AccountId: 011433970860
ContactId: f3d71486-7372-414f-9208-867eb9481e53
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1255869 ms
Total Talk Time (AGENT): 362717 ms
Total Talk Time (CUSTOMER): 252937 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/f3d71486-7372-414f-9208-867eb9481e53_20250321T14:08_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], this is [PII] in [PII]. How are you doing?
[AGENT][POSITIVE] Good. How are you?
[CUSTOMER][POSITIVE] Doing great, doing great, um, can I please give you a policy number? I'm just calling to check on a claim for one of our customers.
[AGENT][POSITIVE] Yeah, absolutely. Happy to check on a claim today, [PII]. Go ahead with the policy number.
[CUSTOMER][NEUTRAL] It is 244.
[CUSTOMER][NEUTRAL] 6176
[AGENT][NEUTRAL] All right, let me pull that up here one moment.
[AGENT][NEUTRAL] All right. And then what is the insured's name?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's [PII] and date of birth is [PII].
[AGENT][POSITIVE] Thank you. One second.
[AGENT][NEUTRAL] OK, and is the claim under [PII]?
[CUSTOMER][NEUTRAL] We actually have some under [PII] and under [PII]. We're just trying to find out that their well we're just basically just trying to find out that their wellnesses get paid for 24 and 25.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let's see here.
[AGENT][NEUTRAL] OK, so it looks like it was paid out on the [PII].
[AGENT][NEUTRAL] It looks like um
[AGENT][NEUTRAL] For the wellness claims, so they were paid out.
[AGENT][NEUTRAL] I check on the [PII].
[CUSTOMER][NEUTRAL] OK, so for is that for?
[CUSTOMER][NEUTRAL] Is that for [PII] or [PII]?
[AGENT][NEUTRAL] So the one, it was $100. I would have to look to see what their benefit payment was. I'm wondering if they did.
[AGENT][NEUTRAL] All right, that one is just on [PII]'s, it looks like for the $100.
[CUSTOMER][NEUTRAL] OK, and that was for which year?
[AGENT][NEUTRAL] Looks like [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so [PII] just got paid $100 on [PII].
[AGENT][NEUTRAL] Mhm. And I don't see any other claims for him, just that one, that was submitted. So that one was paid. There was nothing else that I see for him.
[AGENT][NEUTRAL] And the one for [PII] is still showing in progress. There's nothing on that one.
[CUSTOMER][NEUTRAL] OK, do you say that lease has been paid for [PII] or [PII] yet?
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] No, it hasn't. Everything is still showing in progress.
[CUSTOMER][NEUTRAL] I wonder what's going on with the wellnesses. They're normally fast.
[AGENT][NEUTRAL] Yeah, I don't know. Do you know, was hers a double year or was his a double, cause like I said, his only shows 2025, but I didn't pull a claim to see what exactly what was submitted.
[CUSTOMER][NEGATIVE] Normally I can see it on my side, but what happened was, APL does this weird thing where if an employee retires, it falls off of my system so I can't see the claims, which doesn't make any sense because I still have to service them into retirement. So, but it pulls it off of my agent website where I can't see the claims anymore. That's why I'm having to fumble through this, um.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So, but I thought they've already gotten some wellnesses from us. I could have swore because they told me they got some some stuff from APL. Do you show that they're set up on ACH with [PII]'s dropped into their account or was it a paper check?
[AGENT][NEGATIVE] No, it's a paper check. That's what I also had checked. Yeah, they're getting sick checks. There's no ACH on here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so we have claims that are pending on [PII] and there is a claim still pending on [PII].
[AGENT][NEUTRAL] No, I, I do not see one, [PII], that's pending for [PII]. I just showed that one and then that one was actually paid and the check would have been sent out on the [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. OK, sorry about that. OK, but that was on [PII].
[AGENT][NEUTRAL] No, that's OK.
[AGENT][NEUTRAL] Yeah, yeah, yeah, yeah, so what I show was that his was completed in full. It is the one payment for [PII], um, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't know if they thought they submitted more than that.
[CUSTOMER][NEUTRAL] How do I
[CUSTOMER][NEUTRAL] OK, how do I figure out what's going on with those ones for [PII]? Is there some something I can do to see what's going on? Like when was it received I guess is what I'm saying.
[AGENT][NEUTRAL] Yeah, let me see.
[CUSTOMER][NEUTRAL] Sometimes I notice some claims will just get caught up and uh.
[CUSTOMER][NEUTRAL] Get caught in a little gray area for a second until we get them.
[CUSTOMER][NEUTRAL] Look at
[AGENT][NEUTRAL] Let me look and see here one second.
[AGENT][NEUTRAL] OK, let me see here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I was trying to see if I could find any other notes or.
[AGENT][NEUTRAL] Anything. I'm pulling her claim itself to see if I can see anything.
[CUSTOMER][NEUTRAL] Because it feels like we sent in hers. I thought it was weeks ago.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, because hers was sent in, it shows on the [PII].
[CUSTOMER][NEUTRAL] Do you think maybe it it got looked over?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] You overlooked I'm sorry.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me, [PII], if you don't mind, place you on a brief hold. Let me reach out to the examiner that was working on this and just see if they can give me any more information on it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, yeah, not a problem. Do you mind holding for a few moments?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][POSITIVE] OK, thanks.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] R2
[AGENT][NEUTRAL] OK, so part to pay.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] 800 for it it's just for.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] So
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Ferring
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][POSITIVE] Good morning, [PII]. This is [PII] over in customer care. How are you today?
[CUSTOMER][POSITIVE] I'm good, [PII] how are you?
[AGENT][NEUTRAL] I'm good, thank you for asking. Um, I have a question on a claim. If I give you a claim number, is that maybe something you could look at and try and help me decipher what the denial is for?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, awesome. Do you want the policy number or claim number?
[CUSTOMER][NEUTRAL] Uh, let me get the policy number first.
[AGENT][NEUTRAL] OK, no worries. It's 244-617-6.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the claim is for [PII] and it's claim number 357.
[AGENT][NEUTRAL] 553 1.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so it says index error see part two, and the insured's calling on a wellness claim that was submitted one for her and then one for the husband. I see the husband's one was paid.
[AGENT][NEUTRAL] But I'm not sure what the error was on [PII], and they just wanna know if they need to submit anything else.
[CUSTOMER][NEUTRAL] OK, yeah, let me take a look at what was submitted.
[AGENT][NEUTRAL] And then I was scrolling through that.
[AGENT][NEUTRAL] Based off their policy, it seemed like they both should be able to get a wellness for the year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so [PII] and then [PII].
[CUSTOMER][NEUTRAL] Was mentioned as the patient wellness PSA OK.
[CUSTOMER][NEUTRAL] OK. Also [PII].
[AGENT][NEUTRAL] It looks like they may have submitted both for [PII], huh? I may have just
[CUSTOMER][NEUTRAL] Yeah, because all of these documents have his name at the top, and we don't as of right now like I'm on page 11 and I don't see her name on and the form that they filled out had his name and he signed it so it doesn't look like she actually submitted her wellness um which is why it says see part two because everything submitted was for him.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Oh, that makes total sense now. It was just clicking. I'm, I haven't had enough coffee. I'm sorry.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, that's OK. Look, I get it. I haven't had all mine yet either, and I hadn't been here for about 25 minutes, so I feel you, but yeah, so.
[AGENT][NEUTRAL] Yeah, yeah, me too, girl. Yeah, OK.
[CUSTOMER][NEUTRAL] So if she's trying to submit for herself, we did not get that we only got his.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, OK, perfect sense. Thank you so much. I appreciate you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. You're welcome. No problem at all.
[AGENT][POSITIVE] Have a good day.
[AGENT][NEUTRAL] Thank you [PII] so much for waiting. Um, so in looking at the claim submission, um, under [PII]'s, it looks like when it says about the patient all the information that we got had [PII]'s name on it. So we actually never got a wellness claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For [PII]. Does that make sense?
[CUSTOMER][NEUTRAL] OK, so you're saying, uh, the information we received that [PII]'s name on it and it does not have [PII]'s name on it.
[AGENT][NEUTRAL] Right. It's saying about the patient and both of the submissions on about the patient are [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so that's why hers is showing, um, it had an error code on it, and that's why I called the examiner cause it said see part two. And I was like, I don't get what you're talking about. And she's like, well, it's only [PII]'s part two on the plan. So it was like a double submission for [PII], basically.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] OK, I found one of the things they sent me, it's her actual mammogram that has her name on it, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I can, I can email this. The problem is I can't upload it because the.
[AGENT][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] They took them out of my system because they're retired so it makes everything take a lot longer, so where, where could I email this to get it expedited so they could put it in her file?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Um, generally we don't accept any of those documents via email just because email is not secure, um, you know, we only accept them. Fax is the other, the quickest other way to get it to us honestly.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What would be the best do you have the fax number to claims?
[AGENT][POSITIVE] Yeah, absolutely. So the fax number, are you ready?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And I would just basically tell them the policy number and who it's for.
[AGENT][POSITIVE] Mhm yep, absolutely, and just mark attention to claims, yep.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] I will attempt to do it like that and I appreciate your time this morning.
[AGENT][POSITIVE] Yeah, not a problem, anything else I can check on for you?
[CUSTOMER][POSITIVE] That's it. Have a great day.
[AGENT][POSITIVE] All right you too bye bye.