AccountId: 011433970860
ContactId: 229d0325-d4a6-4d55-a849-bffbd39f15d5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 307899 ms
Total Talk Time (AGENT): 120019 ms
Total Talk Time (CUSTOMER): 67105 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/229d0325-d4a6-4d55-a849-bffbd39f15d5_20250416T22:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi sir, my name is [PII]. Um, I had a question on my, uh, on my claims. I uploaded a claim for blood work and I haven't gotten anything like responded to see if it was gonna get covered or not.
[AGENT][NEUTRAL] OK. Do you have your policy number?
[CUSTOMER][NEUTRAL] That number.
[CUSTOMER][NEUTRAL] The policy shirt number on the card?
[AGENT][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] That would be 02584974.
[AGENT][NEUTRAL] Alright let me pull this up here one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right. And then [PII], I will need to get please for verification, your date of birth and address.
[CUSTOMER][NEUTRAL] OK, on [PII].
[AGENT][NEUTRAL] And then can I get your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Alright, so it looks like all the claims submitted on the [PII], that was a week ago today, are still in a pending status. Nothing has been decided on them.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, generally claims take about 5 to 7 business days. We do only work Monday through Friday, so hopefully you should hear something by the end of the week as far as the decision on them.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] Do you know if my plan actually covers blood work just by a win?
[AGENT][NEUTRAL] Uh, I can pull the policy and take a look here.
[AGENT][NEUTRAL] OK. So it looks like
[AGENT][NEUTRAL] Did you have it, the lab work done like at an office for a doctor, or was it at a lab facility?
[CUSTOMER][NEUTRAL] It was done at a lab called Quest Diagnostics.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I don't see that laboratory tests are covered on here.
[AGENT][NEUTRAL] Um, I just showed like diagnostic testing, but that would not be considered lab tests. That's like medical imaging.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So that would mean there was nothing done with that?
[AGENT][NEUTRAL] Yeah, so if it's not covered, it'll just be denied and then you'll be sent out an explanation of benefits just showing why um it would just say that it wasn't a covered um.
[AGENT][NEUTRAL] Benefit under your policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I assume they haven't sent out anything like that yet because I haven't received anything.
[AGENT][NEUTRAL] Yeah, no, and you wouldn't have gotten anything like that yet because everything is still in progress, like they haven't denied anything or approved anything yet, so it would need to be processed before you would get any of that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did your name is
[CUSTOMER][NEUTRAL] Well, right now I just gotta wait.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Oh, I was just saying right now I just got a waiter.
[AGENT][NEUTRAL] Yeah, I mean there's nothing else more that we can do at this time um if you want to call back and check on it, I would recommend waiting until Friday um but yeah it's, you know, you just have to wait for the claims department to process it at this point.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um, but it's on file, right? The, um, because I, I submitted like the.
[CUSTOMER][NEUTRAL] The file for the claim and the bill, so that could actually be looked over. I think that one should be on there now. OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][POSITIVE] Yep, everything is there, so yeah, just give it a couple more days, right?
[CUSTOMER][POSITIVE] OK, thank you very much.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.