AccountId: 011433970860
ContactId: c8492600-7aaf-4b0a-a31d-da05f5897b10
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 379260 ms
Total Talk Time (AGENT): 178673 ms
Total Talk Time (CUSTOMER): 180712 ms
Interruptions: 7
Overall Sentiment: AGENT=1.6, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/c8492600-7aaf-4b0a-a31d-da05f5897b10_20250115T16:40_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], it's gonna be [PII]. I'm an APL agent, um, and I just need your help to see if the claim's been processed yet or not.
[AGENT][NEUTRAL] OK, yeah, I can check on that claim for you. I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] Oh [PII] and let me give you my best call back number and tell me when you're ready it's [PII].
[AGENT][POSITIVE] Yes, please. Thank you.
[AGENT][NEUTRAL] Yes. Mhm.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][NEUTRAL] And then did you have that uh policy number [PII]?
[CUSTOMER][NEUTRAL] Yeah, it's gonna be the let me just tell you the behind the scenes story, so the lady gave birth underneath her husband's policy.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um APL for whatever reason uh denied the claim because they put his new policy which had a new effective date instead of the old policy so the old policy number is 253.
[CUSTOMER][NEUTRAL] 8076 it's uh for [PII].
[CUSTOMER][NEUTRAL] And his date of birth is tell me when you're ready when it's up on your screen.
[AGENT][NEUTRAL] OK, one moment please [PII].
[AGENT][NEUTRAL] OK, yes, I'm ready for his date of birth.
[CUSTOMER][NEUTRAL] Alright, so it's [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And then yeah and then this is for his wife which the um.
[CUSTOMER][NEUTRAL] I have an old claim number, but I know a new claim number is going to be issued, but this is for date of service for his wife on [PII] of last year.
[AGENT][NEUTRAL] [PII], OK, for is it mhm.
[CUSTOMER][NEUTRAL] Yeah, her name is um [PII], yeah, [PII] and her date of birth is [PII].
[AGENT][NEUTRAL] Got it. OK, thank you for that. OK, the date of service was [PII], correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That is the effective date for this policy. Give me just a moment.
[CUSTOMER][NEUTRAL] Yeah, yeah, sure.
[CUSTOMER][NEUTRAL] Uh, now in my own defense I might be calling at least 3 days early because I think I just did this on Friday or Monday of this week, but I just happen to have um sometimes you guys process when it goes back to the auditor within the next day and I figure I'd give it a shot while I have some extra time.
[AGENT][POSITIVE] No worries.
[AGENT][POSITIVE] Sure, absolutely.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, really quick, [PII], um, can I get your uh email address that we've got on file for you?
[CUSTOMER][NEGATIVE] Yeah, sadly it's like one from [PII]. It's [PII]. Yeah, it's OK. I, you know, if it's not broke, don't fix it. [PII] because nobody can say you financially here in [PII] [PII], which I'm even shocked over thanks.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] OK, thank you for verifying that.
[AGENT][POSITIVE] I appreciate it. OK, let's see here.
[CUSTOMER][NEUTRAL] Yeah, and welcome on board. I don't think I've ever spoken to you before, so.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] No, um, yeah, I went full time here, uh, in July, so yeah, still getting to know everybody but thank you I appreciate it, so.
[CUSTOMER][POSITIVE] Oh good.
[CUSTOMER][POSITIVE] Yeah, normally I'll always say [PII] a heck of a nice guy, so it, it refreshes your memory. So I held back because I know you don't know who I am, but I am really abnormally normal. Thanks.
[AGENT][POSITIVE] Well, I do now, so thank you.
[AGENT][NEUTRAL] Alright, so I do see that we have received a claim for Melena on [PII], so that sounds right. date of service [PII]. OK, so we did receive this claim. It looks like we paid a benefit of $268.46.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] And I can get you that updated claim number when you're ready.
[CUSTOMER][POSITIVE] Yeah, I'm all set go ahead.
[AGENT][NEUTRAL] OK, it is 355-0912.
[AGENT][NEUTRAL] And let me check. This did go as a paper check.
[CUSTOMER][NEUTRAL] Oh, that claim number seems one digit off uh 371.
[AGENT][POSITIVE] Oh, you're right, you're right. I'm so sorry.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Um, wait, no, yeah, 355.
[CUSTOMER][NEUTRAL] No 1234567 no, you're right, that's it. OK, just 64.
[AGENT][NEUTRAL] OK, no, it looks wrong to me too, actually. I looked at it and I was like, wait, could have sworn I just copy and face that. OK, so let me verify when that check was issued. It looks like it went directly to the.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Provider, but let me see.
[AGENT][NEUTRAL] Yes, so the check was issued, uh, [PII] and it went to Radilogy Associates of Hollywood Inc.
[CUSTOMER][NEGATIVE] OK, and uh my last stupid man question is.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So it's, it's 42 68 46 but I see that um um.
[CUSTOMER][NEUTRAL] That the charge is 5 $530 so what, what's the discrepancy?
[AGENT][NEUTRAL] Let's see, give me just a moment here because what I've got here shows that there were two procedures, one for $149.38 1 for $119.08. So I will get that pulled up most of the time it's as this is a secondary medical, the total bill amount that they show is going to be before the primary paid, that's the amount before primary, um, but I can definitely verify that.
[CUSTOMER][NEUTRAL] Yeah 2 charges right.
[AGENT][NEUTRAL] So in which case the remaining balance was the 26846.
[CUSTOMER][NEUTRAL] the remaining balance was the 26844.
[AGENT][NEUTRAL] Which is what we paid, but give me just a minute, let me make sure that's the case.
[AGENT][NEUTRAL] Yeah, total bill excuse me, total bill charges $530 so the 26846 was the patient responsibility and of course that is what we paid.
[CUSTOMER][NEUTRAL] 846 was the patient responsibility.
[CUSTOMER][POSITIVE] OK got it alright thank you so much.
[AGENT][NEUTRAL] Yeah, was there anything else I could help you with?
[CUSTOMER][POSITIVE] No, you're very pleasant, thank you and, and, uh, welcome aboard again. OK, thank you, take care bye bye.
[AGENT][POSITIVE] All right yeah thank you it was nice to meet you appreciate it.
[AGENT][NEUTRAL] All right. Bye-bye.