AccountId: 011433970860
ContactId: ba6b5b12-04a3-4235-8295-3599f1b1662b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 579890 ms
Total Talk Time (AGENT): 257505 ms
Total Talk Time (CUSTOMER): 350941 ms
Interruptions: 9
Overall Sentiment: AGENT=0.6, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/ba6b5b12-04a3-4235-8295-3599f1b1662b_20250407T21:21_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], it's [PII] in group billing. I've got a um um an insured and an agent on the phone needing help with some claims. Um, the policy is lapsed in our system, um, but the, the claims were from back when it was still active and apparently.
[AGENT][NEUTRAL] Hey.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, some claims or some bills from provider has gone to collections and uh she wasn't able to get some scans done or something today because she still had too many outstanding things with them, um, so they are needing to get that looked at, um, policy number is 2267917.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And I've got [PII] on the phone, but also I have [PII], the agent.
[CUSTOMER][NEUTRAL] Um, and the callback number is the one that they're calling from is, uh, this callback number is for [PII], but they are both there on the phone.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][POSITIVE] All right, you ready? Here they come. Thanks.
[AGENT][NEUTRAL] Mhm. Bye bye.
[AGENT][NEUTRAL] Hello, [PII] and [PII]?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Hi, my name is [PII]. I'm on the care team and [PII] was telling me that you, uh, we need to go over some claims. Hey.
[CUSTOMER][NEUTRAL] Hey, [PII].
[CUSTOMER][NEUTRAL] Yes, yes, please. Um, I have, I have [PII], the member here with me. I'm from the broker's office and she's, she's, she was explaining to me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And she's been having a lot of issues with um lab uh with claims from Quest Diagnostics. It's a lab facility.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Uh, she went in for some labs today and they basically did not perform any procedure on her. They, as a matter of fact, they told her that she couldn't even, she couldn't be there because she had too many outstanding balances due. That was news to her because she thought the gap was taking care of everything. So I'm just trying to figure out what is going on, either they're not submitting it correctly to APL, if there's missing info, just trying to figure out.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Why, what's going on specific claims here?
[AGENT][NEUTRAL] So the first
[AGENT][NEUTRAL] OK, so the first thing we need to do, um, do you, do you all have the dates of service for those outfits? That would, that's where I would start.
[CUSTOMER][NEUTRAL] Not, not really.
[AGENT][NEUTRAL] So is there a way that we can give them a
[CUSTOMER][NEUTRAL] No, not really. She has, she has a lot.
[AGENT][NEUTRAL] Is there a way that um like do y'all have their number? I can maybe call them on my end to get those dates and then I'll be able to use those dates to see if there's claims here. If there's no claims here, they haven't filed it. If there is a claim here, then I, you know, I can get the decision.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Thing is it's 5:24 here and all these labs are already closed, um.
[AGENT][NEUTRAL] So let's do this.
[CUSTOMER][NEUTRAL] But I was, I was hoping, I don't know if you could do like a search for just Quest diagnostics and see anything prior to October and see what you see cause apparently they haven't, but they haven't gotten any of them. So we just find one and find out why one wasn't um.
[CUSTOMER][NEUTRAL] That, that would probably tell us a lot. Now, she has other claims that she said that has APL has paid perfectly. Like there's no issues. It's just really the, the, the lab itself. I don't know what the heck is going on. And we were on online, on the online portal, but the ELBs are not generating.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, if there's no claim here, there, there won't be an EOB, but the, so I'm trying.
[AGENT][NEUTRAL] So do y'all know like around about time because I will have to go through each claim since [PII] to see which ones are claimed, which ones are requests and which aren't if I have like a date, right? I can like try to query a little bit or because it's it's nowhere I could put like quest diagnostic or, you know what I'm saying like I would have to go through if we have to.
[CUSTOMER][NEUTRAL] Oh, you don't, you don't see it by like the script, right.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] Right, and do a search by name. That's right. OK.
[AGENT][NEUTRAL] Yeah, so do you have like a roundabout time, like I can, hm, you said before [PII]?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, because her her policy terminated in November. Um, is there any way we can see the time frame on when you went to the land?
[AGENT][NEUTRAL] Well, it has been 24.
[AGENT][NEUTRAL] Let me see what these are.
[AGENT][NEUTRAL] I see tons from
[AGENT][NEUTRAL] Because I'm, I'm just going through the ones one by one, but so far I see a ton from Diagnostic of [PII]. I haven't even seen the Quest yet, but I'm still going through each one.
[CUSTOMER][NEUTRAL] Like one day.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Acquire strength.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You have the, the email?
[AGENT][NEUTRAL] OK, here goes one. Hold on.
[CUSTOMER][NEUTRAL] Oh, you found one?
[AGENT][NEUTRAL] I just found one.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um, let me see. This is for [PII] September.
[CUSTOMER][NEUTRAL] Was it in [PII]?
[CUSTOMER][NEUTRAL] Oh wow. [PII]. And was that one paid or not or was it denied?
[AGENT][NEUTRAL] Oh, and you know what else I'm seeing? They, they don't file their claims on time. This has, this was, well, not on time, but I'm saying they filed them late. So [PII], we didn't receive it until [PII], and yes, we paid out on this claim.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, we paid the total bill.
[CUSTOMER][NEUTRAL] You paid it you paid it directly to them.
[AGENT][NEUTRAL] Mhm. $85.41. I can give you the claim number.
[CUSTOMER][NEUTRAL] 85. Can you put 85, write this down $85? And how much, how many cents?
[AGENT][NEUTRAL] 41
[CUSTOMER][NEUTRAL] 41 cents from [PII]. They didn't get that till just a few months ago, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] They just got it in December.
[AGENT][NEUTRAL] Mhm, we received it.
[CUSTOMER][NEUTRAL] And it was paid directly to them.
[AGENT][NEUTRAL] Yeah, it looks like this one might be them too.
[CUSTOMER][NEUTRAL] Was it paid directly to them?
[AGENT][NEUTRAL] Yes, it was paid directly to them, and they received an explanation of benefits with the check. Oh, you know what I can do? Hold on. Let me see if the check's been cashed.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] The lab to request.
[AGENT][POSITIVE] Because then we know they got it for sure.
[AGENT][NEUTRAL] And there's one below it too. I just found 2. Hold on one moment.
[AGENT][NEUTRAL] So the check for the $85.41 we issued it on [PII], and they cashed it on January.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII], the check was mailed dated [PII], and they cashed it.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] On [PII], and they cashed the check in on January what?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then there was one right below it. Hold on one moment, let me go back to that one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then also on the [PII].
[AGENT][NEGATIVE] On [PII], we received another claim.
[AGENT][NEUTRAL] This is for [PII] also, but there are different charges. This one totaled $272.34.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] 272.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $272 and how many cents?
[AGENT][NEUTRAL] 34.
[CUSTOMER][POSITIVE] 34 cents. So there's already been two claims that are that have been submitted super late, but both have been paid. OK, well that, that's, you know, this is a good sign.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let me see if this one cleared.
[AGENT][NEUTRAL] Oh yeah, and that one cleared. um, it was sent the same day, [PII], and it cleared the same day, [PII].
[CUSTOMER][NEUTRAL] 578142.
[CUSTOMER][NEUTRAL] The same day, so it was, it was together with the same check, same payment of 85.
[CUSTOMER][POSITIVE] OK. You know what we're gonna do? We're um I'm gonna get with [PII] and call the facility tomorrow morning and get all the dates of service.
[AGENT][POSITIVE] Wow.
[AGENT][NEUTRAL] Yeah, do that and then give us a call and ask for me and we'll go through each of them. Mhm.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] Yeah, and then we could go one by one.
[CUSTOMER][NEUTRAL] Yeah, because honestly, I, I was kind of hoping, I was kinda hoping you would tell me that, no, they never submitted any claim.
[CUSTOMER][NEUTRAL] Because then we can kind of raise hell over there.
[AGENT][POSITIVE] Oh, that would be easy, right.
[CUSTOMER][NEUTRAL] Yeah, that would be easy, but now that I see, number one, that they're submitting them super late, but for them to kick her out today of the lab is unacceptable, because they've, they've been paid already. Exactly, and they cleared them, and I'm very glad you gave me those dates.
[AGENT][NEUTRAL] And they've received the payment, that is.
[AGENT][POSITIVE] And cleared it, yes.
[CUSTOMER][NEUTRAL] Because yeah we're uh we're gonna, we're gonna call tomorrow when they open and then I am going to call, I'm gonna call you back tomorrow with her.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] With hopefully more dates of service and we can look at all of them.
[AGENT][NEUTRAL] We sure can. With the dates of service, I can just type it in there and everything, everything that's from that date will pop up.
[CUSTOMER][NEUTRAL] And what's your
[CUSTOMER][POSITIVE] Yeah, perfect and what's your name?
[AGENT][NEUTRAL] My name is [PII]. I'm the only [PII] here, um, so anybody will be able to get you to me.
[CUSTOMER][POSITIVE] [PII], you're the only [PII] there. OK, perfect. That'll be easy enough. Thank you so much, [PII]. I appreciate your help today. I'll call you tomorrow morning.
[AGENT][NEUTRAL] Yes,
[AGENT][NEUTRAL] You're very welcome. Alright, well, I'm in the office at, I don't know if you're central or where, where are you located?
[CUSTOMER][POSITIVE] All right have a good one.
[CUSTOMER][NEUTRAL] I'm, I'm Eastern. I'm Eastern, so I'll call you like around [PII] my time, right?
[AGENT][POSITIVE] OK, good. I am too.
[CUSTOMER][NEUTRAL] Oh, you're Eastern too, OK.
[AGENT][NEUTRAL] Mhm. So [PII] is fine.
[CUSTOMER][NEUTRAL] Yeah, I'll try, I'll call you like around [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect thank you.
[AGENT][POSITIVE] You're very welcome. Well, was there anything else I can help you with tonight?
[AGENT][NEUTRAL] Or today?
[CUSTOMER][POSITIVE] No, that is it. No, that's it. Thank you very much.
[AGENT][POSITIVE] Alright, well, thanks for calling APL. You're welcome. Y'all have a good evening. Bye-bye.
[CUSTOMER][NEUTRAL] Alright bye.