AccountId: 011433970860
ContactId: 2e249d9d-dcfa-46da-baa4-534554711d1e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 384700 ms
Total Talk Time (AGENT): 132734 ms
Total Talk Time (CUSTOMER): 131806 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/2e249d9d-dcfa-46da-baa4-534554711d1e_20250602T14:29_UTC.wav
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[AGENT][POSITIVE] Good morning thank you for calling ATL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. I'm calling about a claim that I submitted and I've never used this kind of insurance before, so I'm just curious to see.
[CUSTOMER][NEUTRAL] How things are going and if I submitted everything correctly.
[AGENT][NEUTRAL] OK, do you have a phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Thank you. And do you have your policy number?
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] 02592554
[AGENT][NEUTRAL] Thank you, hold on one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And can I verify your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Can I verify your address and email address, please?
[CUSTOMER][NEUTRAL] [PII] and the email is [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And you want to know the status of the claim that you had sent in and how it's being processed?
[CUSTOMER][NEUTRAL] Yeah, because at first I sent in forms and then they said and I got a response saying.
[CUSTOMER][NEUTRAL] I did not submit the charges, so then I resubmitted the invoice from the doctor's office the 2nd time, so I didn't really know what I was doing.
[AGENT][NEUTRAL] OK. Hold on just a moment. Let me look at it for you.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I see where we got it in.
[AGENT][NEUTRAL] And they were asking for information on
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One and then we got some more information in and it was denied. We are in receipt of claim form that was completed by you. However, there were no charges submitted. If you are needing to file a claim, please submit the itemized charges in order for benefits to be considered.
[CUSTOMER][NEUTRAL] And that's what I did the 2nd time.
[AGENT][NEUTRAL] S
[CUSTOMER][NEGATIVE] But I don't know through your portal there wasn't a way for me to.
[CUSTOMER][NEUTRAL] Like do an addendum to that first claim, so I just resubmitted the new.
[CUSTOMER][NEUTRAL] Which is called the um the invoice.
[AGENT][NEUTRAL] When did you send a new claim in?
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] When did you upload it?
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Um, it was sometime around [PII] because then I got a, a letter from you guys saying that you've received the claim on the [PII].
[AGENT][NEUTRAL] Yes, ma'am, we did, and that's what it was denied for asking for more information. So it's, we still need the information they were asking for the first time, um, on all.
[CUSTOMER][NEUTRAL] OK, how do I get that to you?
[AGENT][NEUTRAL] All claims we need an itemized bill.
[CUSTOMER][NEUTRAL] OK, I have that.
[AGENT][NEUTRAL] That has the procedure codes and diagnosis codes.
[AGENT][NEUTRAL] And the charges
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then we need the explanation of benefits from your primary insurance showing what was applied to your deductible co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then when I have that, how do I submit it?
[AGENT][NEUTRAL] You can submit it through the portal like you did the other one. Yes, ma'am.
[CUSTOMER][NEUTRAL] Through portal, so it'd be like a 3rd upload, OK.
[AGENT][POSITIVE] Yes ma'am, you can just upload it. It doesn't have to be.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, yeah, the, the invoice I have from them, it has the procedure.
[CUSTOMER][NEUTRAL] The diagnosis, I'm trying to see if it has a code.
[CUSTOMER][NEUTRAL] I mean it has description of services and it has like code numbers before them, so I assume that's what you need.
[AGENT][NEUTRAL] Right, it, it probably doesn't have the diagnosis code, so you'll probably have to call them and tell them you need something with the diagnosis code. Most of the time on the bills, they do not put the diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The diagnosis code is what you went there for the procedure codes is what they did while you were there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, I will get in touch with them and try to get this.
[CUSTOMER][NEUTRAL] Today and send it out to you.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] Um, that's it for now. Thank you.
[AGENT][POSITIVE] Thank you, Ms. [PII] for calling APL. You have a good day.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][POSITIVE] Thank you