AccountId: 011433970860
ContactId: fc14b9f9-1513-469d-a936-54958629819c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 514700 ms
Total Talk Time (AGENT): 168757 ms
Total Talk Time (CUSTOMER): 278822 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/fc14b9f9-1513-469d-a936-54958629819c_20250205T15:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh [PII], I just uh wanted to do a claim status check.
[AGENT][NEUTRAL] Yeah, I could check on a claim for you. um, what was your name?
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[AGENT][NEUTRAL] I'm sorry, you said [PII]?
[CUSTOMER][NEUTRAL] Uh huh, [PII], yes.
[AGENT][NEUTRAL] OK. Are you with a, uh, provider or you, are you the insured, ma'am?
[CUSTOMER][NEGATIVE] Provider and actually I just called I spoke with someone but I gave them the wrong claim.
[AGENT][POSITIVE] Oh, OK, no worries, um, alrighty yeah I could check on that for you. uh, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] Thank you and then do you have that policy number?
[CUSTOMER][NEUTRAL] I do. It is 022-038-887.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Um, her name is [PII]. Her date of birth is [PII].
[AGENT][NEUTRAL] OK perfect thank you for that and uh what was the date of service for this claim [PII]?
[CUSTOMER][NEUTRAL] Um, it was an [PII] date of service and apparently there were two different claims. Um, this one was 300.
[AGENT][NEUTRAL] I'm sorry, um,
[AGENT][NEUTRAL] I'm so sorry man it kind of uh cut out you said [PII] um.
[AGENT][NEUTRAL] I didn't hear anything after that. I'm sorry, [PII]? OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, and the claim amount, um, it would have been $308.
[AGENT][NEUTRAL] 308. OK. Was that the amount before or after major medical paid?
[CUSTOMER][NEUTRAL] Uh, after the, um, it would have been $60 after the primary payment. Mhm.
[AGENT][NEUTRAL] 60 after.
[AGENT][POSITIVE] Got it. OK, thank you one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, was this with, uh, Dominion Behavioral Healthcare?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I did find this claim, uh, looks like we did pay that $60 benefit. Um, let me know when you're ready I can give you that claim number.
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] Alrighty, that is 33.
[AGENT][NEUTRAL] 81
[AGENT][NEUTRAL] 127.
[CUSTOMER][NEUTRAL] Alright, hold on one second.
[CUSTOMER][NEUTRAL] OK, so let me, let me ask you a question, OK, because I'm gonna give you the same date of service.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, because it's two different, two different providers, so.
[CUSTOMER][NEUTRAL] I know it seems like I was given the same information.
[CUSTOMER][NEUTRAL] For the other claim.
[CUSTOMER][NEUTRAL] That we had for $150.
[AGENT][NEUTRAL] Um, I don't see a claim for $150 unless that was the amount after. The only other claim I have for this state of service for [PII], um, it was $187.80. It is also from Dominion Behavioral Healthcare.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, can you hold on for me for one second?
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Cuz what they did was.
[CUSTOMER][NEUTRAL] I'm just gonna pull up the you all EOB for the date that we have.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the 38, 0, you know what, it is a different check number. I'm, I'm sorry. Oh, but we have one here for 150, but the check number is different, 1820796. Now I've already have the information for the 338-1127.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Yes, OK, that's the $60.01.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, but you can't see like the total. OK, and that was what did I give you? I gave you $308 correct.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so that is the one for the $308. Now, why am I showing?
[CUSTOMER][NEUTRAL] I have a, they post it OK.
[CUSTOMER][NEUTRAL] Now you said you didn't see another [PII].
[AGENT][NEUTRAL] I only see one other one, ma'am, and it's um the total uh we got was 18,780, but it was from Dominion Behavioral Healthcare.
[CUSTOMER][NEUTRAL] Uh-huh, you said 180.
[CUSTOMER][NEUTRAL] OK, I don't know.
[AGENT][NEGATIVE] And we were unable to pay that claim.
[CUSTOMER][NEUTRAL] OK, I don't even see. I'm sorry, I, I just don't, I don't even see something's being filed with that, but I, I'm just saying I'm gonna have to double check on our end because the claim.
[AGENT][NEUTRAL] No, you're OK.
[CUSTOMER][NEUTRAL] That they have is being submitted for $150 which would have been $60 after it was manually done though but they had like a check number of 1820796. I, I don't know where that's.
[AGENT][NEUTRAL] Yes, that was the check for the claim I just looked at the one ending in 1127.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, OK, but that was where they got that posted on the wrong one because you said you all, you don't even have another claim for 1 150, you have something for 187 something. OK, on the same date. It was 18,780 did you say?
[AGENT][NEUTRAL] Oh, I see.
[AGENT][NEUTRAL] Yes, 18,780.
[AGENT][NEUTRAL] 80, yes. Uh, we were unable to pay that as uh office visits are not covered under this policy.
[AGENT][NEUTRAL] Uh, would you like me to send you the uh.
[CUSTOMER][NEUTRAL] Oh, that's what happened.
[AGENT][NEUTRAL] Oh, go ahead, sorry.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Apparently that might be what it is because this was an office visit. 99205.
[CUSTOMER][NEUTRAL] Like I said, not.
[CUSTOMER][POSITIVE] So I'll pay that one. I don't know. I'm gonna have to figure it out. OK, um, [PII], thank you so much for all of your help.
[AGENT][NEUTRAL] Yeah, um, if you'd like I can send you copies of these EOBs if you need those. It does have the claim numbers with the check number as well.
[CUSTOMER][NEUTRAL] OK, is it possible, can you, can you, uh, fax it to my secure fax?
[AGENT][POSITIVE] Of course, absolutely. Did you want me to send both of these to you?
[CUSTOMER][NEUTRAL] Yeah, if you could send both of those and and [PII], I'm sorry, I, I was given information on, oh no, I don't.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][POSITIVE] That's gonna cover what I needed anyway, that'll be great and I'll give you my secure fax number when you're ready.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] I am ready when you are.
[CUSTOMER][NEUTRAL] OK, 804.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 355.
[CUSTOMER][NEUTRAL] 9966.
[CUSTOMER][NEUTRAL] And I'll spell my name for you. It is [PII]
[AGENT][NEUTRAL] I'm sorry, um, it.
[CUSTOMER][NEGATIVE] I'm breaking up.
[AGENT][NEUTRAL] Yes, just a bit. Could you repeat the last four digits? I'm sorry.
[CUSTOMER][NEUTRAL] OK, 9966.
[AGENT][NEUTRAL] Oh my goodness, it cut out again. I'm so sorry. I heard 99.
[CUSTOMER][NEUTRAL] OK, hold on one second.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] It's 8 OK 996-6804-3559966 mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Got it. OK.
[CUSTOMER][NEUTRAL] And the um my name is [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Got it. OK, alrighty, I will get both of these sent to you. Um, should get them here in maybe 10-15 minutes depending on how busy your machine is. Did you have any other questions for me, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Um, no, thank you very much.
[AGENT][POSITIVE] Of course, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too now bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.