AccountId: 011433970860
ContactId: 35bab347-35e6-4bc0-bf45-92cd849452f6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 343130 ms
Total Talk Time (AGENT): 126585 ms
Total Talk Time (CUSTOMER): 155458 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/35bab347-35e6-4bc0-bf45-92cd849452f6_20250311T16:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi there, I had a question about a claim.
[AGENT][NEUTRAL] Sure, I can look at that claim for you. Uh, what was your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Last name is spelled [PII]
[AGENT][NEUTRAL] OK, was this claim for you, [PII]?
[CUSTOMER][NEUTRAL] It's for my son.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright and then uh can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] 253.
[CUSTOMER][NEUTRAL] 6441.
[AGENT][NEUTRAL] OK, thank you, and I'm just gonna verify some information really quick. Uh, can I get your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address we've got on file for you. uh, looks like it is a Hotmail account.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Got it. OK, thank you so much for verifying that information, [PII]. uh, so this was for, uh, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Alrighty, give me just a moment, let me take a look here.
[AGENT][NEUTRAL] OK, so looks like there were a couple of items on this claim, so the first.
[AGENT][NEUTRAL] Was for an X-ray.
[AGENT][NEUTRAL] And which that is not going to be covered under this policy. Uh, it does state that diagnostic X-rays are not covered. The other item, however, uh, looks like we're missing some information. Uh, we need the fully itemized bill that shows diagnosis and procedure codes.
[AGENT][NEUTRAL] And you can get that from the provider that he went to for treatment.
[CUSTOMER][NEUTRAL] So, so my first thing is I received uh documents in the mail from you that I needed to fill out the accident claim form which I have it. I, I filled it out and then it's like the authorization to request information from protected health and I filled that and I can I can send those over.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] So my fir my my first question is do I to send these over to you do I just upload these files as like a new claim?
[AGENT][POSITIVE] You absolutely can.
[AGENT][POSITIVE] That is perfectly fine. Mhm.
[CUSTOMER][NEUTRAL] And, and you can
[CUSTOMER][NEUTRAL] OK, and you and you'll be able to link that to this existing plan.
[AGENT][POSITIVE] Yes, that's perfectly fine.
[CUSTOMER][NEUTRAL] OK, and then my, my next part is on that the, the documents that I had already sent over.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, because I, I guess I should have filled out the accident claim form along with this and sent it over. It would have been easier, but I just, I, I wasn't understanding how to submit the claim.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] But the document I sent over from, so the provider was the urgent care. So I got, I got the medical notes and it shows that there was an X-ray. It's got the date, it has the doctor, it has the uh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Who's the other document?
[CUSTOMER][NEUTRAL] Maybe.
[CUSTOMER][NEUTRAL] Yeah, I didn't send that over. Oh wait, no, that's for me, so.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It has the document notes, it, it doesn't have.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like a diagnosis code on their notes though.
[AGENT][NEUTRAL] Right, right, um, most of the time that's not going to be something they would just hand you uh unless you ask for it, uh, so we do need that itemized statement that shows the diagnosis and procedure codes so you can ask them for that information to send you if there's any confusion, um, they're more than welcome to give us a call as well we do talk to providers all the time.
[CUSTOMER][NEUTRAL] OK, and then the only, so the only benefit this would would apply to is just that it went to a like a an office is, is that the only thing that this claim is gonna qualify for?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Um, I couldn't tell you that 100% without the claim first being filed, as I'm not quite sure what all kinds of treatment he received.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I need to go back to them and ask them for uh the diagnosis comes on a more detailed uh.
[AGENT][NEUTRAL] The, yes, so the itemized statement that shows diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then when I, I mean when I be able to receive that, I just upload that as another document.
[AGENT][NEUTRAL] All right, yes.
[AGENT][POSITIVE] Yes, that's perfectly fine.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, did you have any questions for me? Yes.
[CUSTOMER][NEUTRAL] OK, and if, and if they have a question, can they contact you at this same phone number?
[AGENT][POSITIVE] Absolutely, yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, that was my last question.
[AGENT][POSITIVE] Alright, well thanks for giving us a call, [PII]. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.