AccountId: 011433970860
ContactId: 056a9414-00a4-484b-908e-9bf6bac26b9d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 901090 ms
Total Talk Time (AGENT): 376851 ms
Total Talk Time (CUSTOMER): 195547 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/056a9414-00a4-484b-908e-9bf6bac26b9d_20250212T18:37_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Hey, hello, this is [PII]. Um, I have a couple questions. Um, I'm kinda, I kinda wanna get an update on the case I filed.
[CUSTOMER][NEUTRAL] I'm not sure I can who I can speak to.
[AGENT][NEUTRAL] OK, Miss
[AGENT][NEUTRAL] OK, Mr. [PII], so you're the insured and you have filed a claim with APL that you're wanting to get status on?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, see, the case is that, uh, the guy that, that, that offered the insurance to me, I haven't been able to get a hold of him for like a week or two.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEGATIVE] I'm just trying to, you know, I'm getting a little frustrated trying to communicate with him and he won't communicate back with me.
[CUSTOMER][NEUTRAL] So, um, I have to ask my boss if I could get the number of uh the actual company so that I can call and ask because I just can't get a hold of him.
[AGENT][NEUTRAL] OK, Mr. [PII], so I can help you um in checking claim status. First off, what's a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] 02283755
[AGENT][NEUTRAL] OK, thank you. So give me a moment please to get your information pulled up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, Mr. [PII], I will have to verify several things with you first for security and also any information that is provided today would be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. Your date of birth is [PII]. Is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so bear with me just a moment. I need to look at a piece of information, Mr. [PII]. Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry, I have one of my screens, uh, that I had to reopen, so it's, it's just gonna take a moment. I'm sorry.
[CUSTOMER][NEUTRAL] You're fine.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you for your patience, Mr. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and the next piece of information to verify with me, Mr. [PII] is gonna be your.
[AGENT][NEUTRAL] Home mailing address?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, thank you. The phone number that we have on file for you is the same as the one that you gave me, so that is your best contact number, is that correct?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] Thank you and I do need to add an email address for you. What email would you like for us to have on file?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so that is all of the information that I need to verify with you, Mr. [PII]. I do see that we
[AGENT][NEUTRAL] Processed a claim on yesterday for you uh this is.
[AGENT][NEGATIVE] And it was denied.
[AGENT][NEUTRAL] The reason for the denial on this claim, one of the reasons there's two different remarks. The first one, it says that we need the enclosed claim form completed by the insured, giving a detailed description of the accident or diagnosis of sickness.
[AGENT][NEUTRAL] And the other remark states this policy provides benefits for actual charges incurred as a result of a covered accident. Please submit fully itemized bills with diagnosis and procedure codes for further consideration of the policy benefits.
[AGENT][NEUTRAL] Now Mr. [PII], I can, yes, we're just needing that additional information for the claim to be reviewed.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] Now, I can see
[CUSTOMER][NEUTRAL] Repeat the information because I was not I oh my [PII].
[AGENT][NEUTRAL] Mhm. Actually,
[AGENT][NEUTRAL] Um, so, OK, what's gonna be easier than you trying to write all this down, Mr. [PII]? Do you have access to the Internet where you can set up your profile in our portal? OK, I'm going to email you a user guide for our portal here at APL. It's called the online service center.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And once you set up your profile, you will be able to see this claim.
[AGENT][POSITIVE] And you will be able to see the explanation of benefits with the remarks that I just read to you.
[AGENT][NEUTRAL] So that you can get that information and then submit it to us.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] You serious?
[AGENT][NEUTRAL] Yes sir we're just needing additional information to review.
[CUSTOMER][NEGATIVE] This is not what I was told.
[CUSTOMER][NEUTRAL] Whenever I signed up for this insurance.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Now I have just emailed that user guide that I was talking about to you. The email, Mr. [PII] that you're gonna receive from me is going to come from [PII].
[AGENT][NEUTRAL] And it has that attachment with the instructions for setting up your portal but again we're needing a fully itemized bill.
[AGENT][NEUTRAL] With the diagnosis.
[CUSTOMER][NEUTRAL] I, I sent, I sent.
[CUSTOMER][NEUTRAL] I gave, I gave my, my employer my automized bill of all the stuff that was, that was charged to me.
[AGENT][NEUTRAL] OK. And it also has to include your diagnosis and procedure.
[CUSTOMER][NEUTRAL] And it's
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][NEUTRAL] It, it did, it says, it says it on the paper that I, I gave my employer.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It says I was seeing for a, for a back injury and how long I was there, and how much they charged, and how much I had to pay there out of pocket.
[AGENT][NEUTRAL] Let me look at the documents um that we received if you, and you do have the right to file an appeal, Mr. [PII], within 180 days.
[AGENT][NEUTRAL] Give me just a moment and I can tell you what we received.
[AGENT][NEUTRAL] So the information we received was the claimant's statement.
[AGENT][NEGATIVE] There is not an itemized bill, no, sir.
[CUSTOMER][NEUTRAL] Do you not have
[CUSTOMER][POSITIVE] Basically, I, I, I, I emailed it to, is there a way I can email it to you so you can look at it? I don't have, I can't wait.
[AGENT][NEUTRAL] No sir, we can't accept claims via email for security reasons, but you can upload your information into that portal. It can also be faxed to our secured fax line. Obviously the portal is the quickest way to get it sent in to us for review.
[AGENT][NEUTRAL] But if you don't have the ability to do that, you can fax it or it can be mailed, but we cannot accept claims information via email.
[CUSTOMER][NEUTRAL] Would you, would
[CUSTOMER][NEUTRAL] She said this is, this is the reason why I needed to speak with somebody because [PII], the person who I was supposed to be in contact with, has not had a single con, you know, with me, and I asked what I needed to do, and he gave me a paper to to fill up. I had already turned in my itemized bill from my, from the hospital to my employer and
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I was told that all I needed because [PII] came while we were at work and he just dropped off the paper with the envelope on the PO box where it was gonna be shipped.
[CUSTOMER][NEUTRAL] And said that's all I needed to do. I was.
[CUSTOMER][NEGATIVE] This is frustrating. I'm not trying to take it out on you. It's just very frustrating.
[AGENT][NEUTRAL] No, I understand. No, sir, I understand your frustration. Um, but again, I'm, you know, I'm very sorry for the, for the circumstances and the situation, but the only two things that we received was
[AGENT][NEGATIVE] The claimant statement and then the 2nd page, it was 2 pages where you signed the second one.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Showing that was the authorization to use or disclose your protected health information document. That's all we received. We did not receive any itemized bills.
[AGENT][NEGATIVE] At all.
[AGENT][NEUTRAL] But if you have that information, then yes, once again, cause you can see those remarks that I read to you.
[AGENT][NEUTRAL] In your portal to know exactly what we need.
[CUSTOMER][NEUTRAL] So that
[CUSTOMER][NEUTRAL] So the email that you
[CUSTOMER][NEUTRAL] The email that you sent me, is there like a thing I have to sign up for?
[AGENT][NEUTRAL] Yes sir, that's the portal that I'm referring to and I sent you the instructions for how to set that up.
[AGENT][NEUTRAL] Where you can submit your information to us that way and you can also see the remarks that I read to you on your claim.
[CUSTOMER][NEUTRAL] OK, well I guess I'll, I'll, I'll set up the account and, and call as soon as I send this in because I'm, I'm, I'm sure now I have to wait another 2-3 days for you guys to review this.
[AGENT][NEUTRAL] Yes, so review time once we receive information is 7 to 10 business days.
[CUSTOMER][NEUTRAL] That's crazy. Gosh.
[AGENT][NEUTRAL] But again, I'm sorry, we that we did not receive any of your itemized bills that included your diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] That's crazy.
[CUSTOMER][NEUTRAL] 22.
[CUSTOMER][NEUTRAL] That's crazy. I've been waiting 2 weeks. That's crazy.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] Is there anything else that I can help you with at the moment, Mr. [PII]?
[CUSTOMER][NEUTRAL] No, there's, there's nothing else.
[AGENT][NEUTRAL] OK, well, if that.
[CUSTOMER][NEUTRAL] Who, who, who, who can, who can I make a complaint to?
[AGENT][NEUTRAL] Uh, regarding your
[AGENT][NEUTRAL] Regarding my company or regarding?
[AGENT][NEUTRAL] The information, I, I don't know who was sending us there was someone else sending us this information besides you?