AccountId: 011433970860
ContactId: a8c05be4-4f66-4387-aec4-14d3f568ffaf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 674309 ms
Total Talk Time (AGENT): 194759 ms
Total Talk Time (CUSTOMER): 236002 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/a8c05be4-4f66-4387-aec4-14d3f568ffaf_20250311T21:16_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I am calling on behalf of, um, an employee. I'm with the agent's office.
[CUSTOMER][NEUTRAL] I was calling to get um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Kind of an update on a claim but we needed something corrected as well.
[AGENT][NEUTRAL] OK, uh, Ms. [PII], what's that policy number, please?
[CUSTOMER][NEUTRAL] Policy number 2579993.
[AGENT][NEUTRAL] OK, thank you. And what um broker's office are you calling from?
[CUSTOMER][NEUTRAL] Crescent City Benefits.
[AGENT][NEUTRAL] I think I've talked to you before and what's a good callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and that patient's name, date of birth?
[AGENT][NEUTRAL] Or insured's name or patient, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] and let me go.
[CUSTOMER][NEUTRAL] Get his date of birth. It's on a different screen for me.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and the claim was for him?
[CUSTOMER][NEUTRAL] The claim was for his wife, [PII].
[AGENT][NEUTRAL] OK, because I did not.
[CUSTOMER][NEUTRAL] I have the claim number if that helps.
[AGENT][NEUTRAL] OK, what's the claim number?
[CUSTOMER][NEUTRAL] Claim number is 3572454.
[AGENT][NEUTRAL] 2
[AGENT][NEUTRAL] 4
[AGENT][NEUTRAL] Uh, looks like this was two days of service, [PII] and [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I actually sent in an email earlier and I did get a response saying that um.
[CUSTOMER][NEUTRAL] Y'all needed the itemized bill and we've been trying to to tell him that so we're gonna reach out to him again um but he had I was wondering if we could get the explanation of benefits corrected and sent out the explanation of benefits that was sent to him let me go back to that screen because he had forwarded it to us.
[CUSTOMER][NEUTRAL] It states these services were rendered after coverage was terminated.
[AGENT][NEUTRAL] On that a UB?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mm, let me look at it. Give me one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I don't see on this claim where it was denied as a service rendered after policy terminated.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so maybe they did update it and he just hasn't received that yet because he received two of them.
[AGENT][NEUTRAL] Oh, OK. It more than likely.
[CUSTOMER][NEUTRAL] OK, so you're showing in the system that it it does need the the itemized bill with the charges and procedure codes and diagnosis.
[AGENT][NEUTRAL] Uh, yes. Looks like the process is needing the billing with diagnosis and procedure codes. And
[AGENT][NEUTRAL] please submit, yeah, it looks like he just uh requested an itemized bill with those diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] OK, is there any way you could email me that explanation of benefits so I have proof to show him he's been kind of difficult to deal with.
[AGENT][NEUTRAL] Worth it. OK. Give me one moment.
[CUSTOMER][NEUTRAL] So we've been trying to tell him what he needs to to send us but he's just been sending us the.
[CUSTOMER][NEUTRAL] EOB from his insurance company like 3 different times.
[AGENT][NEUTRAL] Yeah, we can't use an EOB to process.
[CUSTOMER][NEUTRAL] Yeah, that's what we keep telling him, but he insisted to upload it so we did.
[AGENT][NEUTRAL] They insist though, but um, what's your email address, Ms. [PII]?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] OK, right.
[AGENT][NEUTRAL] Oh, apparently I already had your email address.
[AGENT][NEUTRAL] Let me see for patient.
[AGENT][NEUTRAL] The scales.
[AGENT][NEUTRAL] OK, give me one moment just making sure that I got it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Alrighty, I have just sent that over. I hope you see you in a few moments.
[CUSTOMER][NEUTRAL] Perfect and then there's one other claim if you could check on it since I have you on the phone I also sent the email um with this question.
[AGENT][NEUTRAL] For the same patient or different patient?
[CUSTOMER][NEUTRAL] Different patient.
[AGENT][NEUTRAL] OK, uh, what's that policy number?
[CUSTOMER][NEUTRAL] Um, OK, let me get it pulled up. I have a claim number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Does that work or do I need to pull the policy number up?
[AGENT][NEUTRAL] Um, if you have the claim number, I can use that.
[CUSTOMER][NEUTRAL] OK, it's claim number 3557389.
[AGENT][NEUTRAL] OK, give me one quick moment.
[AGENT][NEUTRAL] O N CP.
[AGENT][NEUTRAL] 3557.
[AGENT][NEUTRAL] Oliver
[AGENT][NEUTRAL] Bruise Hill, Brutus Hill, OK.
[CUSTOMER][NEUTRAL] Rudeil senior, yes.
[CUSTOMER][NEUTRAL] I was just wondering if you showed that the check cleared um.
[CUSTOMER][NEUTRAL] He had uh left us a voicemail saying he hasn't received any money so I'm just trying to figure out before I give him a call back if it's this claim or he does have two other claims one's in progress and then one's still in line to be reviewed.
[CUSTOMER][NEUTRAL] I just wanna make sure he received this before I give him a call.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I do show that this claim paid and looks like it cleared as of [PII].
[CUSTOMER][POSITIVE] OK, so it did clear perfect.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And you said [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] You are welcome. I'm sorry, I'm just.
[AGENT][NEUTRAL] Oh, yeah, I do show the other claim being received on the [PII] and it's in line for processing.
[CUSTOMER][NEUTRAL] OK, um, and then I do have.
[CUSTOMER][NEUTRAL] I actually sent the email about 3.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Three people, but since I have you on the phone, if you could look up one more person for me.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] Same company different person.
[AGENT][NEUTRAL] OK. Uh, what's that next policy number or claim number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So it's gonna be two claim numbers. First one is 3573955.
[AGENT][NEUTRAL] OK, and that insured's name?
[CUSTOMER][NEUTRAL] Um, the owner is [PII]. The claim is under his son [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And see.
[AGENT][NEUTRAL] And process as it incurred prior to the effective date of coverage.
[AGENT][NEUTRAL] Which this one.
[AGENT][NEUTRAL] Shows the effective date of June. Well, I'm looking at the wrong one. Give me one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. Uh, effective [PII].
[AGENT][NEUTRAL] And this data service was in [PII].
[CUSTOMER][NEUTRAL] OK, I wonder if he sent us some wrong documents.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, I don't see anything prior to [PII].
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] He probably sent in the wrong on wrong documents and we missed that too, OK.
[AGENT][NEUTRAL] 8
[AGENT][NEUTRAL] And you say you had another claim number?
[CUSTOMER][NEUTRAL] It's probably gonna be the same thing, um.
[CUSTOMER][NEUTRAL] Yeah, it's for his hospital policy, uh, claim number 3573588, same person [PII].
[AGENT][NEUTRAL] Uh, the same cause this is, looks like, oh wow, yeah, a good bit of dates, uh, all in year [PII].
[CUSTOMER][POSITIVE] Yeah, OK, alrighty, well that's solved that issue, thank you so much.
[AGENT][POSITIVE] You are welcome and you have a great day, Ms. [PII]. Thank you for calling APL.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you you have a good day as well bye.
[AGENT][NEUTRAL] Bye.