AccountId: 011433970860
ContactId: ba27b573-8179-4379-abbf-7fbcbbe6b21c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 713679 ms
Total Talk Time (AGENT): 192461 ms
Total Talk Time (CUSTOMER): 403584 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/ba27b573-8179-4379-abbf-7fbcbbe6b21c_20250117T16:42_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], um, my name is [PII], and I received a statement from APL on an explanation of benefits. I need to check on the data service and the provider of this claim that was paid by you guys.
[AGENT][POSITIVE] It would be my pleasure to assist you, Mr. [PII]. Do you have that claim number or policy number?
[CUSTOMER][NEUTRAL] Yeah, policy number is 02230090 and it says the insured and claimant was [PII], my wife.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] Do you mind verifying your date of birth, please, sir?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] And your current mailing address?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] All right. Thank you, Mr. [PII]. And what is your callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] All right. Thank you, sir.
[AGENT][NEUTRAL] And was this for?
[AGENT][NEUTRAL] Um, data service [PII] for an emergency room visit.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, the provider of service it says Nick Claw Children's Hospital. I don't know what that is.
[AGENT][NEUTRAL] OK, let me get that pulled up real quick, bear with me just one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I'm just getting that pulled up. It just takes me a minute and I can give you more specific information.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I apologize. It's taking me just a minute.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Do you mind holding while I transfer you to our claims department one moment thank you.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Yeah, thank you.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] This is [PII]. How may I help you?
[AGENT][POSITIVE] Hi, [PII]. Happy Friday. Happy 3 day weekend, woo hoo.
[CUSTOMER][POSITIVE] Oh yeah, I know, finally, yeah, nice.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I've got an, uh, well, it's a dependent on the line, but he's calling about his wife's claim, um, policy number 223.
[AGENT][NEUTRAL] 0090.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, Mr. [PII] is checking, they've received the EOB for claim number 354.
[AGENT][NEUTRAL] 8152.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And he's calling to see what.
[AGENT][NEUTRAL] This is for for a Nicholas Children's Hospital for his wife.
[CUSTOMER][NEUTRAL] Oh, yes, of course. Um, yeah, I'm sorry, I'm just waiting for it to come out my uh.
[AGENT][NEGATIVE] I know it's going so slow.
[CUSTOMER][NEGATIVE] I know it is. It's really a pain. OK, so this is just sent.
[CUSTOMER][NEUTRAL] OK, and he wants to know because it says Children's Hospital, he's wondering what the heck, right?
[CUSTOMER][NEUTRAL] OK, yeah, no, I get it, I get it, yeah, that's, uh, so yeah, I'm just pulling it up here.
[AGENT][POSITIVE] Yep, yep, yep, yep. Yeah, I would too.
[CUSTOMER][NEUTRAL] No, I completely understand.
[AGENT][NEGATIVE] I finally got it to come up and it looks like it's the wrong provider and I don't even understand the benefit amount.
[CUSTOMER][NEUTRAL] $100 OK.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] How do we pay $600? Oh, gosh.
[CUSTOMER][NEUTRAL] It's a good question. Um, let's see.
[AGENT][NEGATIVE] I think this is all totally wrong.
[CUSTOMER][POSITIVE] OK, so we got the person, right? That's always good.
[CUSTOMER][NEUTRAL] Whoa.
[CUSTOMER][NEUTRAL] Oh Lord love a duck. OK, so yeah, it is, it's way off. It's, uh, OK, all right, yeah, OK, so let's see, so that's all, that's her. This is this, this is that, so this is all office. Now I'm thinking she doesn't, this, these don't have office. Well, I'll just check. I, I'm pretty certain that this, this wouldn't, none of this would be covered but 230,090.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] All right, so we know about that. OK, so what, um, um, so what I can do is I can explain to them that uh this is um none of this is covered because they don't have the office visit for one thing and the rest of the stuff isn't, you know, there's no charge. And so what I can tell them is that um this is uh the wrong provider was placed on this and what probably ended up happening is that you can open up more than one.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, screen at the same time and I think they probably just pulled the wrong mail number, but that's OK. I'm not gonna tell them that. Uh, I can just tell them that, uh, that, um, this was supposed to be an office visit and sent to the wrong provider, uh, that somehow this got crossed in the mail and, and then we will, we will get it fixed and we will um send it back to, uh, let me see if I can find the doctor's office here.
[CUSTOMER][NEGATIVE] Oh, the thing is annoying.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Then we will we can contact the uh memorial uh internal medicine, um, MH internal medicine doctor um [PII].
[CUSTOMER][POSITIVE] That [PII] and let them know that this is, you know, we can get this fixed so this can be, it's fixable. I don't know what the what the ER thing is, uh, whoever this is, I'll have to figure that one out, but this one I can, uh, I can send it back to the to the uh examiner, but I'll be glad to let them know, um.
[CUSTOMER][NEUTRAL] What is, uh, what's going on with this and uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, so if you just wanna send it, am I talking to [PII]? It's [PII] that I'm talking to, OK.
[AGENT][POSITIVE] It is, it is, and I verified all their information and, and then they'll also get that $600 credited back to his, their policy, right?
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] That's what, yes, that's the first thing that's going to happen is that um when I send this back to [PII], I'm gonna ask that the $600 be credited back to their um uh to their benefits so that, that won't be a problem at all. Um, the, yeah and I'll go ahead and let them know that and, and that will happen today. I'll, I'll have every I can um send all this back and I can.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] Is it
[AGENT][NEUTRAL] Is it [PII] or [PII]?
[CUSTOMER][NEUTRAL] Well, uh, um, on the history thing it says.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Looks like the examiner may be [PII].
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] Well, uh
[CUSTOMER][NEUTRAL] Really, because, well, hang on a second because, here, let me, let me go to history.
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] C X A.
[CUSTOMER][NEUTRAL] Well, but it's, it's OK, so I'm seeing today, I'm seeing you.
[AGENT][NEUTRAL] Aw.
[CUSTOMER][NEUTRAL] We, we, we were
[AGENT][NEUTRAL] That's gonna be the examiner, the username.
[CUSTOMER][NEUTRAL] But it says [PII]. It's.
[AGENT][NEUTRAL] That's weird. But you see on the EOBI it says.
[CUSTOMER][NEUTRAL] I'm looking at the right one, right?
[AGENT][NEUTRAL] He should choose C Z K X A 8 D W.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Hang on just a second, let's see.
[CUSTOMER][NEUTRAL] OK, let me, let me get this.
[CUSTOMER][NEUTRAL] Other thing.
[CUSTOMER][NEGATIVE] Oh, come on, come on.
[CUSTOMER][NEUTRAL] Where are you seeing that?
[AGENT][NEUTRAL] And EOBI under the user code.
[CUSTOMER][NEUTRAL] Oh, yes, I'm sorry. Um, OK, then, well, I don't know what, what it is because, OK, so when I'm, I'm, I pulled up the actual thing. Let me try. OK, let me, hold on a second. I'm gonna try it again. Hang on just a second.
[CUSTOMER][NEUTRAL] OK, so the rolling sequence number.
[CUSTOMER][NEUTRAL] Is 10,625,350. Does that sound right?
[AGENT][NEUTRAL] I don't even, yeah, but I don't even see [PII] in the, in the history.
[CUSTOMER][NEUTRAL] Neither do I, so I don't know, uh.
[AGENT][NEUTRAL] That's weird.
[CUSTOMER][NEUTRAL] OK, so I pulled it back up. I'm going to history and it's, I'm still showing uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Well then, what's uh
[CUSTOMER][NEUTRAL] I'll ask [PII] about this, um.
[AGENT][NEUTRAL] Because it looks like [PII] is the one that processed it.
[AGENT][NEUTRAL] That's weird.
[CUSTOMER][NEUTRAL] [PII], is that?
[AGENT][NEUTRAL] Yeah, yeah. I put in the the ZKXA8DW and it pulls up [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. What did you put that into? What is the, the system that cause I, I've been so long.
[AGENT][NEUTRAL] In Teams if you go up to the search bar and put the user code, you'll get the name of the person.
[CUSTOMER][NEUTRAL] Oh, it seems
[CUSTOMER][NEGATIVE] OK, there was, there used to be a system that we could do that. There was a thing and I never do, I never, I never ever bothered to do that anymore, um.
[CUSTOMER][NEUTRAL] No, yeah, I see where it goes. OK.
[CUSTOMER][NEUTRAL] Well, uh, I wonder if I shouldn't just send it back to both of them.
[CUSTOMER][NEUTRAL] You know, it's, well, I'll send it back to [PII]. It's fine. I'll send it back to [PII]. That's who it goes to. OK, so, OK, so we're good on that. So I'm sending it back to [PII]. And so, um, so what I'm gonna do is I'm gonna send it back to [PII]. I'm gonna ask for this to be, um, reprocessed, OK? And then, uh, what, um, will happen is is that uh that $600 will be uh refunded back to their account. But if you'll let me talk to [PII] then what I will do, uh, [PII] is I, I will just uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] I'll let them know what the problem is without, you know, it's making it sound too awful and uh.
[AGENT][NEUTRAL] Got you
[CUSTOMER][POSITIVE] I'm trying to think of something to say here I'm sorry.
[AGENT][NEUTRAL] Right, I know.
[AGENT][POSITIVE] Oh, well, I appreciate your help. It has been. We get a three-day week in [PII].
[CUSTOMER][NEUTRAL] It's been a long week.
[CUSTOMER][POSITIVE] Well, have a good time doing that. It's nice, isn't it?
[AGENT][POSITIVE] Yes, you have a wonderful day. One moment. Let me get Mr. [PII] on the line.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Mr. [PII], thank you for your patience. I do have [PII] on the line. She has been reviewing that claim information for you and we'll assist you further. You have a wonderful day.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Yes, hi, my name is [PII]. I'm in the claims department. I went ahead and pulled up the, the record and, uh, what, um, what this was is that it was sent to the wrong provider. Uh, it's, uh, they have a, um, they have a provider, uh, federal ID number, and it was, it was like two digits off and that sent it to, uh, Nicholas Children's Hospital rather than, I think his name is, uh, [PII], the doctor at a memorial.
[CUSTOMER][NEUTRAL] So what we're going to do now is um we're going to go ahead and and um send we're we're having the claim reprocessed the uh money that was applied to the um to the ER visit which is not your your wife's is going back into her um her balance.
[AGENT][NEUTRAL] OK