AccountId: 011433970860
ContactId: b3db5e4d-3ffc-4272-9372-6e06ebe6ce3a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 405820 ms
Total Talk Time (AGENT): 199738 ms
Total Talk Time (CUSTOMER): 136228 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/b3db5e4d-3ffc-4272-9372-6e06ebe6ce3a_20250212T17:19_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] Yes, hi, and, um, I have a question. Um, I, I work with uh Hammon and Associates. I don't know what you need from me, but I wanted to find out the my what you call the human resource lady here at the office. She processed some claims on my behalf, and I just don't, I'm sure I want to know what else am I supposed to do or am I, you know, what happens next or is there anything else I'm supposed to do and I go because I was in, in the hospital and everything, so.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, I can definitely help you and see um if the claims have been received and if there's an update. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] My name is, first name is [PII] Last name [PII] What else you said you needed? I'm sorry.
[AGENT][NEUTRAL] Oh, it's OK. Um, a good contact number in case we're disconnected and then your policy number.
[CUSTOMER][NEUTRAL] Mm, OK, OK, my mobile [PII] and I don't have the policy on me. I'm, I'm hiding in the conference room at the office. Can, can you take my birthday and social or?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can look it up with your social.
[CUSTOMER][NEUTRAL] OK, my social is [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So I'm just waiting for the policy to come up here. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Here we go.
[AGENT][NEUTRAL] And can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][POSITIVE] [PII]. My mailing address is [PII] and the email I believe you guys have is, is I'm, I'm gonna give you both, so truly blessed [PII] or [PII].
[AGENT][NEUTRAL] This one is your work email.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, and thank you so much for verifying your information. Um, so were these, were they sent in in January or this, this is something recent?
[CUSTOMER][NEUTRAL] I think they were saying in the beginning, the end of December or the beginning of January 1 of them.
[CUSTOMER][NEUTRAL] It was the claims were submitted. I see online that it says process, but I don't know what that means.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so there's 12345 claims that were processed. Um, the first claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Came in.
[AGENT][NEUTRAL] Well, actually, I see some from, so I see some from November to January, [PII] to last month. Is it all of these or?
[CUSTOMER][NEUTRAL] OK, probably, yeah, yeah, every last one of them, yes, it was a bunch of them, I believe, yeah.
[AGENT][NEUTRAL] OK, so 12345 of them were paid out. So you want me to give you like the claim number and what was paid to it or?
[CUSTOMER][NEUTRAL] No, I just wanna know what, what, how did, so you guys pay them directly, right?
[AGENT][NEUTRAL] Right, so for 5 of them, they pay directly to the provider. There are 12345 more that were denied. 1 was denied because office visits are not covered by the policy, um, well, actually 2 were denied for that reason. Let me see what the other ones are. Hold on one second.
[CUSTOMER][NEUTRAL] How does that work? OK.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so the provider, the provider filed some of these two. So these are the two that were filed by the OK, I see. OK, so for the two that were denied, um, that the broker submitted, one was denied.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, OK, so one of them gave the denial that it it wasn't really denied. It was just saying it was paid directly to the provider, so they couldn't pay out on the broker's side and then let me see what this other one is.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the other one is showing that the insurance, um, insurance, primary insurance provided full benefits, so there was nothing for us to pay.
[CUSTOMER][NEUTRAL] OK, OK, alright, so there's nothing, so how is if there's anything that I need to still pay, how would I find that out?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] You mean like after these claims, like the ones that were denied?
[CUSTOMER][NEUTRAL] Like is it some, yeah, I.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Then the, so this goes back to the provider or, well, yeah, it goes back to the provider because the ones for the broker just said it was paid to the provider and the um provider is going to mail you a bill or it depends on what they, what their protocol is. Some of them may write it off, some of them may send you a bill.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you tell me the, the amount for the ones that you see that that was denied? Can you give me the amount the amount?
[AGENT][NEUTRAL] Mhm, let me see.
[AGENT][NEUTRAL] This one, is from [PII].
[AGENT][NEUTRAL] Um, $1,155 is from [PII].
[CUSTOMER][NEUTRAL] Mhm, OK.
[AGENT][NEUTRAL] And.
[AGENT][NEUTRAL] What's the other one, that one was because primary pay.
[AGENT][NEUTRAL] This one was, it was paid to the provider. Hold on one second and then this one is the last one.
[AGENT][NEUTRAL] Um, and then the next one is [PII]. Um, it was $688.
[CUSTOMER][POSITIVE] OK, alrighty.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so that's not too bad. Um, OK, that's what I wanted to know.
[AGENT][NEUTRAL] Alright, Ms. [PII], well, was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, ma'am, that'll be all. Thank you so much.
[AGENT][POSITIVE] You're welcome. Well thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.