AccountId: 011433970860
ContactId: a8ea87b9-c270-4c91-aca9-68deeacbd0c2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1046920 ms
Total Talk Time (AGENT): 273184 ms
Total Talk Time (CUSTOMER): 175962 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/a8ea87b9-c270-4c91-aca9-68deeacbd0c2_20250224T17:50_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, I was wanting to check on a claim.
[AGENT][NEUTRAL] OK, and this is for yourself or you're calling for a provider's office?
[CUSTOMER][NEUTRAL] Uh, well, it's for myself.
[AGENT][NEUTRAL] OK and uh may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII] and my name is [PII].
[AGENT][NEUTRAL] OK. And may I have the policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] 857-07
[AGENT][POSITIVE] Mm. Thank you.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The patient, uh, would have been, um, or the insurer would have been [PII].
[AGENT][NEUTRAL] OK. Um, may I have your date of birth for security?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] You want mine or his?
[AGENT][NEUTRAL] Yours, please.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the mailing address on file for verification.
[CUSTOMER][NEUTRAL] Uh, I think you have.
[CUSTOMER][NEUTRAL] His mailing address on there which is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And let's see, so the claim is on [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Last time I called.
[CUSTOMER][NEUTRAL] I talked to someone and they, they said that.
[CUSTOMER][NEGATIVE] It should be mailed out.
[CUSTOMER][NEUTRAL] February, um.
[CUSTOMER][NEUTRAL] Well it was last Friday so it's been.
[CUSTOMER][NEUTRAL] February the
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I'm just wanting to verify if it was mailed out.
[AGENT][NEUTRAL] Yeah, the explanation of benefits was mailed out on the [PII].
[CUSTOMER][NEUTRAL] Do what?
[AGENT][NEUTRAL] The explanation of benefits.
[CUSTOMER][NEUTRAL] What are you asking?
[CUSTOMER][NEUTRAL] The benefits, I guess.
[AGENT][NEUTRAL] No, the explanation.
[CUSTOMER][NEUTRAL] Is that, did they mail out of?
[AGENT][NEUTRAL] Miss Miss [PII], um, we mailed out the explanation of benefits on the [PII]. That's what we send out.
[CUSTOMER][NEUTRAL] OK, so what's, what's that?
[CUSTOMER][NEUTRAL] What's that consist of?
[AGENT][NEUTRAL] It's just the document letting you know that what happened with the claim, um, if we're needing more information or if it was paid, um, it's just information about the claim.
[CUSTOMER][NEUTRAL] And it was mailed out.
[AGENT][NEUTRAL] It was mailed out on the [PII] mhm correct.
[CUSTOMER][NEUTRAL] On the [PII].
[CUSTOMER][NEUTRAL] Well, can you tell me?
[CUSTOMER][NEUTRAL] If it is going to be paid or if I need to send more documents or.
[AGENT][NEUTRAL] It looks
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It looks like we need more documents with the claim, um, it looks like we're gonna need a, a fully itemized bill.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] what I sent you is what, everything is from the doctor's office.
[AGENT][NEUTRAL] OK. Let's see. What I have here under the notes it says bleed, um.
[AGENT][NEUTRAL] OK, in order to complete your claim, additional information is needed since the policy does not include name of beneficiary.
[AGENT][NEUTRAL] In a state that was set up, please send the state testamentary documentation for review. If in a state was not set up, please send a list of nest of kin, including spouse and Mr. [PII]'s McLean children. Please list the names, dates of dates of birth, address, so it's giving you information of what else you can send, like what else is needed to go ahead and complete this claim, OK.
[CUSTOMER][NEUTRAL] Well, whenever I talk to
[CUSTOMER][NEUTRAL] The, the first.
[CUSTOMER][NEGATIVE] Two girls I talked to, which I never get to talk to the same person ever.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] They said that um I was a beneficiary on there. I was the only name on there.
[CUSTOMER][NEUTRAL] And that
[CUSTOMER][NEUTRAL] I need to write my name and address.
[CUSTOMER][NEUTRAL] Which I couldn't really find a place to write, write it down, so I wrote it down at the very bottom.
[CUSTOMER][NEUTRAL] But now you, now I guess you guys need.
[CUSTOMER][NEUTRAL] Our children's names on there.
[AGENT][NEUTRAL] Well, we need documentation indicating that you are the nurse of kin or you're the one that um will receive this benefit.
[CUSTOMER][NEUTRAL] So how am I gonna prove that?
[AGENT][NEUTRAL] Do you have a testament?
[CUSTOMER][NEUTRAL] A testament.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] A testament of what?
[AGENT][NEUTRAL] Of his will.
[CUSTOMER][NEGATIVE] He didn't have a will.
[AGENT][NEUTRAL] You didn't have a wheel. OK. So, um, let's see.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Let me check and see if they send in a form. If they send in a form, all you need to do is fill that form out, OK? Um, bear with me. I'm gonna put you on a brief hold and I'm gonna ask to see if the form was included with that explanation of benefits, OK? One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Miss [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hello. OK, so yeah, you're gonna receive a form that is gonna ask for you to list um all the, the, the next of kin and you can put your information and your children's information and his children's information on that paperwork. Uh now, um the examiner, Ms. [PII], she looked into the the information you send in.
[AGENT][NEGATIVE] And it looks like it's still missing um some information. So she says she needs a fully itemized bill for the surgery that she didn't have all the information she needed to process this claim.
[CUSTOMER][NEUTRAL] Well I guess I'll look and see what she needs. I don't.
[AGENT][NEUTRAL] You can call the hospital, just, yeah, let them know that you need a fully itemized bill with diagnosis code, charge amounts, and just um a detailed.
[CUSTOMER][NEGATIVE] I don't think I can get
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Itemized bill with coding and charge amounts.
[CUSTOMER][NEUTRAL] Did they not send that?
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] It is not what we needed. She went through the paperwork and it, it is not what we need to complete this claim. So we need a fully itemized bill with diagnosis codes and procedure codes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEGATIVE] This is what I hate about.
[CUSTOMER][NEUTRAL] Insurances you guys just prolong it and prolong it and want more and more and more and more information so we finally give up and then you don't have to pay a claim.
[AGENT][NEUTRAL] We just need the correct information to process and that's for all of our claims. We ask for the same information and it needs to have um the coding, the coding is really important to process the claim um based on that we know exactly what to pay, why he went into what surgery was done, what's the reason for the surgery. That's all the coding uh give us a lot of information and we need that information.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] And I'm sitting here reading the coding.
[CUSTOMER][NEUTRAL] At it because I kept copies.
[AGENT][NEUTRAL] What I can do is have the examiner call you. Do you want her to call you directly? OK, let me do that because, yeah, um, yeah, I can only give you what I have, like, like the information I got here and that's all I have and I, I asked her and she said that she still need that information so she can call you and explain to you a little bit better what or how you can get that information. And that's [PII], correct?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'll go ahead and have her call you, OK? If you don't get a call today because it's already [PII], it's gonna be tomorrow, OK?
[CUSTOMER][NEUTRAL] Alright, I'm sure it'll be tomorrow.
[AGENT][NEUTRAL] Mm OK. Is there anything else I may help you with today, Miss [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah