AccountId: 011433970860
ContactId: ed4046bd-5df7-4290-9557-f9c47689b3ab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 696559 ms
Total Talk Time (AGENT): 262040 ms
Total Talk Time (CUSTOMER): 217953 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/ed4046bd-5df7-4290-9557-f9c47689b3ab_20250108T14:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APR. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes, um, I have been getting a lot of, um, correspondence, um, in the mail from APL saying that I need more information on something, but I didn't know what it was. Um, any way you can look into it, I don't even know which claim number it is and nothing. I have nothing with me because I'm in the truck right now, so I need you to let you help, OK.
[AGENT][NEUTRAL] Um, yes, ma'am.
[AGENT][POSITIVE] Yeah, I can assist you. First, can I get your name and a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK, it's [PII], phone number [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, could I get your policy number?
[CUSTOMER][NEUTRAL] Um, that I don't let me pull that up. I did not know that one.
[AGENT][NEUTRAL] And if you don't have it, um,
[CUSTOMER][NEUTRAL] Can you do it by my social security number?
[AGENT][NEUTRAL] Yes, I can look it up by your social.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I found you in our system. Um, please verify your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] [PII] and [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Now please verify your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, your most recent claims. I'm showing one on file for an office visit. Um, it denied because office visits are not covered under the policy and what they billed along with it, um, was an explanation of benefits showing that your primary insurance company did not cover the charges. And if your primary insurance company doesn't cover a charge, then we don't cover it either. And then there's another claim on file.
[AGENT][NEUTRAL] Um, the date of service was for [PII], and that one is also denying because it was billed for an office visit, which is not covered under the policy.
[CUSTOMER][NEUTRAL] You say I'm not, I, I don't have office office visiting in my policy?
[AGENT][NEUTRAL] Right. Services provided in the office, um, that's covered, but the, um, the, the charge for the office visit, which is your co-pay, that is not covered.
[CUSTOMER][NEUTRAL] Oh, OK, so I understand that part. OK, and what other, what, what other thing that was it they said what's the the first part you said?
[AGENT][NEUTRAL] Um, I'm showing that for.
[CUSTOMER][NEUTRAL] When they was asking me for a yo, when they was asking me for additional information, I didn't know what that was for.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Cause I think I went to the hospital, I think 12.
[CUSTOMER][NEUTRAL] I think a total 22 or 3 times or then one time I went to an urgent care.
[AGENT][NEUTRAL] OK. I'm showing that for date of service, [PII].
[AGENT][NEUTRAL] Let's see, those are for outpatient services and I'm showing that all those claims uh paid for [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, those claims paid. I'm not showing where they're asking for additional services and then for ER visit on [PII], I'm showing that those claims paid as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then I think it was.
[CUSTOMER][NEUTRAL] If you see one for [PII].
[CUSTOMER][NEUTRAL] You know what, it might have been [PII]. I don't know. So [PII] and [PII] were were approved.
[AGENT][NEUTRAL] Let's see, I'm showing [PII] was approved. Let's see, [PII], let me go back to that one.
[AGENT][POSITIVE] Yes, ma'am. [PII] was approved also.
[CUSTOMER][NEUTRAL] OK, and then I just got one this morning.
[CUSTOMER][NEUTRAL] Um, on my, um,
[CUSTOMER][NEUTRAL] Text messages worrying about, I know the claim I know the claim numbers for that one though. OK, it says um.
[CUSTOMER][NEUTRAL] 354-831-9
[CUSTOMER][NEUTRAL] And then the other one is.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Just do one at a time because you can do both of them at the same time.
[CUSTOMER][NEUTRAL] So 354-831-9.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Yes, ma'am. That one was for [PII]. I'm showing that um it paid out except for the charge for the co-pay. That one denied.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and then um.
[AGENT][NEUTRAL] Deadline, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, the other one is 354-832-7.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] OK, yeah, that was for data servers, [PII] and that was for an office visit and it denied.
[CUSTOMER][NEUTRAL] OK, OK, I have another one I think it's 354.
[CUSTOMER][NEUTRAL] 667 6
[CUSTOMER][NEUTRAL] You know I just I realized that they send the claim number in the text.
[CUSTOMER][NEUTRAL] As I'm busy I'd be, I just look at it and say log in and I stop reading.
[AGENT][NEGATIVE] Yes, ma'am. And that was the one that I, uh, for [PII] that I told you about earlier that denied for the office visit and then the other lines denied because according to the EOB those services were not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] By the primary insurance.
[CUSTOMER][NEUTRAL] OK, it's so
[CUSTOMER][NEUTRAL] OK, let's go to the next 1 354-420-6.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm not showing that claim number on file. You said 354-4206?
[CUSTOMER][NEUTRAL] Let me make sure I get 354-420-6, yes.
[CUSTOMER][NEUTRAL] It says your claim is now completed reference the following claim number is 354-4206.
[CUSTOMER][NEUTRAL] They texted me on [PII].
[AGENT][NEUTRAL] OK. Yes, ma'am. One moment.
[AGENT][NEUTRAL] OK. Yes, ma'am. I'm showing that that one also denied because according to the EOB your primary insurance did not cover the charge. And again, if your primary insurance doesn't cover a charge, then we don't cover it either. Now, if they receive an updated EOB showing something different, they can also always resubmit it and we'll reprocess it.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, the next one is.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I think that what's that thing that down there to the bottom.
[CUSTOMER][NEUTRAL] No, different 1, 353-7212.
[AGENT][NEUTRAL] OK, I'm showing that this one paid. It was for a date of service [PII] for the ER visit and it paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. The next one is.
[CUSTOMER][NEUTRAL] It's a lot 353-452-9.
[AGENT][NEGATIVE] OK, I'm showing that this one was for the office visit on [PII] and they denied because according to the EOB, your primary insurance did not cover it.
[CUSTOMER][NEUTRAL] OK, and I think the last one I got is.
[CUSTOMER][NEUTRAL] Because I think that had been a
[CUSTOMER][NEUTRAL] Um, no, it's too.
[CUSTOMER][NEUTRAL] Yeah, it's 2 more. OK, 352-735-3.
[AGENT][NEGATIVE] OK. This was for an office visit on [PII]. Um it denied because it was for an office visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I think the last two I think I need.
[CUSTOMER][NEUTRAL] To ask about because this was in October that's when it started [PII].
[CUSTOMER][NEUTRAL] And 3 and [PII].
[AGENT][NEUTRAL] OK. [PII]. It's for an office visit on [PII] and they denied because it was for an office visit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what was the other one?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, this one denied um office visit on [PII] and it denied because according to the primary EOB, the um primary insurance didn't cover the charge. So again, if um they receive an updated EOB showing that they did cover it and something went towards the copay, the co-insurance or deductible, they can um refile the claim for payment.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, I found, OK, because uh, my insurance, my APL starts [PII] every year we start out like these are the last two because it's [PII] and I, and I got nothing else, um, [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, I'm showing that this one paid. It was for durable medical equipment on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am, that one paid.
[CUSTOMER][NEUTRAL] And and the last one was 351-2016.
[AGENT][NEUTRAL] OK. This was for the hospital admission, um, [PII] and I'm showing that that one paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, and that's it then. Thank you so much.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] No, I can shred some of this paperwork that I have now.
[AGENT][POSITIVE] Well, I thank you, [PII] for calling ATL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You as well.
[AGENT][NEUTRAL] Mhm