AccountId: 011433970860
ContactId: 41467f36-ea2c-4e6a-8734-5cabebcb1e1e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 441220 ms
Total Talk Time (AGENT): 180169 ms
Total Talk Time (CUSTOMER): 163239 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/41467f36-ea2c-4e6a-8734-5cabebcb1e1e_20250515T13:40_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. I'm calling because I have submitted a couple claims via email because I had an issue in the website.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, last week they called me, they said they need the form, uh, like one form from the clinic. I got it, but
[CUSTOMER][NEUTRAL] They already processed two of the claims.
[CUSTOMER][NEUTRAL] So I have other claims that I don't know the status. Can you help me, please?
[AGENT][NEUTRAL] Yes, ma'am. Uh, what's your name and your policy number, please?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Policy number is 2593894.
[AGENT][POSITIVE] OK, thank you so much. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and verify your date of birth, mailing address and the email address, please.
[CUSTOMER][NEUTRAL] Date of birth [PII]. What else do you need?
[AGENT][NEUTRAL] Mailing address and email address.
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] And email address is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So you say you had submitted a claim via email and I'm assuming we needed additional information and you have that and wanted to submit that to us?
[CUSTOMER][NEUTRAL] Yes, so I submitted to on the website, right?
[AGENT][NEUTRAL] OK
[CUSTOMER][NEGATIVE] And they asked me for more documents. When I submitted the documents, it went through as a duplicated claim, and then nothing happened. So I sent an email and they said, please send via email.
[CUSTOMER][NEUTRAL] So I sent the new claims as well. I sent everything via email.
[CUSTOMER][NEUTRAL] So they processed 2, and there's 3 pending, but I don't know the status of these 3.
[AGENT][NEUTRAL] Uh, when was the claim email? because I don't, um, the most recent claim received is on [PII].
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] What do you mean they send like an email?
[AGENT][NEUTRAL] Yes, ma'am, you said you had emailed the claim and I'm asking when did you email that claim because the last claim I'm showing received was on [PII] and it was processed on [PII].
[CUSTOMER][NEGATIVE] I don't feel it.
[CUSTOMER][NEUTRAL] I sent an email on [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The email was sent on [PII] at [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, because, um, as far as if you have any other documents, you can still submit those for review.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] So, they didn't go through?
[AGENT][NEUTRAL] Well, I don't, like I said, I show we received a claim on [PII]/7. You say you send the email on [PII].
[CUSTOMER][NEUTRAL] Yes, on [PII].
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so I'm assuming that's the email, so that's the claim that was processed on the [PII] and the check was sent. Did you ever receive that payment?
[CUSTOMER][NEUTRAL] So no, how does that work? I see it was processed here, but I never, I entered my bank account after that, so I don't know how you guys send the payment via check in the mail. Is that how it works?
[AGENT][NEUTRAL] Well, it looks like with this last claim it was processed on the [PII], a check was sent.
[CUSTOMER][NEUTRAL] A check is sent to my address.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. So I have to pay Quest and then I cash the check.
[AGENT][NEUTRAL] Well, the check is yours. I mean, um.
[AGENT][NEUTRAL] It's up to you can question not, but the check is.
[CUSTOMER][NEGATIVE] Right, but I have to pay class. I thought you guys pay class. No.
[AGENT][NEUTRAL] That's if they submit the claim and benefits are assigned, then we do pay the provider, but if an insured submits the claim, um, and has the information we need, we do pay the insured, so.
[AGENT][NEUTRAL] Since we didn't receive the claim from Quest, we paid you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, now,
[CUSTOMER][NEUTRAL] What about the other claims?
[AGENT][NEUTRAL] OK, because other claims I'm showing they were.
[AGENT][NEUTRAL] Or some processes office visits are not covered and it's the same as one for the duplicates. These were in [PII].
[AGENT][NEUTRAL] And that was processed. That's the one where the check was paid was for the [PII] day of service.
[AGENT][NEUTRAL] And there were other charges that were processed as office visits are not covered.
[CUSTOMER][NEUTRAL] Right, I know that.
[CUSTOMER][NEUTRAL] Right, but what I send it to you are not office visits. I already paid for all the office visits that I'm aware. What I sent it to you was exams that my doctor was concerned about my health, requests to do these exams, so I did it.
[AGENT][NEUTRAL] Because some claims I'm showing and received were for lab charges for Quest Diagnostics, which was processed as duplicate several times, but those were received on the.
[AGENT][NEUTRAL] [PII], which processed on the [PII], so I don't show any other pending claims.
[CUSTOMER][NEUTRAL] OK, I'll submit everything online I guess.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEGATIVE] I have to submit everything online again.
[AGENT][NEUTRAL] I'm just saying if you have additional documents, you can submit that to us, but the previous claims that were processed were for days of service of [PII] for request diagnostics, and those were processed as duplicates until we receive the information on the [PII], which was processed and paid.
[AGENT][NEUTRAL] But as far as any pending claims, I don't show any pending claims.
[CUSTOMER][NEUTRAL] OK, I'll submit again.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty thank you.
[AGENT][POSITIVE] Yes, ma'am. Thanks for calling APL. Have a great day, Ms. [PII].
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.