AccountId: 011433970860
ContactId: 1dd924f8-94f8-4df8-b15e-51744280b62a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 254399 ms
Total Talk Time (AGENT): 108899 ms
Total Talk Time (CUSTOMER): 109332 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/1dd924f8-94f8-4df8-b15e-51744280b62a_20250502T15:43_UTC.wav
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[CUSTOMER][NEUTRAL] Hm.
[AGENT][POSITIVE] Good morning. Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], this is [PII] in the customer service department. I've got, um, how are you?
[AGENT][NEUTRAL] Hey, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I've got an agent on the phone. She's calling in regards to an insured's policy. She's wanting to check the claim status.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's Ms. [PII].
[CUSTOMER][NEUTRAL] And I did verify that she is with the agent's office, and she also did verify the name of the um insured and the address as well. So the policy number is 2477075 [PII], and she verified the date of birth too.
[CUSTOMER][NEUTRAL] She said the claim was sent in last week.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So she I guess she's just wanting to see if we process and if you know, I guess the status of everything um her callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alright, I'm ready for it. And you said Ms. [PII]?
[CUSTOMER][NEUTRAL] Alright, here she is, yes, ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, here she goes, thank you.
[AGENT][NEUTRAL] Welcome.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hey, this is [PII] on the care team. So I'll be assisting you with the claim status, and she said it was sent in last week.
[CUSTOMER][NEUTRAL] Uh, the [PII]. I, I sent in the EOB last, uh, on the [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Was it for?
[AGENT][NEUTRAL] There were a few from Quest Diagnostic? OK.
[CUSTOMER][NEUTRAL] For, for quite
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Here we go. I just wanted to make sure I was in the right place. Hold on one moment, let me see what's going on with this claim.
[AGENT][NEUTRAL] So we have received the claim were you needing the claim status or you just want to know if we received it?
[CUSTOMER][NEUTRAL] Well, I wanna make sure it was received. Um, has it been paid out or do you need any additional um information? Are we, I just wanna make sure it was basically being paid out. The rep I transferred me said it was something was paid yesterday but she wasn't sure what.
[AGENT][NEUTRAL] See what was going on.
[AGENT][NEUTRAL] Oh, OK. So, I do have the claim here now, it was not paid, the claim was denied, but it was denied for additional information. Um, this claim here, let me see if this is, this is different. Um, that's a different claim from a different provider. Um, but for the claim you're calling in reference to, so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The, the office visit code was denied because office visits are not covered on the policy, but then all the other codes were denied requesting the um diagnosis code so that could be an itemized bill, doctor's note, discharge, some just anything that shows the the diagnosis.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so there, there's codes on there, so that's not what you need.
[AGENT][NEUTRAL] Right, so those codes are the procedure codes, so that just tells us what what they received and how much they paid for it, but we need to know why.
[CUSTOMER][NEUTRAL] OK, so you need the diagnosis code and you said that could come from uh a the the provider can submit that.
[AGENT][NEUTRAL] Yes, ma'am. It can be an itemized bill. It could be the doctor's note, um, I don't know if it was a hospital, if their discharge summary, um, any test results, just something showing the diagnosis code.
[CUSTOMER][POSITIVE] Got it OK alright I will let her know that. OK, thank you for checking on that.
[AGENT][NEUTRAL] You're very welcome and all the information provided was a verification of benefits, not a guarantee of payment. Was there anything else I can help you with today, Ms. [PII]?
[CUSTOMER][POSITIVE] No, that's it. Thank you again.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a great weekend.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.