AccountId: 011433970860
ContactId: df7747fa-e8a7-4345-830c-4a891283bc62
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 600190 ms
Total Talk Time (AGENT): 235054 ms
Total Talk Time (CUSTOMER): 91934 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/df7747fa-e8a7-4345-830c-4a891283bc62_20250623T19:29_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey, so I'm just trying to get an update on some claims that have been pending for a while.
[AGENT][NEUTRAL] OK, sure, yes, I can assist you with claims. So may I have your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. May I have the policy number?
[CUSTOMER][NEUTRAL] C 0993082
[AGENT][NEUTRAL] Can you repeat the first two digits?
[CUSTOMER][NEUTRAL] See
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, let me try that.
[AGENT][NEUTRAL] OK, is this your personal policy?
[CUSTOMER][NEUTRAL] Through my employer, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, do you see any other numbers besides the one that you're giving me?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Oh, I'm sorry, here's the policy number. I was giving you something else, sorry.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] It's 262-094-5.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right. And may I have your date of birth, mailing address and email address on file for verification?
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] [PII] or you might have a [PII] at Emerald Clinical.
[AGENT][POSITIVE] Yes, that's the one we have. Thank you.
[AGENT][NEUTRAL] OK, I see your secondary policy.
[AGENT][NEUTRAL] OK, so the claims are for um different members, correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. So let me start off with the first one which is [PII]. Let me go ahead and pull up the information on his claim.
[AGENT][NEUTRAL] I'm just waiting on the documents to upload.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK
[AGENT][NEGATIVE] I was denied because we did not see that the major medical apply any amounts towards the deductible co-payment or co-insurance.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Is that the claim for what what amount is that?
[AGENT][NEUTRAL] That's the claim for [PII]. The only one I see here is for let's see.
[CUSTOMER][NEUTRAL] Wait, how much was the one for [PII]?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, bear with me, let me go back to it one moment. 4900.
[CUSTOMER][NEUTRAL] OK, yeah, I understand why that one was denied um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But then what about the one for [PII]?
[AGENT][NEUTRAL] OK, let me go back let me go to the next number one moment OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Well, the one for, um, [PII] was paid. We did send a payment on [PII].
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, for 3:41.
[AGENT][NEUTRAL] Mhm. Yes, $341.81 less than that.
[CUSTOMER][NEUTRAL] Yeah, but there are other.
[CUSTOMER][NEUTRAL] Yeah, but there are other claims that have been pending.
[CUSTOMER][NEUTRAL] So I
[CUSTOMER][NEUTRAL] When I look at my open claims.
[AGENT][NEUTRAL] You mean
[CUSTOMER][NEUTRAL] There's 6 pending.
[AGENT][NEUTRAL] OK, you mean on the claim you're looking at 6 open, uh, that didn't pay.
[CUSTOMER][NEUTRAL] Well they have it looks on here like they haven't been processed yet.
[AGENT][NEUTRAL] They bundle them together whenever they receive claims they bundle them together so let me look at this claim really quick, which is the last 11 moment.
[AGENT][NEUTRAL] OK, on this one we have [PII].
[AGENT][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Diagnosis code [PII].
[AGENT][NEUTRAL] [PII], we need the diagnosis code.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] is the same claim.
[AGENT][NEUTRAL] Bear with me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so for um halls, we have two days of service. Is that correct? [PII] and [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] There's no other claims that you submitted other than those two days of service, correct?
[CUSTOMER][NEUTRAL] No, I think there are more than that, um.
[AGENT][NEUTRAL] What is the date of service?
[CUSTOMER][NEUTRAL] Hold on, I'm looking.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So two different um encounters on the [PII].
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] You mean about the process claims?
[CUSTOMER][NEUTRAL] And then lab work
[CUSTOMER][NEUTRAL] No, I, I'm talking about the pending claims.
[AGENT][NEUTRAL] OK. So, um,
[AGENT][NEUTRAL] And when you say pending claims, I don't see any pending claims. I see that they were all processing under one claim number which is the last 13614336. Um, for, um, [PII], we had the ER visit, we had um.
[AGENT][NEUTRAL] The physician's office and then we had an urgent care which those were paid and then under the same claim we had some um for [PII], it was a facility charge and it was a the office visit um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment, let me pull the AOB one more time.
[CUSTOMER][NEUTRAL] And all of those have been paid, we think.
[AGENT][NEUTRAL] The only one that I don't see payment for is [PII]. Let me see why we didn't pay on [PII]. OK, one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so, um, one of them was a service render in an office setting which is not payable. We don't pay office services and then there's another one that was on the facility charges. Let me check and see what happened to that facility charge.
[CUSTOMER][NEUTRAL] Yeah, that's lab work.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] OK, so for that one, for the lab work that you're saying on the, the pigment, uh, we're gonna need an itemized bill with diagnosis cos and procedure codes on that one.
[CUSTOMER][NEUTRAL] You need an itemized bill for the lab work.
[AGENT][NEUTRAL] Yes, from, from [PII]. Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, I will.
[CUSTOMER][POSITIVE] I will get that and get it over to you. Thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] No, I think that's it.
[AGENT][POSITIVE] OK, well thank you for calling ATL. Have a good afternoon.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thanks.