AccountId: 011433970860
ContactId: a4f5e437-5376-45bf-82bf-e5c7a172c6e7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 331799 ms
Total Talk Time (AGENT): 158848 ms
Total Talk Time (CUSTOMER): 118498 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/a4f5e437-5376-45bf-82bf-e5c7a172c6e7_20250130T15:23_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. Can I help you?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Hey, [PII]. Uh, my name is [PII], and I've been having this ongoing battle with palm MRI. I went to get an MRI uh about 4 months ago.
[CUSTOMER][NEGATIVE] I paid them up upfront cash because they said the insurance didn't approve it.
[CUSTOMER][NEGATIVE] And now I want to get my money back, and uh Admed said they paid them. But APO said Amed said they paid them.
[AGENT][NEUTRAL] OK. Do you have
[CUSTOMER][NEUTRAL] And they say they did not get.
[AGENT][NEUTRAL] Do you have your policy number?
[CUSTOMER][NEUTRAL] Uh, hold on.
[CUSTOMER][NEUTRAL] You want the policy number for Advent?
[AGENT][NEUTRAL] No, your policy number with American Public Life.
[CUSTOMER][NEUTRAL] Oh, OK, hold on, I got, I have that.
[CUSTOMER][NEUTRAL] OK, let's see, my policy number is 01423563.
[AGENT][NEUTRAL] And your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alrighty, can you verify the last four of the policyholder's social?
[CUSTOMER][NEUTRAL] Oh, that's my husband. Oh my [PII]. Area [PII], I too.
[AGENT][NEUTRAL] Can you can you verify his date of birth?
[CUSTOMER][NEUTRAL] Uh, hold on, let me see if I.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right. And what's, uh, the last four of your social?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. And your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Perfect. And please verify your billing address.
[CUSTOMER][NEUTRAL] My home address is [PII].
[AGENT][NEUTRAL] Perfect. Thank you, Ms. [PII], and let me look here. OK, so you're wanting to check, a check on a claim status to figure out, um, um, if APLs paid their portion or not?
[CUSTOMER][NEUTRAL] Yeah, yeah, 88, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The pump MRI I paid them.
[AGENT][NEUTRAL] OK,
[CUSTOMER][NEUTRAL] And they say they got, they said they got paid from Ahmed, but APL said Ahmed did pay them, but Palm MRI said they did not get paid from uh Amed.
[AGENT][NEUTRAL] OK, so what I'm gonna have to do, Ms. [PII], is get you transferred down to the claims and benefits department so they can further assist you, OK?
[CUSTOMER][NEUTRAL] And so that
[CUSTOMER][POSITIVE] Thank you so much appreciate it.
[AGENT][POSITIVE] You're welcome. Is there anything else in group billing I can help you with today?
[CUSTOMER][POSITIVE] No, that's it. Thank you.
[AGENT][POSITIVE] All righty. Well, thank you for calling APL and you have a good day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[AGENT][NEUTRAL] Hey, [PII], this is [PII] in group billing. Uh, looks like someone spoke to this lady yesterday. Um, policy number 142356.
[CUSTOMER][NEUTRAL] Could you give me a moment, [PII], because I wasn't ready for a policy number if you don't mind.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, I'm ready for it now.
[AGENT][NEUTRAL] 142
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 356 3
[CUSTOMER][NEUTRAL] And who am I speaking with on the, who's on the phone? the provider or the insured?
[AGENT][NEUTRAL] This, this is.
[AGENT][NEUTRAL] The insured's wife, [PII], um,
[AGENT][NEUTRAL] It looks like there was an MRI done. Um, it sounds like from what Ms. [PII] is saying, she's kind of getting a run runaround from, um, from the provider's office or something. I'm, I can't really tell. Um, but she's needing to check on the claim that she called about yesterday, um.
[CUSTOMER][NEUTRAL] Is it for herself or the spouse? Who's the claim for?
[AGENT][NEUTRAL] Cla
[AGENT][NEUTRAL] It's for her for an MRI that was done for her.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, and she's just, she's been told that, um, the claim's been paid, um.
[AGENT][NEUTRAL] But the provider's office is saying that it hasn't been paid and so she's, um, it, she paid for the MRI upfront. So then she filed the claim, um, to I guess get reimbursed. And so that's, that's basically what I'm assuming it's the.
[CUSTOMER][NEUTRAL] Do you have a claim number?
[AGENT][NEUTRAL] Uh, one of them is the 341-3272.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And we were requesting.
[AGENT][NEUTRAL] And it looks like.
[CUSTOMER][NEUTRAL] like we requested diagnosis or uh EOB or something.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Yeah, and whoever she spoke to yesterday, um, said that they would review and call, call them back, but, uh, now the spouse is on the phone.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] For those
[AGENT][NEUTRAL] And it could be that she's not aware that
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] That she can't be just from the last part of this note. Maybe she's not aware that she, the EOB needs to be sent in for the reimbursement to happen.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm, oh, you can send her over. I can speak with her.
[AGENT][POSITIVE] All [PII], here she comes. Thanks.
[CUSTOMER][NEUTRAL] OK.