AccountId: 011433970860
ContactId: c1369f8f-a4be-4ad2-935b-306abda8deb6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 611359 ms
Total Talk Time (AGENT): 240970 ms
Total Talk Time (CUSTOMER): 184215 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/c1369f8f-a4be-4ad2-935b-306abda8deb6_20250217T14:50_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Good morning. This is [PII]. I'm a broker. I'm just calling to check on the claim from one of our customers.
[AGENT][NEUTRAL] Mhm, sure, I can assist you with claims and may I have a callback number just in case we get disconnected, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am, it's [PII].
[AGENT][NEUTRAL] OK. Thank you. Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yes, policy number is 227-0249.
[AGENT][NEUTRAL] OK. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] It, it, um, the owner is [PII] and I believe this claim is actually on his daughter [PII], and she is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I have the date of service if you have it? Yes, fine.
[CUSTOMER][POSITIVE] Sorry about that.
[CUSTOMER][NEUTRAL] Yes, I I believe it's got a sick household [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Let me just a minute.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right, OK, um, let me have just one more detail from you to verify you. May I have your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Alright, I did find the claim. Uh, it looks like we already processed and sent the payment. Um, it was processed on let's see, um, the [PII].
[AGENT][NEUTRAL] And we send a payment amount of 5150 to the member.
[CUSTOMER][NEUTRAL] OK, and um, can you tell me the breakdown? I'm pretty sure I know what it is. Is it the 200 ER 300 X-ray, and is it $50 for the laceration?
[AGENT][POSITIVE] Correct, yes, you got it all right, yes.
[CUSTOMER][POSITIVE] I figured I had a I had these plans memorized so I had a good idea. OK, that, that'll work. I appreciate your time. Um, there was one more question I had if you don't mind.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Yeah yeah.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah. Mhm. Sure, go ahead.
[CUSTOMER][NEUTRAL] Let's, OK, let's see here.
[CUSTOMER][NEUTRAL] Trying to pull it up real quick here.
[CUSTOMER][NEUTRAL] OK, can I give you one more policy number?
[AGENT][NEUTRAL] Sure, go ahead.
[CUSTOMER][NEUTRAL] OK, policy number is.
[CUSTOMER][NEUTRAL] Alright, the system decided was gonna think right there, uh, OK.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Policy number is 2271246.
[AGENT][NEUTRAL] OK, what's the name and date of birth?
[CUSTOMER][NEUTRAL] Uh, it's, well, the, um, it's [PII], but her husband is [PII].
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] His date of birth should be uh [PII].
[AGENT][POSITIVE] Perfect. OK, and what's the date of service on this one?
[CUSTOMER][NEGATIVE] Um, I think it's multiple dates of service. I think it's a, it, it's a recurrence of cancer.
[AGENT][NEUTRAL] OK. All right, let's see.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so I see a lot of um.
[AGENT][NEUTRAL] Claimed now, um, the most recent one that it was sent on [PII] is in line to be processed. It has not been processed yet and it looks like it's the information that we were asking for.
[AGENT][NEUTRAL] So this one is not finalized yet. It looks like, um, again the last information we received was [PII] and it's in line to be processed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right, um.
[CUSTOMER][POSITIVE] I apologize to do this to you. I have one more person that just came to me, um, can we jump to one more profile?
[AGENT][NEUTRAL] Uh yeah, give me just a second, let me go ahead and finalize the note on one of these.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Let's see one moment. No, it's fine.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] It doesn't stop. The phone just rings nonstop here.
[AGENT][NEUTRAL] It's fine.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, go ahead with the next one.
[CUSTOMER][NEUTRAL] OK, last one is [PII], um, policy number 247-866-2.
[AGENT][NEUTRAL] OK, and what's his date of birth?
[CUSTOMER][NEUTRAL] And the last, the last three of his claim number is 330.
[CUSTOMER][NEUTRAL] Let me get to the um.
[CUSTOMER][NEUTRAL] Trying to get your date of birth on here [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Um,
[AGENT][NEGATIVE] Looks like this one is denied. Let me check and see what.
[AGENT][NEUTRAL] I'm still waiting on the EOP to pull up.
[CUSTOMER][NEUTRAL] And I see something else that was they had sent in something on [PII] as well.
[CUSTOMER][NEUTRAL] Um, I don't know if it's connected to that claim.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] I can check on that.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Be sure.
[CUSTOMER][NEUTRAL] I got it. Yeah. 000, look at that screen, uh, yep.
[CUSTOMER][NEUTRAL] Working from home, look what he did, look.
[CUSTOMER][POSITIVE] Working from home, my son just cleared my screen uh.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] Uh oh.
[CUSTOMER][NEGATIVE] we have a sick family today, so, uh.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm, OK.
[CUSTOMER][POSITIVE] It's just I was laughing.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Cause I work from home today and he, he came and just cleared my whole computer screen.
[AGENT][POSITIVE] Oh wow, yeah.
[AGENT][NEUTRAL] That happens when you have little ones.
[AGENT][NEUTRAL] I work from home too and I sometimes have my little ones, yeah, yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh really? It was
[CUSTOMER][POSITIVE] Yeah, it's uh, it definitely makes it a little more challenging when you're trying to, uh, you know, get a bunch of work done, you know.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yeah, it is, especially when they're like really little and they're like they just wanna be with you. You're like way.
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] OK, um, OK, so this one for Mr. [PII], it looks like it was denied because um.
[AGENT][NEUTRAL] The beneficiary not directly on your leg. OK, so it was an artificial insemination or in vitro and that's not covered under the policy. Um, that's for the one ending on 330, which is the date of service of [PII].
[AGENT][NEUTRAL] Um, let me check the other one and see what is this about.
[AGENT][NEUTRAL] Oh it's the same thing, [PII].
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So it got declined basically you said because it was um.
[AGENT][NEUTRAL] It's an uncovered service under the policy, let's say an artificial insemination mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] When I read it just now, it said he was having a um this is ATL system OK jeez, no, it, it said something about a vasectomy or something. I'm sorry, it's, it's chaos here.
[AGENT][NEUTRAL] Unless it's
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] It it's many things, yeah, it's OK. Uh, so the policy doesn't cover artificial insemination, in vitro fertilization, um, tube fertilization. Um, it doesn't, um, cover, let's see, any.
[AGENT][NEUTRAL] any sterilization, uh, any vasectomy or reversal, anything like that. So that's all listed on the EOB. Everything that is not covered is just listed on the EOB. So it's one of those.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] But it is not covered by the policy.
[CUSTOMER][NEGATIVE] So basically nothing
[CUSTOMER][NEUTRAL] So basically they're trying to say that's an elective thing that he had done.
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][POSITIVE] OK, got it. That's all I need to know thank you so much for your help.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You're welcome. Is there anything else I can help you with today, Mr. [PII]?
[CUSTOMER][POSITIVE] That's it. Have a great day.
[AGENT][POSITIVE] You too. Have a good weekend thank you for calling ATL. Bye-bye. You're welcome.
[CUSTOMER][POSITIVE] Thank you bye bye.