AccountId: 011433970860
ContactId: a55e71d9-49cc-4b49-87bb-b16cde0cbd96
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 620739 ms
Total Talk Time (AGENT): 179264 ms
Total Talk Time (CUSTOMER): 114243 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/a55e71d9-49cc-4b49-87bb-b16cde0cbd96_20250408T14:23_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEGATIVE] Hi, I'm calling about a claim that says process but it says amount paid 0 and I don't understand why.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] OK. Can I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Um, [PII] [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, and is this for yourself or are you with the provider?
[CUSTOMER][NEUTRAL] Myself.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is your policy number?
[CUSTOMER][NEUTRAL] It is 259-736-3.
[AGENT][NEUTRAL] It is 2.
[AGENT][NEUTRAL] OK, it's pulling it up just a little bit slow.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK, I just need to verify a few pieces of information. What is your birth date?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you and then lastly your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and what was that? Do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] Yeah, it is 358-612-3.
[AGENT][NEUTRAL] Um, looks like we, there were several charges on here and it looks like there's several different.
[AGENT][NEUTRAL] Um,
[AGENT][NEGATIVE] Denial codes.
[AGENT][NEUTRAL] Um, let's see, let me pull up the actual.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, there were like
[CUSTOMER][NEUTRAL] Two I think or 3 denial codes for certain things but I didn't even get charged for those, but there were charges of 317 $617.23.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] $4,651.98 $7.77.
[CUSTOMER][NEUTRAL] Uh, for and it was all for inpatient.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] It looks like part of what was missing was your primary explanation of benefits from your primary insurance.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] What do you mean?
[AGENT][NEUTRAL] Who's your primary insurance through?
[CUSTOMER][NEUTRAL] A Florida blue.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, trying to go through these, let me see.
[AGENT][NEUTRAL] I can't see the.
[CUSTOMER][NEUTRAL] Which is where I got that.
[CUSTOMER][NEUTRAL] Then from
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can't see the EO the explanation of benefits yet because it's just processed today. Let me see.
[AGENT][NEUTRAL] I'm trying to see which, what goes with what.
[CUSTOMER][NEUTRAL] Yeah, because I can click on file and it pulls the EOB right up. It literally states right on there that this is not a bill. This is an explanation of benefits.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Well, let's
[AGENT][NEUTRAL] I don't know why it's not in the system for me. Let's see.
[AGENT][NEUTRAL] OK, let me, can I place you on a brief hold if you don't mind?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] I can see that you'll be.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thanks for holding um do you mind if I transfer you to our claims department? They're the ones who process this they have access to more information than I do and then they can go line by line through the claim on what's what's happening here because I can't see the EOB but you can so.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, so but it's showing that it was denied?
[CUSTOMER][NEUTRAL] Or did it just not update the amount of money that's getting paid out for it and like on my dashboard or what?
[AGENT][NEUTRAL] So it's showing that it's denied. There's several reasons here. Part of it looks like what we received, we need supporting documentation that this is an accident or sickness.
[AGENT][NEUTRAL] Um, that typically would include
[CUSTOMER][NEGATIVE] It's cancer
[AGENT][NEUTRAL] Right, I understand it's just what we received from you it didn't have that on there so that's why I was gonna transfer you to the claims department they can they're the ones who process these so they can talk with you about exactly what's needed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, is it OK if I transfer you over there?
[CUSTOMER][POSITIVE] Yeah thank you.
[AGENT][NEUTRAL] OK, thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, [PII], this is [PII] on the care team. I have a policyholder on the line. She wants to go over her claim denial and
[AGENT][NEUTRAL] It, it looks like it just processed today, but she can see the EOB but I can't see it.
[AGENT][NEUTRAL] Um, so I was gonna see if you can help her, um, go through the claim denial because like I said I can't see the EOB so I and she's she wants to know exactly why things are denied.
[CUSTOMER][NEUTRAL] OK, sure. Do you have the policy number?
[AGENT][NEUTRAL] Yes, it's, um, hold on just a second, and I've verified her information. Um, policy number is 02597363.
[AGENT][NEUTRAL] Yeah I've got [PII] on the phone.
[CUSTOMER][NEUTRAL] OK, and do you have a callback number?
[AGENT][NEUTRAL] Callback number is [PII].
[CUSTOMER][POSITIVE] OK, thank you, give me just a second here.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK, and what was the claim number that she or I guess the one that was just processed today?
[AGENT][NEUTRAL] Yeah, 358-612-3.
[CUSTOMER][POSITIVE] OK, uh, I'm ready for it, thank you.
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][POSITIVE] Hello, thank you for holding this is [PII].
[CUSTOMER][NEUTRAL] Hi [PII] um they transfer.