AccountId: 011433970860
ContactId: b570660e-7529-4f54-8d96-c6b477322d1f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 556500 ms
Total Talk Time (AGENT): 263108 ms
Total Talk Time (CUSTOMER): 175122 ms
Interruptions: 8
Overall Sentiment: AGENT=-0.8, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/b570660e-7529-4f54-8d96-c6b477322d1f_20250117T13:26_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] from Language Link how are you doing?
[AGENT][NEUTRAL] I'm fine, [PII]. How are you today?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Good, I am trying to figure out what's going on with some denied claims.
[AGENT][NEUTRAL] Well, how can I
[AGENT][NEUTRAL] OK, and these claims are for yourself, [PII] that you're wanting to check status on?
[CUSTOMER][NEUTRAL] No, they're not. They're for a patient.
[AGENT][NEUTRAL] OK, so you're with the provider's office, is that correct? Yes, sir, I can, OK, I can help you with that. So you have multiple claims for one patient that you're needing information on?
[CUSTOMER][POSITIVE] Correct, that is correct.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK, [PII]. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] Uh, policy number is 02455568.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 002455568, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] One moment please.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] And first name again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and what is the first date of service and total bill amount for him please?
[CUSTOMER][NEUTRAL] You want a claim number would that be easier?
[AGENT][NEUTRAL] If you already have the claim number, sure.
[CUSTOMER][NEUTRAL] I do, it's 354-2384. Let's start with that one.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] So this one goes from yep 11:19 to 11:27 24.
[AGENT][NEUTRAL] OK, so I do show that on this policy, I mean on this claim rather, there was a benefit paid in the amount of $14.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] That's nice. Can you please tell me why you denied the rest of them?
[AGENT][NEUTRAL] Sure. And also, have you all received your explanation of benefits, [PII]?
[CUSTOMER][NEUTRAL] Have it in my hand.
[AGENT][NEGATIVE] Hey, there should have been 2 pages.
[AGENT][NEUTRAL] Our front and back of the one document.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] There's nothing on the back.
[AGENT][NEUTRAL] Huh, and there's only one page, is that correct?
[CUSTOMER][NEGATIVE] What's technically 2 pages, double-sided.
[CUSTOMER][NEUTRAL] But there's nothing under the remarks.
[AGENT][NEUTRAL] Give me just one moment.
[AGENT][NEUTRAL] OK, so for the 1126, 27, 21, and 20 on this claim, it states that patients, uh, excuse me, insured's major medical coverage provided full benefits. There are no benefits payable for this procedure.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then for a
[CUSTOMER][NEUTRAL] Can you explain that to me?
[CUSTOMER][NEUTRAL] I, I, I again, I've been doing this for 15 years and I make a load of money. I'm, I'm surprised, so please explain to me, so the insurance paid 0.
[AGENT][NEUTRAL] This policy is a supplemental policy that helps with co-pays.
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] I'm, I'm aware of how it works both legally and fundamentally, so my question again is.
[AGENT][NEUTRAL] Well, yes.
[AGENT][POSITIVE] OK, [PII], I'm trying to help you, yes, and I'm trying to read you the remo.
[CUSTOMER][NEGATIVE] I know that, but I'm so sick of insurance companies. So again, primary insurance, that's nice. Primary insurance denied it, right? They said benefits were exhausted. So how are you telling me the primary, you do see it cause I sent you guys the primary, so that's impossible.
[AGENT][NEUTRAL] I'm very sorry, but.
[AGENT][NEUTRAL] I don't see that.
[CUSTOMER][NEUTRAL] The same way that you paid the $14 right? You saw that it was paid at $0. So that is not the case.
[CUSTOMER][NEUTRAL] All up, please.
[AGENT][NEUTRAL] [PII], I am looking at the remarks on this claim and I'm only able to see and read to you what I can see.
[CUSTOMER][NEGATIVE] OK, so what kind of waste of time strategy shall I take to get you guys what you need? I know it's frustrating for you, but believe me, I have hundreds of these. This is way more frustrating for me. So can you please tell me?
[AGENT][NEUTRAL] Let me look at specifics.
[AGENT][NEUTRAL] Uh
[AGENT][POSITIVE] Yes, one, but I can't, I can, I'm trying to help you.
[CUSTOMER][NEUTRAL] What would you like me to do so I can, I understand, but I'm not calling to waste time so tell me exactly how I can send you guys.
[AGENT][NEUTRAL] OK, you can the right to file an appeal within 180 days from the date of the decision if you disagree with that. Mhm, and that is the next.
[CUSTOMER][NEUTRAL] I, I hear you and I, yeah, yeah, yeah, yeah, yeah. Anyway.
[CUSTOMER][NEGATIVE] How do I get you guys personally a copy of the explanation of benefits so you could physically look at it and say, yes, we made a mistake, so I can move on with my day. I don't want to go back and forth and appeal and wait 60 days and 90 days and wait for someone not to do something. I just want it done.
[AGENT][NEUTRAL] [PII], I'm sorry, but.
[AGENT][NEUTRAL] [PII] is the claims fax number. That's the claims fax number that you just asked for.
[CUSTOMER][NEUTRAL] What's that?
[CUSTOMER][NEUTRAL] So you want me to fax it?
[CUSTOMER][NEUTRAL] OK, so 877. What is it?
[AGENT][NEUTRAL] 3659423
[CUSTOMER][NEUTRAL] And you're telling me that based on the information I sent you.
[CUSTOMER][NEUTRAL] Insurance paid in full, primary, is that correct?
[AGENT][NEUTRAL] That is what I see according to the remarks on this explanation to be.
[CUSTOMER][NEUTRAL] Can you pull up the image of what you received, please?
[AGENT][POSITIVE] Actually, I'm not able to, [PII], but I'll be happy to connect you to someone who can possibly pull this up for you.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Is there anything else I can help you with today first?
[CUSTOMER][NEUTRAL] Nope.
[AGENT][POSITIVE] Thank you for calling APL. I hope you have a very nice weekend.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] This is [PII].
[AGENT][NEUTRAL] [PII], this is [PII]. How are you today?
[CUSTOMER][POSITIVE] I'm good how are you?
[AGENT][NEGATIVE] I am terrible. I have the rudest caller on my front line. I cannot pull up the information and on base for whatever reason. He is extremely rude. He is with the provider's office and I am done with him talking to me like a dog without ending the call.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The policy number is 02455568.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and the only claim number he would give me to this point because he won't.
[AGENT][NEUTRAL] 354.
[AGENT][NEUTRAL] 2384. I don't wanna say anything inappropriate on this recorded line.
[CUSTOMER][NEUTRAL] And what's his name?
[AGENT][NEUTRAL] His name is [PII].
[CUSTOMER][NEUTRAL] And which part is he looking for?
[AGENT][NEGATIVE] 3. He is sick of insurance companies. He, I, I told him about the appeal. He don't wanna hear none of that. I told him about um.
[AGENT][NEGATIVE] The states the primary insurance company paid in full. He don't want to hear any of that. He was just demanding.
[AGENT][NEGATIVE] That, you know, so anyway, he wanted, how to, how to send this to me to prove that they paid and we made a mistake and on and on and on. I just threw out the fax number and that's it.
[AGENT][NEGATIVE] I mean, I'm, I almost hung up on him. I have almost disconnected the call because of how he's talking to me.
[CUSTOMER][POSITIVE] OK. I do apologize for him. I'm sorry.
[AGENT][NEGATIVE] I'm very, and I am sorry, [PII]. Well, I'm sorry that you're gonna have to deal with him as well, but, um, uh, um, it's, yeah, he's extremely rude.
[CUSTOMER][NEUTRAL] OK, I got them.
[AGENT][NEGATIVE] And he's gonna have to have, there's more than one claim, but we couldn't even get through this one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm sorry, will you please let me know how this call turns out?
[CUSTOMER][POSITIVE] Yes, ma'am. Will do.
[AGENT][POSITIVE] You're the best. Thank you, [PII].
[CUSTOMER][POSITIVE] You're welcome. Have a great day.
[AGENT][POSITIVE] And again, I hope you do too. OK, bye-bye.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.