AccountId: 011433970860
ContactId: f9579c0f-30ab-4984-9863-43e055156eb2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 519140 ms
Total Talk Time (AGENT): 203567 ms
Total Talk Time (CUSTOMER): 176394 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/f9579c0f-30ab-4984-9863-43e055156eb2_20250110T19:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, um, I was calling about some claims that got denied and I just wanted to understand what the reason is or if they need to be resubmitted a certain way.
[AGENT][NEUTRAL] OK, I can help you with your claim information. um, can you please give me your name and your call back number just in case our call is disconnected.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] OK, and Miss [PII], what it, yeah, go ahead.
[CUSTOMER][NEUTRAL] And it's not
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, Miss [PII], what is your policy number?
[CUSTOMER][NEUTRAL] It is um 1947648.
[AGENT][NEUTRAL] OK, let me pull that policy in for us real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, Ms. [PII], can you verify your date of birth for me?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Thank you. And then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] It's [PII]. Um, honestly, I don't even know what email you have. I don't know if you have.
[CUSTOMER][NEUTRAL] The [PII], or [PII], or [PII]. We have like 15 emails so I can keep me, I can keep naming.
[AGENT][POSITIVE] Yeah, you gave me the [PII] one, that's good. OK, what is
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Well, what is, um, the cell phone number on the policy?
[CUSTOMER][NEUTRAL] Um, it's probably [PII].
[AGENT][POSITIVE] Yes, thank you so much. I appreciate you verifying the policy for me and is the claim for yourself?
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, the first claim is for myself.
[AGENT][NEUTRAL] OK, let me look at yours first.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the claim number?
[CUSTOMER][NEUTRAL] Uh, you know what? I don't have the claim number in front of me. Can I give you the date?
[CUSTOMER][NEUTRAL] A service
[AGENT][NEUTRAL] The yeah, the what's the data service?
[CUSTOMER][NEUTRAL] It's um 5/21 of 2024.
[AGENT][NEUTRAL] OK, let's look and see.
[AGENT][POSITIVE] Of course it's taking its sweet time. I'm sorry.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's gonna be just a second.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what was the name of the place that you went to when you had your procedures done?
[CUSTOMER][NEUTRAL] Um, it's, uh, well, the bill is from Women's Care. It was at [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Right, OK, thank you, I appreciate that. OK, so looking at this.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim was denied because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK. So, even though it's at, like, they're located at a hospital, like it was like a surgery, like I had anesthesia and everything.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It's not
[AGENT][NEUTRAL] The way that the claim was sent in from the, your primary insurance?
[CUSTOMER][NEUTRAL] Covered?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Is by what we go by as far as what we pay so on the explanation of benefits from your primary that's what we look at so looking at it.
[AGENT][NEUTRAL] From what they sent in the.
[AGENT][NEUTRAL] The claim was denied because the surfaces are not covered if performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK, so how would I, like, since it was at Baptist South Hospital, like in their Baptist office, um, is there a way they can resubmit it or how?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, they can they can resubmit it if they if they want to um.
[CUSTOMER][NEUTRAL] What I need to call them.
[AGENT][NEUTRAL] I can um actually if you wanna talk to a claims examiner or somebody in the claims department as to what needs to be done, um we can do that also.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Alright, and what, and who was the second claim for?
[CUSTOMER][NEUTRAL] Uh, the second one is for [PII], my daughter.
[AGENT][NEUTRAL] OK, I can't give her claim information out because she's over the age of [PII]. Um, HIPAA doesn't allow me to do that.
[CUSTOMER][NEUTRAL] OK, do you want me to touch him?
[AGENT][NEUTRAL] So she'll have to
[CUSTOMER][NEUTRAL] Can I, can I patch her in?
[AGENT][NEUTRAL] Yeah, sure, sure.
[CUSTOMER][NEUTRAL] OK, hold on one second because.
[CUSTOMER][NEUTRAL] Uh, let me see how I do that, um, a call.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hold on. She's on the phone. Are you there?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][POSITIVE] Oh, I'm so sorry. She just texted me. Yeah, yeah, yeah. Sorry. I think she didn't know what I was. Are you there?
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEUTRAL] Yes, ma'am, I'm here.
[CUSTOMER][NEUTRAL] Oh, OK, um, she said that she's gonna call me in a second, hold on. May have called back, um, OK.
[CUSTOMER][NEUTRAL] And with insurance. I guess I could have her call back with me, um.
[AGENT][POSITIVE] Yes, if you wanna do that or if she wants to call back on her own and find out about it either way is fine.
[CUSTOMER][NEUTRAL] And they need to talk to you.
[CUSTOMER][NEUTRAL] OK. And as far as the
[AGENT][NEUTRAL] In the meantime, uh-huh.
[CUSTOMER][NEUTRAL] Claims, yeah, the claims examiner, how does that work?
[AGENT][NEUTRAL] OK, I'm gonna transfer you on over to the claims department. It's gonna be a brief hold while I transfer you, OK?
[CUSTOMER][POSITIVE] OK thanks.
[AGENT][POSITIVE] You're welcome you have a great weekend and thanks for calling APL.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], it's [PII]. I've got um Miss [PII], uh, I can't say her last name anyway, her policy number is 194.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 7648.
[AGENT][NEUTRAL] And she's calling about claim number 350.
[AGENT][NEUTRAL] 68 I'm sorry, 873.
[AGENT][NEUTRAL] I read her the remarks on the claim and she wants further assistance.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, um, 3506873, is that for her or somebody else on the policy?
[AGENT][NEUTRAL] It's for her.
[CUSTOMER][NEUTRAL] That part OK alright.
[AGENT][NEUTRAL] Uh, [PII]'s part two. I'm sorry, I should have told you that.
[CUSTOMER][POSITIVE] No problem, no problem. OK, thank you so much. I'm ready thank you.
[AGENT][NEUTRAL] She's part 2.
[AGENT][POSITIVE] Thanks [PII]. Have a good weekend. Bye bye.
[CUSTOMER][POSITIVE] OK, I'm ready. You're welcome. You too, thank you.