AccountId: 011433970860
ContactId: 10ccca96-11ff-433b-96e7-e161720c63aa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 712150 ms
Total Talk Time (AGENT): 425411 ms
Total Talk Time (CUSTOMER): 155985 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/10ccca96-11ff-433b-96e7-e161720c63aa_20250415T13:02_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]
[CUSTOMER][NEUTRAL] I put in a claim last week for.
[CUSTOMER][NEUTRAL] About 3 to 4 appointments that I had last year.
[CUSTOMER][NEUTRAL] And I just got a notification that it's completed, but when I went to the app, the amount paid says 0, so I'm trying to think I can get some more clarity on it.
[AGENT][NEUTRAL] OK, I am so sorry. I can, I can barely understand you. It sounds like you're just a long way with a lot of static on the line.
[CUSTOMER][NEUTRAL] OK, one second.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Is it better?
[AGENT][NEUTRAL] Uh, that is a little better, yes, ma'am. So, did you say that you put a claim in or claims, you received a notification, but you're not able to see the status when you log in. Is that correct?
[CUSTOMER][NEGATIVE] No, I put a claim in and the notification that I received says it's completed, uh, but it says that the amount paid is 0.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so you're needing to see about the claim status on that claim, is that correct? Yes, ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] Yes, ma'am. Mhm. Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII], um first name is spelled [PII] Last name is spelled [PII]
[AGENT][NEUTRAL] And how do you pronounce your last name, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], OK. All right, thank you. And then what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] 01 2nd, I'm driving. Hold on.
[AGENT][NEUTRAL] OK. [PII], if you're the primary subscriber on the policy, if it's easier, I can look it up with your social. I don't want you to not be safe if you're driving.
[CUSTOMER][NEUTRAL] Policy number is 2485386.
[AGENT][NEUTRAL] OK, thank you. Give me a couple of moments please to get your policy information pulled up first off.
[CUSTOMER][NEUTRAL] Sure, yeah.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. I will need to verify several things with you first for security. So first off, if you would please verify your date of birth.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And your home mailing address, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your zip code?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. The phone number that is 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][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, thank you. And lastly, what is your email address, please, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you very much.
[AGENT][NEUTRAL] OK [PII], so I do see that we only have one claim on file for you and yes ma'am, um, that has been reviewed it went through our, you will be able to see this information later it has even though it went through our nightly processing last night, it still takes a little time for you to be able to see your explanation of benefits.
[AGENT][NEUTRAL] So any time you have a claim and it's the same scenario where you've gotten a text saying that it's been reviewed and you can't see it then always call us, OK? And we'll be happy to uh look at it with you. So on this claim, yes ma'am, I can see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] That it was denied and give me just a moment to get the remarks pulled up.
[AGENT][NEUTRAL] OK, so yes, ma'am, I can see it was for multiple dates of service. So for your data service back in June.
[AGENT][NEUTRAL] Of [PII].
[AGENT][NEUTRAL] It states that receipt of your claim is acknowledged. However, in order to provide further consideration of this loss under this policy, we will need supporting documentation to evidence the accident sickness. Supporting documentation may include, but is not limited to itemized bills with the diagnosis codes.
[AGENT][NEUTRAL] Super bills, office notes or hospital admission and discharge summaries and or diagnostic testing. So we just need some additional information, it appears that it's the diagnosis.
[CUSTOMER][NEUTRAL] Um, I, the document that I submitted, that doc the document that I submitted was 2 pages and the bottom half had like the itemized bill on it. So it had the um the, the charge code and everything on it.
[AGENT][NEUTRAL] For that data service.
[CUSTOMER][NEUTRAL] I don't know if you're able to see that part and tell me if that's the like the accurate document that they need.
[AGENT][NEUTRAL] OK, so let's let me look at the uh the other ones. Let me just go through the remarks first. So that was for the [PII] data service that was an outpatient.
[AGENT][NEUTRAL] Looks like a facility charge. Then there was an office visit on [PII], but office visits are not covered under this supplemental policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So that's why that now for your [PII] data service also it states the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the next date of service for [PII], it also states the same thing as far as the service is not covered when performed in a doctor's office or clinic.
[AGENT][NEGATIVE] Office visits are not covered.
[AGENT][NEUTRAL] And then there was one additional charge. It states policy provides no benefits for the treatment of conditions other than a sickness or injury as defined by the policy.
[CUSTOMER][NEUTRAL] And which one is that one for?
[AGENT][NEUTRAL] That is also for the 228 data service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, as.
[CUSTOMER][NEUTRAL] OK, so the one that's um
[AGENT][NEUTRAL] As far as your 610, no, ma'am, I was gonna say for the 610 data service, give me just a moment and let me see what.
[CUSTOMER][NEUTRAL] Sorry, go ahead.
[AGENT][NEUTRAL] That was for Northeast Endoscopy. It's what it looks like that data service was for. So give me one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so let's see. So I see on 6:10, I see the the explanation of benefits.
[AGENT][NEUTRAL] But it doesn't, an explanation of benefits is that you, there's 31 pages, so let me look. That doesn't have the diagnosis code on it. That just is the
[AGENT][NEUTRAL] What was billed.
[AGENT][NEUTRAL] So let me keep looking.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] And you said that the diagnosis code would have been on the last page?
[CUSTOMER][NEGATIVE] So, um, when I download the attachment because I download it right from my, um, insurance company, the claim, the bottom half has like the break it and then it has like the diagnostic code or whatever I, I believe, but I'm not correct.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] OK, so, no, ma'am, those codes that are on, on your explanation of benefits or for what the procedures were.
[AGENT][NEUTRAL] We need the diagnosis code which tells why they did it, why they did, you know, your test.
[CUSTOMER][NEUTRAL] OK, OK, um, if I get that in today.
[AGENT][NEUTRAL] So that's the
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] Mhm. No, ma'am, go ahead with your question.
[CUSTOMER][NEUTRAL] If I
[CUSTOMER][NEUTRAL] If I get that in today, do you know how long it would take for it to process again?
[AGENT][NEUTRAL] Probably I mean it's once we receive information on this type of claim, it's usually about 5 to 7 to 10 business days, but it could be sooner. That's just an approximate. But you can upload that information into your portal just like you did this other. Now when you upload it in there, [PII], you can't attach it to this specific claim number, so you're just gonna upload it like.
[AGENT][NEUTRAL] You're submitting a new claim, but our system will know that that is documentation that we were.
[AGENT][NEUTRAL] You know, in need of for further review on this claim.
[AGENT][NEUTRAL] Does that make sense?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So, yes, ma'am, just upload it, uh-huh, just upload it and you should get another confirmation that it was received by us. And then everything as far as that goes will be just like this time. And then once it's been reviewed, you should receive another text alert.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And I, I just basically need to um
[CUSTOMER][NEUTRAL] Um, I just basically need to contact the doctor's office and I'm asking them for a diagnostic bill or itemized bill.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] I would ask them for an itemized bill with a diagnosis, DIAG.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] NOSIS, the why you had it done. We, we know what you had, we just need the why you had to have it done.
[AGENT][NEUTRAL] Does that make sense? So, diagnostic is actually what the, they did, OK? So, diagnosis is the why.
[CUSTOMER][POSITIVE] OK, OK, cool.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, OK. I will get in contact with them and have that emailed to me.
[AGENT][NEUTRAL] OK, well, is there anything else at the moment, [PII], I can help you with?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] Well, it was um my pleasure in speaking with you today. Thank you so much for calling APL and I hope you have a very nice day.
[CUSTOMER][POSITIVE] Thank you. You as well.
[AGENT][POSITIVE] Yes, ma'am. Thank you too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.