AccountId: 011433970860
ContactId: afe42a77-7c83-4db8-982d-7558c84133de
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 509890 ms
Total Talk Time (AGENT): 225586 ms
Total Talk Time (CUSTOMER): 212176 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/afe42a77-7c83-4db8-982d-7558c84133de_20250407T14:37_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good morning. Um, I got a statement from you guys, uh, for my husband. Uh, I can, what number do you need to, you could check it a claim number or policy number? What do you need?
[AGENT][NEUTRAL] Um, well, 1st may I have your name and a good contact number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. My name is [PII] and the last name is [PII]
[AGENT][NEUTRAL] Thank you and um just a good contact number and then your policy number or the claim number if you have it, whichever is easier.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Sure, yeah, I have it, um, phone number is [PII], and I have policy number and a claim number, whatever you want. What is more what is more efficient.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Um, we can, we can, I'll actually need both, so that's fine.
[CUSTOMER][NEUTRAL] OK, alright, alright, here's the policy number it's 0208.
[CUSTOMER][NEUTRAL] 8979
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] The claim number is 358.
[CUSTOMER][NEUTRAL] 2066.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] All right, and you're on the policy as well. Um, [PII], can you verify your date of birth and the mailing address on file?
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] 61657 uh [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. OK, so I have the claim here and then what questions did you have?
[CUSTOMER][NEUTRAL] Well, first of all, um, Central DuPage Hospital, my husband, is this regarding me or him, this claim?
[AGENT][NEUTRAL] Um, this is for Mr. [PII].
[CUSTOMER][NEUTRAL] OK, he has never gone to Central DuPage Hospital, never.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Ever never
[AGENT][NEUTRAL] So this is what we'll do. I'm going to pull up the documents because so that I can see where the claim came from and then we can go from there.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Because we can't process it unless they send it in. So let's see where it came from.
[CUSTOMER][NEUTRAL] Right, right, right.
[AGENT][NEUTRAL] It's coming up now it's just loading. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][NEUTRAL] Um, OK, so I'm just gonna tell you what I see and then you let me know what it's supposed to be or, or if this is, I need to escalate this. So, um, it looks like it's some labs, um, from [PII]. I'm trying to
[CUSTOMER][POSITIVE] Yes, he did go for some labs, yes.
[AGENT][NEUTRAL] So that's what this is for. This is, this is all lab charges.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] He was not at Central DuPage Hospital. He was not, he was not at Central DuPage Hospital.
[AGENT][NEUTRAL] Where did he go for the labs?
[CUSTOMER][NEUTRAL] We live in the city. I'm sure it was somewhere like in uh Northwestern.
[CUSTOMER][NEUTRAL] Affiliated with Northwestern Hospital.
[AGENT][NEUTRAL] OK, hold on one second, let me go to the 2nd page.
[CUSTOMER][NEUTRAL] Central DuPage Hospital is way in the suburbs. We live in the city and he goes, we go to the city, yeah.
[AGENT][NEUTRAL] Right, but if they have a billing location and this is where their bills come from.
[AGENT][NEUTRAL] Hold on, let me look and see what came through.
[CUSTOMER][NEGATIVE] I can't believe Northwestern, yeah, yeah.
[AGENT][NEUTRAL] I see if they can give me an order and doctor or something on here. Hold on one second. I'm just looking through what they sent.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] I mean, the only, the only thing we can do is reach out to first.
[AGENT][NEUTRAL] If they didn't go to Central DuPage, then where did they go on this date because they sent this through, they sent this through the major insurance as well and they paid, so.
[CUSTOMER][NEUTRAL] He did not
[AGENT][NEUTRAL] What, where did he go on [PII]?
[CUSTOMER][NEUTRAL] This is so weird. Doctor [PII], Doctor [PII].
[AGENT][NEUTRAL] [PII], yeah, that's who's on this order.
[CUSTOMER][NEUTRAL] [PII], yeah, [PII], yeah.
[AGENT][NEUTRAL] OK, so I don't know if maybe they use Central to pay or what, but that's the doctor on here and he, he did have labs, so.
[CUSTOMER][NEUTRAL] And this was, I was at.
[CUSTOMER][NEUTRAL] OK, so they did forward to to his main insurance and the main insurance paid it.
[AGENT][NEUTRAL] Right, so we're second to United Healthcare. So they sent it to United Healthcare first, UnitedHealthcare paid and then they sent the it looks like $40.63 to us, and we paid that.
[CUSTOMER][NEUTRAL] Right, how much did UnitedHealthcare pay?
[AGENT][NEUTRAL] Um, let's see if I can see that.
[AGENT][NEGATIVE] They really didn't. There was an adjustment of $539.37 and then the $40.63 was for the deductible and we paid that part of the patient responsibility.
[AGENT][POSITIVE] And that was, that took care of the whole.
[CUSTOMER][NEUTRAL] OK, hold on, just say, say that again, say that again. So United Healthcare paid what 55.
[AGENT][NEUTRAL] So the total charges
[CUSTOMER][NEUTRAL] Go ahead, I'm sorry.
[AGENT][NEUTRAL] The total charges $580.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] There was a patient responsibility of $40.63 which we paid.
[AGENT][NEUTRAL] And then there was an adjustment.
[CUSTOMER][NEUTRAL] Oh, OK, it was a patient responsibility.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm I'm writing it as you're talking. OK, go ahead, adjustment.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yes, there was an adjustment of $539.37.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh, OK, so.
[CUSTOMER][NEGATIVE] Oh, so he owes nothing.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh, all right. I, you know, when I saw when I saw Central DuPage Hospital.
[CUSTOMER][NEUTRAL] I thought, huh, so the adjustment was was the was the payment from United Healthcare, correct?
[AGENT][NEGATIVE] Basically, I mean, yeah, you know, it wasn't like a real payment, but yes, it did, it was taken off.
[CUSTOMER][NEUTRAL] I mean theoretically that's where it came from.
[CUSTOMER][POSITIVE] The adjustment was made by United Healthcare and then the secondary was you and then you, you, you took responsibility for that. OK, I'm happy, I'm happy.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, it sounds like Central DuPage has like multiple locations and their billing. Yeah, cause uh
[CUSTOMER][NEUTRAL] I got it I got it.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[AGENT][NEUTRAL] That's the doctor on here, [PII]. Oh, it might be [PII]. I see that now.
[CUSTOMER][NEUTRAL] [PII], I know, [PII] [PII], I don't know. I, yeah, I don't know either. I'm with you. Yeah, yeah. OK. All right. Thank you so much for your patience.
[AGENT][NEUTRAL] Yeah, it may.
[AGENT][NEGATIVE] But yes, it is a zero balance.
[AGENT][POSITIVE] Oh, you're welcome.
[CUSTOMER][POSITIVE] That is awesome. That's what I like to hear 0 balance, OK.
[AGENT][NEUTRAL] Me too.
[CUSTOMER][POSITIVE] All right, thank you so much have a have a great week OK?
[AGENT][NEUTRAL] Thank you, Miss. Um, well, I was gonna try to say your last name. I'm just gonna say,
[CUSTOMER][NEUTRAL] With with [PII] with [PII].
[AGENT][POSITIVE] With [PII]. OK, thank you, Miss [PII].
[CUSTOMER][POSITIVE] It's tough. I with like [PII], yeah, that's fine. Thank you so much. I appreciate it.
[AGENT][POSITIVE] You're welcome. Thanks for calling API. I hope you have a great week.
[CUSTOMER][NEUTRAL] OK, have a.
[CUSTOMER][POSITIVE] Thanks, hon. Thank you. You too. OK, bye.
[AGENT][NEUTRAL] Bye bye.