AccountId: 011433970860
ContactId: b340e9f8-2e8d-4b84-9051-fa66a171e00c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 378779 ms
Total Talk Time (AGENT): 168697 ms
Total Talk Time (CUSTOMER): 165987 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/b340e9f8-2e8d-4b84-9051-fa66a171e00c_20250513T17:27_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling on behalf of one of my employees that we filed a claim for, uh, group number 25054. Um, are you gonna be able to help me look into that?
[AGENT][NEUTRAL] Uh, I should be able to let's, um, verify your group real quick, um, [PII], and may I get your callback number, sir, just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes ma'am, you may. It's [PII].
[AGENT][POSITIVE] Thank you, sir. And then
[AGENT][NEUTRAL] Let me look on your group real quick.
[AGENT][NEUTRAL] It could be just a moment.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And it's 25054, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, all right, thank you very much and can you please verify your group address for me, [PII]?
[CUSTOMER][NEUTRAL] Yes, ma'am. It's [PII], um, and it should be uh [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the um member's name and date of birth and policy number?
[CUSTOMER][POSITIVE] Yes ma'am, it's [PII]. I'm gonna get her date of birth for you real quick.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] [PII]'s date of birth is [PII] and the policy number is 2605742.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK and then um do you know when you sent to end the claim, sir? Oh, she only has one so let me look at it.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][POSITIVE] Thank you
[AGENT][NEUTRAL] OK, let me see what there's any information.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] OK, so looking at the claim um under this patient's policy under this member's policy outpatients are, are noncovered and so the claim was denied because outpatient is not covered under the patient's plan.
[CUSTOMER][NEUTRAL] I figured
[CUSTOMER][NEUTRAL] Did she get did she get um notified of that or did they reach out to her to let her know?
[AGENT][NEUTRAL] Yes, they send letters.
[CUSTOMER][NEUTRAL] Do you know if
[CUSTOMER][NEUTRAL] OK, so that's through the mail basically so she, so um it wouldn't have been like some type of electronic email or anything like that?
[AGENT][NEUTRAL] Well, looking at it, it was uh filed through the online service center, so then the confirmation and the information would have come through the online service center.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, well, oh, OK, so I mean let me just see because I see on my end it says status and it says processed um because I was the one who filed it through our portal.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] But um,
[CUSTOMER][NEUTRAL] I figured that they either like reach out to her directly to let her know so did they send that uh uh hard copy to her address on file?
[AGENT][NEUTRAL] Yes, they will send it to our address on file.
[CUSTOMER][NEUTRAL] Do you know if that's if that's been already mailed out or not?
[AGENT][NEUTRAL] No sir, um, I can't, I'm not in the claims department so I can't check to see if they've already mailed that but let me, let me look and see if I can find a copy of it because if I can find a copy then it's been sent so let me look real quick.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] No, that'd be awesome that'd be awesome just because she's inquiring to me and I usually tell them to wait until APL reaches out to let them know or not just so it doesn't come directly from me and then I get all the all the flack from that, you know what I'm saying?
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, I do. I understand.
[CUSTOMER][NEUTRAL] But I kinda, I kinda already let her know that I kinda already let her know that it wasn't looking too good since it was an outpatient because she had originally told me it was a hospital stay, um, and not an outpatient situation so it's kind of her own fault, but at the same time I just want to get something in writing from y'all to let her know.
[AGENT][NEUTRAL] I feel you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] I understand. Let me look and see if there's been anything sent that I can peep into.
[CUSTOMER][POSITIVE] Yes ma'am thank you [PII].
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] I'm not seeing anything as of yet, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I do see the claim information.
[CUSTOMER][NEGATIVE] So maybe I shouldn't even tell her maybe I should just I should just tell her, hey, be looking out in the mail for something from no I'm just kidding. I'll just go ahead and tell her, um, just, just to break the news.
[AGENT][NEUTRAL] Well, um, it
[AGENT][NEUTRAL] Yeah, it was actually uh processed today so she wouldn't have received it yet because it was just processed but I was that's why I was looking to see if the letter the.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Letter was downloaded yet but it'd probably have to process overnight for it to show up.
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] So, so let me ask you this story, could I just give her the APL number and she could call in herself and then inquire about her claim and then y'all would be able to tell her that because if she has any follow up questions or anything like that?
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, yes, and you can let all, all of.
[CUSTOMER][NEUTRAL] OK, so would it be the same number that I just.
[AGENT][NEUTRAL] Yes sir, the same number you called in you can let everybody know if they wanna call and check on their claims even if you have filed them for them, they can do that at any time.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] OK, that is so perfect, [PII], thank you so much for your time and and your great help, ma'am.
[AGENT][POSITIVE] You're very welcome, [PII]. Is that everything I can help you with before we go, sir?
[CUSTOMER][POSITIVE] Yes ma'am, you were excellent [PII] thank you so much and I hope you have a good rest of your week, ma'am.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] You too you have a blessed rest of your week, [PII] and thanks for calling APL sir.
[CUSTOMER][NEUTRAL] Yes ma'am bye.
[AGENT][NEUTRAL] Bye bye.