AccountId: 011433970860
ContactId: a8c56bdf-c1d7-45fe-b9c3-7365a32497e6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 410820 ms
Total Talk Time (AGENT): 183460 ms
Total Talk Time (CUSTOMER): 171839 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/a8c56bdf-c1d7-45fe-b9c3-7365a32497e6_20250113T20:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, you say [PII]?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Hey, my name is [PII]. Um, I am helping someone with their claims who has a cancer claim. I've been helping her since last fall.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And I have a, I was the agent that wrote on the policy. What information do you need from me before I ask my question?
[AGENT][NEUTRAL] OK, Ms. [PII], can you please give me the group number?
[CUSTOMER][NEUTRAL] it's a policy individual.
[AGENT][NEUTRAL] OK, what's the individual's policy number?
[CUSTOMER][NEUTRAL] 728463
[AGENT][NEUTRAL] OK. And then what is the insured's name, please?
[CUSTOMER][NEUTRAL] Uh, it might be under [PII] or [PII] or [PII].
[AGENT][NEUTRAL] OK. Let me pull that policy in real quick.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, I do show [PII]'s policy. Um, is [PII] there for me to be able to talk to, to make sure it's OK to discuss the policy with you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, because I've signed a form to check the policy for, for [PII]. Yeah, for [PII] or [PII]. Yeah, I've been working on, yeah.
[AGENT][NEUTRAL] Oh, you did.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK, let me um look for that form real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you so much. I appreciate it.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] OK, I see you, Ms. [PII]. Thank you so much.
[CUSTOMER][POSITIVE] Thank you very much.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so you said you, you had, um, if you were calling about about his claim, is that correct?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] A question.
[CUSTOMER][NEUTRAL] Yes, yes, um, I have uploaded and filed a lot of claims on her behalf.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then I would call every once a while and say, hey, what more do y'all need? It's not on the claim. Uh, and we're fixing to file a whole bunch more because she has since had her actual surgery and some stuff. But I want to know, is there anything outstanding that on some of these claims that y'all need more information on?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Uh, I can absolutely look at that for you. Um, I see, let's see.
[AGENT][NEUTRAL] Do you want, how far do you need me to go back to [PII]?
[CUSTOMER][NEUTRAL] And I'm
[AGENT][NEUTRAL] It looks like that's when the claim started for her.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, I know she's had some checks issue, but I've been trying to follow up behind the scenes and see what information y'all need or are waiting on because she doesn't know how to file this. She's just a nurse.
[AGENT][NEUTRAL] Oh, yes. OK. OK, let's see.
[CUSTOMER][NEUTRAL] You know, yeah.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Let me look at her, see if there's anything that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I guess as you find them, if you could give me the date, I'm gonna make a list here of what's needed.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] It's gonna take me just a moment to go through them um.
[CUSTOMER][POSITIVE] That's fine. That's no problem.
[AGENT][POSITIVE] OK, those have been taken care of.
[AGENT][NEUTRAL] It doesn't look so um what I'm, well, there's one that has a different code. The ones that I'm looking at were like duplicate claims because they were sent in more than once.
[CUSTOMER][NEUTRAL] Yes, we
[CUSTOMER][NEUTRAL] We knew there were some of those, yes, OK.
[AGENT][NEUTRAL] OK, let me keep looking.
[AGENT][NEUTRAL] OK, here's one that needs an itemized hospital facility billing with all charges fully identified that is claim number.
[AGENT][NEUTRAL] 3479895.
[CUSTOMER][NEUTRAL] 3479895
[AGENT][NEUTRAL] 95. Yes, ma'am.
[CUSTOMER][NEUTRAL] And I just need to go into the website and look for that. I mean, I know how to access that or.
[AGENT][NEUTRAL] Yes, ma'am. That's, it has a um denial code of needing the explanation of, uh, I'm sorry, the itemized statement with all the charges, procedure codes, and diagnosis.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, I my procedure code.
[CUSTOMER][NEUTRAL] Is there a date for that?
[CUSTOMER][NEUTRAL] Stay or the date, OK.
[AGENT][NEUTRAL] Yes, ma'am, um, the day.
[AGENT][NEUTRAL] Right, the date was on the date of service is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 328. I wonder if that was her original.
[CUSTOMER][NEUTRAL] Mammogram, hmm 328. Is there a facility name?
[CUSTOMER][POSITIVE] Wow
[AGENT][NEUTRAL] Yes, ma'am. Let me go back to it. I can look at it.
[CUSTOMER][NEUTRAL] Because that may be included in what we're fixing to send in. I'm not sure, but I can try to match it up.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Uh, Houston Methodist.
[CUSTOMER][NEUTRAL] Yeah, [PII], that's where she works, Houston Methodist.
[CUSTOMER][NEUTRAL] OK, is it a
[CUSTOMER][NEUTRAL] Anything other than that or just Houston Methodist Hospital?
[AGENT][NEUTRAL] It's just, it just says on this all I see is Houston Methodist.
[CUSTOMER][NEUTRAL] OK. Well, that's one we can check on, OK?
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Yeah, absolutely, and if it's a duplicate, which I don't see that it is, if it's a duplicate, of course you know they'll let you know the claims department will let you know it's not been filed, um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And then
[AGENT][NEGATIVE] Those are duplicate.
[AGENT][NEUTRAL] Those are paid.
[AGENT][POSITIVE] That's the only one I see. I think you guys have done a pretty darn good job of taking care of them.
[CUSTOMER][NEUTRAL] Wow, I hope so. OK. Well, before I upload these others and send them in, I told her I was gonna call today and just sort of see where we were.
[CUSTOMER][POSITIVE] Yeah, perfect. OK, I can work on that and then I'll get these others uploaded. Thank you so much, [PII].
[AGENT][POSITIVE] You're so very welcome, Ms. [PII].
[CUSTOMER][POSITIVE] All right. OK. I'm sure I'll be calling back. Thank you very much. OK.
[AGENT][POSITIVE] We thank you.
[AGENT][POSITIVE] OK. Well, if you, you already know if you need help, just pick up the phone. We're all here willing to help you guys.
[CUSTOMER][POSITIVE] Thank you very much. Appreciate it.
[AGENT][POSITIVE] You're welcome. You have a blessed day, Ms. [PII]. Thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You too. Bye-bye.