AccountId: 011433970860
ContactId: 433d13fe-15f6-470c-99ac-0c4b58700b45
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 663419 ms
Total Talk Time (AGENT): 207577 ms
Total Talk Time (CUSTOMER): 192513 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/433d13fe-15f6-470c-99ac-0c4b58700b45_20250407T16:28_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I'm calling on behalf of the agent's office to assist on a claim.
[AGENT][NEUTRAL] OK, sure, Miss [PII], I can assist you. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 244-6222
[AGENT][NEUTRAL] OK. And what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][POSITIVE] OK, thank you, Ms. [PII].
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, looks like we received a claim on [PII] and it was processed on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] And which one was that? Because there was 2, there was a wellness and there was uh an accident.
[AGENT][POSITIVE] Uh, it looks like this one is for the wellness. Um, this one is for the wellness this. Mhm, correct.
[CUSTOMER][NEUTRAL] And that was for $50?
[CUSTOMER][NEUTRAL] OK. And what about the accident?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, let me check this paperwork and see what they're needing. One moment.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] I'm waiting on the documents to pull up. OK, one moment.
[CUSTOMER][POSITIVE] Yeah, no problem.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I mean
[AGENT][NEUTRAL] OK, so they need supporting documents based on the explanation of benefits. Um, the supporting documents is gonna be either the office note, hospital admission and discharge summaries, or diagnostic testing results.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, because they
[CUSTOMER][NEUTRAL] They did submit.
[CUSTOMER][NEUTRAL] Documentation of a diagnosis.
[CUSTOMER][NEUTRAL] From the doctor's office.
[AGENT][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] And how um they had ordered a referral to physical therapy.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, it says that um let me see, I'm just reading aside what is in the explanation of benefits, but it says, OK, so this is an acknowledgement of the claim submitted. However, um, need supporting documentation to evidence the accident and when it occurred.
[AGENT][NEUTRAL] And then it's just saying supporting documents include but are not limited to office note, hospital admission, or discharge summaries or diagnostic testing results.
[AGENT][NEUTRAL] So I guess that documents was not enough to determine the accident.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, maybe you could transfer me to a claims examiner, um, just because I'm looking at what what was submitted and I'm just trying to figure out the best way to explain this to.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You wanna go to support. OK.
[CUSTOMER][NEUTRAL] Um, the employee without them, you know, saying, well, we submitted all that because we have like the bills with the diagnosis codes, so I'm assuming maybe the diagnosis codes may not indicate that it was due to an accident, but it.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm, I'm just not 100% sure because they also submitted, you know, laboratory and X-rays and stuff like that, so just trying to get a better understanding or a better way to explain it to the employee.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] I understand Ms. [PII]. Let me go ahead and get the claim support team on the line for us, OK? One moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] Deferring.
[CUSTOMER][POSITIVE] Good morning and thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], how are you? This is [PII].
[CUSTOMER][NEUTRAL] I'm fine thanks how are you?
[AGENT][NEUTRAL] I'm good, thank you. I have a, a broker on the line. Um, her name is [PII] and she's calling about an accident claim. Um, the policy number is 2446222.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And um she's just uh confused about the claim number 3583264. I did read out what we're needing, but she said that um she believes that they send all the information that is needed, so she needs to help understanding why we're still asking for these things or what's the purpose.
[CUSTOMER][NEUTRAL] OK, I'm sorry, what was the claim number?
[AGENT][NEUTRAL] It's 3583264.
[AGENT][NEUTRAL] For [PII], I'm sorry, part 2, part 2. I'm so sorry, yeah, part 2.
[CUSTOMER][NEUTRAL] Is it under, what's the, the part?
[CUSTOMER][NEUTRAL] OK, and I'm sorry, I'm sorry, can you tell me again what the claim number was?
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] Oh, I'm sorry, what was the claim number again for part two?
[AGENT][NEUTRAL] 3583264.
[CUSTOMER][NEUTRAL] OK, give me just a second.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you ready for her?
[CUSTOMER][NEUTRAL] Oh, I'm still pulling up the information. Um, are you able to tell her to give me just a second so I can pull the information and be able to assist her.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me put you on hold and go back to her, OK? One moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding Mr.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK. Uh, I have Ms. [PII] on the other line. She's trying to go through all the paperwork before she gets the call, OK? But she's getting ready to speak to you, OK? It's gonna be one more minute. I'm sorry.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, just let me know when you're ready, OK?
[CUSTOMER][NEUTRAL] OK, I'm just still pulling it up here, the claim.
[CUSTOMER][NEUTRAL] OK, I have everything up, so thank you. um, and so you said her name was [PII] and do you have a, a callback number?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][POSITIVE] OK, great, thank you.
[AGENT][POSITIVE] You're welcome. Here she goes. Thank you. Thank you for holding, Ms. [PII]. I got Miss [PII] on the line for us.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][POSITIVE] Thank you for holding, this is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi [PII], I was just trying to get um a better explanation of the supporting documents that are needed. Um, when I was on the phone with the employee earlier, she seemed a little upset that she saw the claim showed zero amount paid online, um.
[CUSTOMER][NEUTRAL] So I just wanna make sure I have a clear explanation when I give her a call back on.
[CUSTOMER][NEUTRAL] What documents to get because I, I see that we uploaded the first office visit with the diagnosis, then there was um some X-rays done from that visit.
[CUSTOMER][NEUTRAL] So the [PII] was the first visit and the diagnosis and then they had X-rays done and then um.
[CUSTOMER][NEUTRAL] A referral was sent for.