AccountId: 011433970860
ContactId: b1732e1d-1ecb-4a3d-8e6b-85569fd1047e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 497329 ms
Total Talk Time (AGENT): 219476 ms
Total Talk Time (CUSTOMER): 258289 ms
Interruptions: 9
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/b1732e1d-1ecb-4a3d-8e6b-85569fd1047e_20250109T21:54_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hi there [PII], it's [PII] at Bear's Furniture Company. I'm having a problem with a claim from one of my employees. I just need you to look it up for me, please. Our group number is 18691.
[AGENT][NEUTRAL] OK, so, so you have a question regarding a specific claim for a member?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I can help you as much as I can. Um, what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII] I'm sorry [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. So give me, uh, what is the member's policy number?
[CUSTOMER][POSITIVE] I have everything right here.
[CUSTOMER][NEUTRAL] T.
[CUSTOMER][NEUTRAL] 1840968
[CUSTOMER][NEUTRAL] No, I'm sorry, jeez, it's [PII]. I'm exhausted. 184-0962.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Oh no.
[AGENT][NEUTRAL] OK, thank you. One moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so, so I will need to verify several things with you first for security and also any information that I can provide today will be a verification of benefits and not a guarantee of payment. So first, if you'll please verify your email address.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The letter [PII] and then another [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] [PII] and that's the letter [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. And the primary phone number for the group is we show, well, we show it as the same as the one that you gave me, OK?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] And what is the member's name and date of birth?
[CUSTOMER][NEUTRAL] Last name is [PII], first name [PII] Her date of birth is [PII], and I do have a claim number when you're ready.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so now,
[AGENT][NEUTRAL] Is Miss [PII] there with you?
[CUSTOMER][NEGATIVE] No, no, I filed the claim on her behalf. This is my 4th phone call trying to find out when she's going to get paid. She had 5 days in the hospital in November. I filed the claim. It was denied because they didn't have the.
[CUSTOMER][NEUTRAL] Diagnostic code and then they said oh we see it the member put the diagnosis on her claim form so it will go through.
[CUSTOMER][NEUTRAL] I called back a second time.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] When she didn't get a check yet and they said it was denied.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I said, well, I know it was denied, but when I spoke to you a week ago, you told me it would go through because she put the diagnosis on her claim form as high blood pressure. Oh, no problem, we will reprocess it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So that was 3 calls today she called me and she got a denial letter in the mail so I don't know if that was denial #1 or denial #2.
[AGENT][NEUTRAL] OK, so I will.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so, so we need to just check on this claim that you had submitted. What is the data service that it was submitted for, so.
[AGENT][NEUTRAL] Or do you have other uh-huh.
[CUSTOMER][NEUTRAL] The dates of er yeah I have everything here because I filed the claim for her. The dates of service were [PII].
[AGENT][POSITIVE] Yeah, you can give me a call.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sorry, one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I know my system is.
[AGENT][POSITIVE] Oh goodness. OK.
[AGENT][NEUTRAL] Bear with me just a moment.
[CUSTOMER][POSITIVE] Absolutely.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I can see.
[AGENT][NEUTRAL] That they're OK, let me just double check. OK, so we did receive that initial claim which was reviewed under the 354 which I know you can see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 5855. That is the one that was denied.
[AGENT][NEUTRAL] Then
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was processed again on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's under the claim number 354-69998.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there has been a benefit issued to the member?
[CUSTOMER][POSITIVE] Yay!
[AGENT][NEUTRAL] Yes, ma'am. And it was, um, issued on a single check. It's a paper check.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Uh-huh, but it did get reprocessed. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, do you have the date of that, uh, processing just so I could let her know.
[AGENT][NEUTRAL] Mhm. this was processed on, I believe it was, let me get back to the screen, [PII].
[AGENT][NEUTRAL] So, that would have, I have to look at the calendar. I was doing pretty good with my days and now we're a little too long on Friday. OK, so the check, yes, ma'am. So the check wouldn't have gone out until at least the [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, that, yeah, that was actually that was Friday. OK, so that was Friday, that was Friday.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] So she's just not had time to receive it yet. But, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, so when she got the letter of denial that must have been for the first time it got denied, right?
[AGENT][NEUTRAL] Probably, she would have, yeah, you would let me um let me look and see if there was.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Because that claim, the denial was processed on [PII], so that would make sense that she, because the, you know, with the holiday, we were out, you know, on the [PII], obviously, so that would have probably been mailed to her on the [PII]. We got that in, so yeah, so that's what happened. She received that.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh OK OK got it that makes sense.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Right, right, right, yeah, I got it.
[CUSTOMER][NEUTRAL] That makes sense.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just overlapping of the way things are submitted and processed.
[CUSTOMER][NEUTRAL] OK, yeah, that's what I figured happened so is the amount of the check 2500 or 2400?
[AGENT][NEUTRAL] 28.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] 2800?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh cool, because they go from day one.
[AGENT][NEUTRAL] Mhm, so she thought.
[CUSTOMER][NEUTRAL] OK, $2000 2000 dollars plus.
[AGENT][NEUTRAL] And then the 400 and 400.
[CUSTOMER][POSITIVE] OK, 400 and 400 awesome thank you so much. You are gonna make her very happy, always a pleasure, always a pleasure doing business with you. Thank you so much bye bye.
[AGENT][POSITIVE] You are very.
[AGENT][NEUTRAL] Yes, sir. I'm sure.
[AGENT][POSITIVE] Wow.
[AGENT][POSITIVE] Well, we appreciate your business as well and thank you again, [PII]. I mean, [PII], I'm calling you the wrong name now, [PII], [PII], I hope you have a nice evening.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's OK. No problem. You too, dear. Take care. Bye-bye.
[AGENT][NEUTRAL] And, yes, ma'am. You have, bye-bye.