AccountId: 011433970860
ContactId: fc7d23ae-1807-43aa-9692-8835367b0170
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 492720 ms
Total Talk Time (AGENT): 212961 ms
Total Talk Time (CUSTOMER): 142347 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/fc7d23ae-1807-43aa-9692-8835367b0170_20250604T13:23_UTC.wav
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[CUSTOMER][NEUTRAL] Mm
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh yes, ma'am. This is [PII].
[CUSTOMER][NEUTRAL] The policy number is 02405400.
[AGENT][NEUTRAL] OK, and how may I assist you today, Mr. [PII]?
[CUSTOMER][NEUTRAL] Uh, I was wondering, uh, have you processed the claim or get the $2500 yet?
[AGENT][NEUTRAL] Um, I can definitely take a look into your claims for you. Um, Mr. [PII], can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[CUSTOMER][NEUTRAL] Email address is [PII].
[CUSTOMER][NEUTRAL] And what else you needed?
[AGENT][NEUTRAL] Um, your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And so you're looking for a claim to pay out.
[AGENT][NEUTRAL] The $2500?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Is it for inpatient, like were you admitted into the hospital or was it something outpatient?
[CUSTOMER][NEUTRAL] Uh, Empire.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] See, while I was out here on the road, my boss lady, I think she's the administrator.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] She was talking to somebody to help me fill it out and she says I should be getting the $2500 and I was just double checking.
[AGENT][NEUTRAL] Well, do you know when she sent it because we haven't received anything since March of this year. Is it something recent or this is old?
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEGATIVE] OK, I don't think they've sent it yet. The last thing we received came in on [PII], and we haven't processed anything for you since March.
[AGENT][NEUTRAL] So I'm wondering if they, do you know if they sent it in?
[CUSTOMER][NEUTRAL] I think she said she did it online.
[AGENT][NEUTRAL] Well, even if she did it online, we, we, we would have been able to see it the same day, um, but
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, I even
[CUSTOMER][NEUTRAL] Well, maybe, maybe she's telling me a story. I don't know.
[AGENT][NEUTRAL] Well, I would hope not. Um.
[AGENT][NEUTRAL] Yeah, I would ask her, I will ask her if she has sent it. Is there any other, let me see. Just trying to, OK, this is the only policy. I was trying to see maybe it was another policy and it was put somewhere else, but no, sir, this is the only policy. Um, yeah, I will see if she sent it to us and then if she did send it, how did she send it and have her give us a call if she needs to, but no, sir, we don't have anything here since March.
[CUSTOMER][NEUTRAL] Oh, me too.
[CUSTOMER][NEUTRAL] March
[AGENT][NEUTRAL] Yes, sir. [PII] [PII] it came in.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Was the last thing we processed for you?
[CUSTOMER][NEUTRAL] OK, yeah, I had um.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], um.
[CUSTOMER][NEUTRAL] Sometime towards the end of March, I had a colonoscopy done.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Would that be covered?
[AGENT][NEUTRAL] A colonoscopy?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Let me see if your policy um specifies. Hold on one second.
[AGENT][NEUTRAL] Because it looks like it came in in March, but the actual date of service is December, I'm sorry, it's [PII]. It's from Saint Luke's Physician Group.
[CUSTOMER][NEUTRAL] Uh, when I had that call in Knox is [PII] I believe.
[AGENT][NEUTRAL] OK, hold on one second.
[CUSTOMER][NEUTRAL] I, I can go to look in my um.
[CUSTOMER][NEUTRAL] Yeah, let me put my stuff up here.
[CUSTOMER][NEUTRAL] I can look in the medical chart and tell you what date it is if you need me to.
[AGENT][NEUTRAL] Oh, no, no, no, it's OK.
[AGENT][NEUTRAL] I'm just gonna look in here and see. I'm just trying to some some policies specify what diagnostic testing you can get and some don't. So as long I'm just making sure the colonoscopy is here.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Uh, one moment.
[AGENT][NEUTRAL] Yeah, this doesn't specify. So you're fine as long as it was in an outpatient facility, it should be OK, but of course, we can't guarantee anything until we get the coding, but it um it doesn't specify a particular diagnostic test, so.
[AGENT][NEUTRAL] we should be OK.
[AGENT][NEUTRAL] But I would, um
[CUSTOMER][NEUTRAL] Well, I'm trying to
[CUSTOMER][NEUTRAL] What would I need to do to.
[CUSTOMER][NEUTRAL] Um, [PII] is when I had it.
[AGENT][NEGATIVE] OK, yeah, this definitely isn't for that then.
[AGENT][NEUTRAL] This is from something in February.
[AGENT][NEUTRAL] So yeah, they haven't, they haven't sent it to us.
[CUSTOMER][NEUTRAL] Uh, does the hospital have to send it to you, or do I do that? or how does that work?
[AGENT][NEUTRAL] Well, it depends. Um, you can, well, when you gave your insurance information, did you give the hospital our ID card?
[AGENT][NEUTRAL] As well.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so they should be filing it, um.
[AGENT][NEUTRAL] The hospital should be filing the claims if they have our information like [PII]'s submitted this one I'm looking at, um.
[AGENT][NEUTRAL] So yeah, they should be billing us. I will contact the, I would do two things. I will contact the hospital or the doctor's office wherever you got the service, make sure they have my um secondary insurance on there and I would tell them to bill my secondary insurance.
[AGENT][NEUTRAL] And then after I tell them that I would talk to the employer or, you know, whoever was supposed to be sending it and see how they sent it.
[AGENT][NEUTRAL] Or if they sent it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, I, I can do that and then.
[CUSTOMER][NEUTRAL] Let me call the hospital first billing department.
[AGENT][NEUTRAL] Mhm, and let them know you have this.
[CUSTOMER][NEUTRAL] And they.
[CUSTOMER][NEUTRAL] Secondary, I know.
[CUSTOMER][NEUTRAL] So the I was looking here.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] What's the last one I had? It says offered business are not covered by above numbered policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, let me give him a call and give them the information and all that.
[AGENT][NEUTRAL] Alrighty, and Mr. [PII], was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] We'll go.
[CUSTOMER][POSITIVE] No ma'am, that'll do it now so thank you very much.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.