AccountId: 011433970860
ContactId: 417e12fe-5c1a-45c3-b04d-cd1f8492d590
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 446320 ms
Total Talk Time (AGENT): 158100 ms
Total Talk Time (CUSTOMER): 90298 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.4, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/417e12fe-5c1a-45c3-b04d-cd1f8492d590_20250521T18:36_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEGATIVE] Yes, I have a problem with the claim.
[AGENT][NEUTRAL] OK, may I ask who's calling?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], what is the policy number?
[CUSTOMER][NEUTRAL] Group number or?
[AGENT][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] Oh, I get 01660267.
[AGENT][NEUTRAL] OK, thank you. One moment please.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And verify your date of birth, mailing address and email address, please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] And whatever else you have on record is correct. I've done this 100 times. I need to speak to somebody about my problem.
[AGENT][NEUTRAL] I understand sir, but I need to verify who you are. It's part of verification is your mail address and email address please.
[CUSTOMER][NEUTRAL] [PII], mailing address is [PII]. I don't know what email address you have on record. It's probably [PII], but I have multiple email addresses. I don't know what you have on record. I need assistance with this. I've given you my group number, my number. Can we please move on?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I just got a call a little while ago, OK? And somebody called me and said that the claim was being denied for the 3rd time and I need to speak to somebody who's gonna help resolve this.
[AGENT][NEUTRAL] OK, what was the date of service of the claim?
[CUSTOMER][NEUTRAL] Do you have any information about the most recent claim?
[AGENT][NEUTRAL] Well, the most recent claim ratio, go ahead.
[CUSTOMER][NEUTRAL] The data service
[CUSTOMER][NEUTRAL] It currently it's [PII] is the date of service.
[AGENT][NEUTRAL] Uh, do you have the name of the providers in regards to?
[CUSTOMER][NEUTRAL] Quest Diagnostics.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK one moment.
[AGENT][NEUTRAL] Because most recent claim process as a duplicate, uh, claim previously needed itemized billing.
[AGENT][NEUTRAL] What diagnosis and procedure codes?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That is correct and I resubmitted the claim with the bill from Quest.
[AGENT][NEUTRAL] And that claim process is a duplicate.
[AGENT][NEUTRAL] One moment, see what we received.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] OK, let me transfer you to um a representative for the claims department because it looks like you had spoke to a representative and they state that on the EOB looks like it was.
[AGENT][NEUTRAL] Added on the EOB we received, but we're still needing itemized billing, but hold on one moment, please.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Rude, no phone.
[CUSTOMER][NEUTRAL] Transferring.
[AGENT][NEGATIVE] Rude.
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling AP. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey, [PII], um, I have an insurer on the phone who is irate. He's refused, oh well, he at first didn't wanna verify his information and got a little testy with me, but it's OK.
[AGENT][NEUTRAL] Anyway, uh, it looks like someone had called him and told him, um, about his claim it's on a Medlink, and I explained to him.
[CUSTOMER][NEUTRAL] What's the policy number?
[AGENT][NEUTRAL] 1660267.
[CUSTOMER][NEUTRAL] And what claim is, who is it? what claim is it in regards to?
[AGENT][NEUTRAL] Uh, the data service is 42, um, the last claim that was processed was a duplicate, the 3600626.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] The diagnosis codes are on the claim, but it's on the EOB. It wasn't necessarily the additional documentation from the provider.
[AGENT][NEUTRAL] It just looks like someone added the diagnosis codes on the EOB.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Right, so we would need that supporting documentation from the provider.
[CUSTOMER][NEUTRAL] We can't, we don't accept the diagnosis written in.
[CUSTOMER][NEUTRAL] Or typed in.
[AGENT][NEUTRAL] OK, can you explain it to him before he starts screaming at me?
[CUSTOMER][NEUTRAL] Yeah, I can explain it to him.
[AGENT][NEUTRAL] You know, I explained to them [PII].
[CUSTOMER][NEUTRAL] And this is Mr.
[CUSTOMER][NEUTRAL] Right, OK.
[AGENT][NEGATIVE] Please don't ask for uh verify his information. He's already good. I'm sorry, I'm being pissy. Um.
[AGENT][NEUTRAL] And I did verify what I can, um, and the information is correct. I know when you're ready, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure you can send them to me.
[AGENT][POSITIVE] Alright, I appreciate you.
[CUSTOMER][POSITIVE] Mhm. You're welcome.
[AGENT][NEUTRAL] Bye.