of benefits and not a guarantee of payment. So first off, if you please verify your date of birth.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you provided for me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Thank you and lastly your email address please.
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] OK, thank you. So I can see Ms. [PII], it looks like something has been placed on your profile, uh, today it's in line for review. Give me just a moment to pull that document so that I can see exactly what it is to verify that, you know, that is the document, yes ma'am.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Any question?
[AGENT][NEUTRAL] Do you know who the sender was of the
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Fax
[CUSTOMER][NEUTRAL] Yes, it was from it was from Blue Cross Blue Shield of Arkansas.
[AGENT][NEUTRAL] OK, so it looks, OK, so it does look like there have been 15 pages total, including the cover received today.
[CUSTOMER][NEUTRAL] Or it should have been.
[CUSTOMER][POSITIVE] Oh wow.
[AGENT][NEUTRAL] It's what we received.
[CUSTOMER][NEUTRAL] Maybe, man.
[CUSTOMER][NEUTRAL] Would an EOB be that long?
[AGENT][NEUTRAL] Mm, it could be from multiple dates of service they probably just um sent multiple.
[CUSTOMER][NEUTRAL] Possibly um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Within a date range probably again I can't say but I can tell that that's what this is and it is from Blue Cross. I can see that.
[CUSTOMER][NEUTRAL] Well, with that with.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, so maybe, maybe they'll, I don't need to send anything else though then, right?
[AGENT][NEUTRAL] Um, not at this time is.
[AGENT][NEUTRAL] Uh, let me look at the most. Do you what date of service was this for that they were sending me?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, I believe it was [PII].
[AGENT][NEUTRAL] OK, let me see if I can locate the claim for that.
[CUSTOMER][NEUTRAL] 24.
[CUSTOMER][NEUTRAL] It was a large claim, I will say that because I had a lot done that day.
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] No, you can.
[AGENT][NEUTRAL] And what claim, who was the provider that the claim we that we were needing the EO?
[CUSTOMER][NEUTRAL] One
[AGENT][NEUTRAL] Do you know?
[CUSTOMER][NEUTRAL] Well, the, the provider is, oh, you mean where I had it done at? That would have been UT Southwestern, um, at the, uh, cancer center, the outpatient cancer building. I believe the address is, might be, it's either [PII] or 59 something.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can, well, I can see that for that particular data service um that we did need.
[AGENT][NEUTRAL] We did need a copy of the primary insurance company's explanation of benefits. I can see that that's under claim number.
[AGENT][NEUTRAL] 3551454.
[CUSTOMER][NEUTRAL] OK, let me write that claim number down because I'll get it.
[AGENT][NEUTRAL] Uh, and I can, yes ma'am, and I, and you can see these um also in your portal because I can see that you are set up.
[CUSTOMER][NEUTRAL] OK, so they did send the EOB though like they were supposed to yesterday or no?
[AGENT][NEUTRAL] We did receive a large explanation of benefits from, but it has not from Blue Cross, but it has not been reviewed yet.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, so and then what was that finding?
[AGENT][NEUTRAL] That's why you may not can see that in.
[AGENT][NEUTRAL] Well, there's not been a claim number assigned to what we received from Blue Cross, but there was a claim that we processed in which we did indicate that we needed the primary insurance company's explanation of benefits for your data service of [PII] and that was processed under claim 355.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 1454.
[CUSTOMER][NEUTRAL] OK, so you're thinking maybe it's being reviewed soon?
[AGENT][NEUTRAL] Well, it will be 7 to 10 business days.
[CUSTOMER][NEUTRAL] OK, alright, well thank you for checking so there's nothing else I need to do.
[AGENT][NEUTRAL] But it was
[AGENT][NEUTRAL] No, ma'am, not at this time as far in regards to that. We'll just wait um for that to be reviewed and then once, once it has, I believe I also noticed that you were set up.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Uh, let me check one thing.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So you are you have opted in for text notification alerts so you should receive a text message once the claim has been reviewed once this information has been reviewed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, and is mine still set up where it comes like directly to my bank?
[AGENT][NEUTRAL] You do have direct deposit information on file, yes ma'am.
[CUSTOMER][POSITIVE] OK. All right, well, thank you, ma'am.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Well, you are certainly very welcome. Is there anything else that I could help you with today?
[CUSTOMER][POSITIVE] No, ma'am. You have a good day.
[AGENT][POSITIVE] You too, Ms. [PII]. So thank you again for calling APL.
[CUSTOMER][NEUTRAL] Uh huh bye bye