AccountId: 011433970860
ContactId: c3038a0a-a4ae-48cf-aea5-b618a2b24b54
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 462119 ms
Total Talk Time (AGENT): 135967 ms
Total Talk Time (CUSTOMER): 107926 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/c3038a0a-a4ae-48cf-aea5-b618a2b24b54_20250428T14:52_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII] in [PII], how you doing?
[AGENT][POSITIVE] Good. How are you doing, [PII]?
[CUSTOMER][POSITIVE] Doing great, doing great. I am just trying to see if I could check on a claim for one of our customers.
[AGENT][NEUTRAL] Oh, of course. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, let's see.
[CUSTOMER][NEUTRAL] Sorry, I was bouncing off of the screen so I can get the date of birth for you because I knew that was coming. Let's see.
[AGENT][POSITIVE] Yeah, you're OK.
[CUSTOMER][NEUTRAL] Um, policy number is 2572267.
[AGENT][POSITIVE] OK, perfect. Thank you.
[CUSTOMER][NEUTRAL] And I believe that it's for [PII].
[AGENT][NEUTRAL] Yes, and his date of birth?
[CUSTOMER][NEUTRAL] Let's see, claim number ends in 587. I think date of birth is [PII].
[AGENT][NEUTRAL] That's close.
[CUSTOMER][NEUTRAL] That's what it says on this EOB but it might be wrong.
[CUSTOMER][NEUTRAL] Sometimes it's hard to read some of these uh
[AGENT][NEUTRAL] OK, and then did you say you had that claim number?
[CUSTOMER][NEUTRAL] Yes, the claim number looks like it is 359-0587.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] Is there another area you could check that date of birth?
[CUSTOMER][NEUTRAL] It's normally on the
[CUSTOMER][NEUTRAL] It's only on the, uh, what you call it? um.
[CUSTOMER][NEUTRAL] [PII], but it's not on here so it's not [PII].
[AGENT][NEUTRAL] Looks like.
[CUSTOMER][NEUTRAL] What other info could I give you on him?
[CUSTOMER][NEUTRAL] That would help you. Let's see, I, I don't have the employee up his last is it's [PII] is the last four of his social.
[AGENT][POSITIVE] Yes, yes, that will do. That's totally fine. Um, his birthday is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so I did find that.
[CUSTOMER][NEUTRAL] Sorry, you know what? I was reading it wrong. I see now. OK, I'm sorry, go ahead.
[AGENT][NEUTRAL] Oh no, you're OK. Um, so I did find that claim number for you and it looks like the received date is [PII]. The process date is [PII].
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Just a minute.
[AGENT][NEUTRAL] OK, so it looks like this claim was denied because the hospital confinement benefit is not payable on any day a hospital admission benefit paid.
[AGENT][NEUTRAL] So it looks like due to their benefits, this was not payable.
[CUSTOMER][NEUTRAL] Oh, let me go back.
[CUSTOMER][NEUTRAL] So it's not
[CUSTOMER][NEGATIVE] It's not paid, you said any time.
[CUSTOMER][NEUTRAL] What's paid? I'm sorry.
[AGENT][NEUTRAL] So the denial code is, it says the hospital confinement benefit.
[AGENT][NEUTRAL] is not payable on any day a hospital admission benefit paid. So it looks like we paid a hospital.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So the admission did pay?
[AGENT][NEUTRAL] Yes, the hospital admission benefit did pay, so that's why the confinement didn't. Yes. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, no, no, because it sounded like you were saying he got 0. OK, so he did get the.
[CUSTOMER][NEUTRAL] The $1000 is that right?
[AGENT][NEUTRAL] Let's see, let me go back really quick.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yes, so it looks like we.
[CUSTOMER][NEGATIVE] Phones are blowing up here.
[AGENT][NEUTRAL] Oh, you're OK. It looks like we paid the $1000.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I
[CUSTOMER][NEUTRAL] So we got $1000 total.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me check that. I'm gonna double check the um check number really quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And see exactly what we paid.
[AGENT][NEUTRAL] Just a second.
[AGENT][NEUTRAL] OK, so it looks like we paid $1000 and 100, so $1100.
[CUSTOMER][NEUTRAL] OK, so 1100 and that was either.
[AGENT][NEUTRAL] We paid.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] That was a paper check?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] And that was paid on.
[CUSTOMER][NEUTRAL] OK, and do you show that it cleared already?
[AGENT][NEUTRAL] No, it has not cleared yet. It still shows as outstanding, but we sent that check [PII]. So it might just take a few more days.
[CUSTOMER][NEUTRAL] OK, I'm trying to get everybody to do direct deposit just because it drags it out so much longer, you know.
[AGENT][POSITIVE] Yes, it does.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, I will work on this from here. I appreciate your time today.
[AGENT][POSITIVE] Yeah, of course. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] That's it. Have a great day.
[AGENT][POSITIVE] All right, yup. Thanks for calling APL. You too.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][POSITIVE] Thank you bye bye.
[CUSTOMER][NEUTRAL] Mhm.