AccountId: 011433970860
ContactId: c106a8b9-b6a9-4bf2-a32a-1ff9da4425b6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 584400 ms
Total Talk Time (AGENT): 241315 ms
Total Talk Time (CUSTOMER): 169529 ms
Interruptions: 5
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/c106a8b9-b6a9-4bf2-a32a-1ff9da4425b6_20250415T15:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling on claim number 35.
[CUSTOMER][NEUTRAL] 73829
[AGENT][POSITIVE] OK, I can help you with your claim. Can I please get your name and your callback number just in case the calls dropped I'll be able to call you right back.
[CUSTOMER][NEUTRAL] My name is [PII] at [PII].
[AGENT][NEUTRAL] OK, thank you, Ms. [PII]. And then what is your um policy number?
[CUSTOMER][NEUTRAL] Oh, we have that again. Hold on one second. Oh yeah, you.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Now if you would like, you can give me your social.
[CUSTOMER][NEUTRAL] Uh, can I give you?
[CUSTOMER][NEUTRAL] OK, I'll give, I'll give the social, one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Ta ta.
[CUSTOMER][NEUTRAL] This is regarding a claim.
[CUSTOMER][NEUTRAL] That my boss put in for his daughter, and you keep calling.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's the claim is still open, so I wanted to give you um
[CUSTOMER][NEUTRAL] An update
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So let me give you the invoice number. Hold on please.
[AGENT][NEUTRAL] OK, so are you calling from the group?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what is the group number?
[CUSTOMER][POSITIVE] Yes, ma'am. OK. Here we go. I gotta get that.
[CUSTOMER][NEGATIVE] OK. Did I already give you the claim number because I'm gonna lose this window here.
[AGENT][POSITIVE] Yes ma'am, you did.
[CUSTOMER][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] My employees, where's that report here we go.
[CUSTOMER][NEUTRAL] Let's say.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you, um,
[CUSTOMER][NEUTRAL] All the information is downloading. Hold on please.
[AGENT][POSITIVE] Yes, ma'am. I think I have it pulled up for you. Can you just give me the name of the group?
[CUSTOMER][NEUTRAL] Total orthopedic care. It's group 17816.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, thank you, Ms. [PII]. And then what is your last name?
[CUSTOMER][NEUTRAL] [PII], [PII]
[AGENT][NEUTRAL] OK, and your email address, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] At
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and then one last verification for the group, can you please give me the physical address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. I appreciate you verifying that information. Is your um boss there where I can um get the verbal consent to discuss the policy?
[CUSTOMER][POSITIVE] Um, hopefully I can get him on the phone.
[AGENT][POSITIVE] Yes, that would be awesome. Thank you.
[CUSTOMER][NEUTRAL] Do you mind holding?
[AGENT][NEUTRAL] I do not mind at all.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Now what's his phone number?
[CUSTOMER][NEUTRAL] Hello, [PII]. Doctor [PII] is on the line.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hi, Doctor [PII]. This is [PII] APL.
[CUSTOMER][NEUTRAL] Sorry, insurance companies never. Hi, how are you? Good. Yes.
[AGENT][NEUTRAL] Yes, sir. I'm doing good. I just need your verbal consent to be able to discuss um your claims with Ms. [PII] and also just to verify your date of birth for me.
[CUSTOMER][POSITIVE] Yes, please do, yeah.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] Thank you. I appreciate you taking your time out to give um clarification and consent. You're welcome, sir.
[CUSTOMER][NEUTRAL] No problem. Thank you. Yeah, just one thing while you talk to her. My daughter had a, a major accident. She was in the ICU for 4 days. So it wasn't an outpatient thing. You guys keep writing down outpatient. Um, so, uh, she was hospitalized and had procedures and surgery, so it was not an outpatient event. OK?
[AGENT][NEUTRAL] OK. All right. I will make a note of that, um, sir.
[CUSTOMER][POSITIVE] Thank you. [PII] will talk to you. I appreciate it.
[AGENT][POSITIVE] Thank you. You have a wonderful day. Thank you, sir.
[CUSTOMER][POSITIVE] Thank you bye bye.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Ms. [PII]?
[CUSTOMER][NEUTRAL] Co.
[AGENT][NEUTRAL] Hi, OK. So, um, the remark that I'm getting on this claim states that, um,
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There's more information needed. Uh, in order to complete the processing of this date of service, please submit a fully itemized bill with diagnosis codes and procedure codes. That's what is needed. Also,
[CUSTOMER][NEUTRAL] Yes, I sent that. I sent that.
[AGENT][NEUTRAL] And also they're needing the explanation of benefits from the major medical insurance.
[CUSTOMER][NEUTRAL] OK. So you don't have that in your file because I did send that.
[AGENT][NEUTRAL] OK, do you know when you sent that in?
[CUSTOMER][NEUTRAL] Around the [PII].
[AGENT][NEUTRAL] OK, let me look and see.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, so what I'm going to do is I'm gonna go ahead and transfer you on over to the claims department so you can speak to a claims specialist they can actually see the paperwork sent in where I can't and I wanna make you uh get good help with this claim because I know you've been working with it for a while so it's gonna be a brief hold while I transfer you on over um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Is there anything else, Ms. [PII], I can help you with before I transfer you to a claim specialist?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][POSITIVE] OK, well, you have a, yes, thank you, and you have a wonderful day and thank you for calling APL. It's gonna be a quick hold.
[CUSTOMER][POSITIVE] Otherwise, we're good.
[CUSTOMER][NEUTRAL] Is she gonna need the
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Good morning. Thanks for calling APO. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, good morning, Ms. [PII]. This is [PII], um, in the care team. I have um Ms. [PII] on the phone. She is the contact for the group, 17816.
[CUSTOMER][NEUTRAL] Can I, OK, what number.
[AGENT][NEUTRAL] Uh, she is
[AGENT][NEUTRAL] She is calling on policy number 2,138,760.
[AGENT][NEUTRAL] I have already uh got the member to verify that it is OK for us to speak to Ms. [PII] about a claim. The claim number is 3573829.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, he is also the owner of the group, um, for.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This is his daughter's claim?
[AGENT][NEUTRAL] He did mention that his daughter was involved in an accident and was hospitalized and it's not outpatient, but I did read the remarks to Ms. [PII] about needing the itemized statement and the EOB.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] When I looked to see the date that she sent it in.
[AGENT][NEUTRAL] It just said it was a duplicate claim, so she's needing more information on this claim um to help get it processed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You can send her over.
[AGENT][POSITIVE] OK, thank you. Bye-bye, Ms. [PII].
[CUSTOMER][NEUTRAL] Mhm.