AccountId: 011433970860
ContactId: 49948763-89db-4ec0-8132-6ef911dbfbe4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 496720 ms
Total Talk Time (AGENT): 184372 ms
Total Talk Time (CUSTOMER): 185355 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/49948763-89db-4ec0-8132-6ef911dbfbe4_20250408T18:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, how are you doing? This is [PII]. How are you?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][NEUTRAL] Good thank you. Listen, we recently filed a claim uh with you guys and we uh got a response not too long ago but I didn't understand the final um conclusion. Can you walk me through it, please?
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] Yes, I can help you with claim status. Can I get your name again? I'm sorry, I didn't catch it.
[CUSTOMER][NEUTRAL] No, that's fine. [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Complete name [PII] mhm.
[AGENT][NEUTRAL] And is the claim for yourself or are you with the provider?
[CUSTOMER][NEUTRAL] My wife.
[AGENT][NEUTRAL] Your wife, OK. Do you have your policy number one?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, uh, let me see. Payer ID or?
[AGENT][NEUTRAL] Uh, it should be a certificate.
[CUSTOMER][NEUTRAL] Let me see, group number payer ID?
[AGENT][NEUTRAL] Uh, certificate number or policy number?
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Are you looking at your card?
[CUSTOMER][NEUTRAL] I have right in front of me the APL card and I only see payer ID group number uh plan.
[CUSTOMER][NEUTRAL] Uh, oh, in hospital benefits certificate number. I see it now.
[AGENT][NEUTRAL] OK, what's that.
[CUSTOMER][NEUTRAL] You need that one in hospital, right?
[AGENT][POSITIVE] Yes, that's good.
[CUSTOMER][NEUTRAL] [PII] [PII] [PII] [PII] [PII] [PII]
[AGENT][NEUTRAL] OK, thank you. And do you have a good callback number, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said the claim was for your wife, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you have her birth date?
[CUSTOMER][NEUTRAL] Do they have a what?
[AGENT][NEUTRAL] Uh, her birthday.
[CUSTOMER][NEUTRAL] For her birthday, uh, yes, uh, [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, thank you. What is your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What.
[AGENT][NEUTRAL] And then lastly, your email address.
[CUSTOMER][NEUTRAL] Did you?
[AGENT][NEUTRAL] Um, your email?
[CUSTOMER][NEUTRAL] My email 1 [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, um, let's see, so was this for [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, OK.
[AGENT][NEUTRAL] Um, it looks like we need the primary explanation of benefits. So do you have insurance through Florida Blue or Aetna or?
[CUSTOMER][NEUTRAL] We, we did, we did send the um the the summary of benefits.
[AGENT][NEUTRAL] OK, let me see what we.
[CUSTOMER][NEUTRAL] We did attach the document we we did attach to that document and also the um I guess the invoice or the um.
[CUSTOMER][NEUTRAL] Whatever the issue for her.
[AGENT][NEUTRAL] OK, let me pull up what we were.
[CUSTOMER][NEUTRAL] Do you want me to send it to you directly?
[CUSTOMER][NEUTRAL] Say say that again, I'm sorry.
[AGENT][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] I'm gonna pull up what we received. Hold on one moment.
[CUSTOMER][NEUTRAL] Oh, OK, OK, OK, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, I pulled up what we received looks like.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] So we received a statement of the account.
[AGENT][NEUTRAL] From concierge diagnostics.
[AGENT][NEUTRAL] But
[CUSTOMER][NEUTRAL] Right, that's the, the, I guess the invoice or bill, yeah, mhm.
[AGENT][NEUTRAL] OK, but we, we need a copy of the explanation of benefits. Who is your primary insurance through? Is that UnitedHealthcare?
[CUSTOMER][NEUTRAL] Again
[CUSTOMER][NEUTRAL] Yes, uh, and again, we did, um, attach that. You don't see it on your end?
[AGENT][NEUTRAL] I see a summary of benefits and coverage. That's just uh, that doesn't show us how UnitedHealthcare paid the claim.
[AGENT][NEUTRAL] I do show that you attached your summary of benefits and coverage, but that just gives a breakdown of how.
[CUSTOMER][NEUTRAL] OK, so I, right, then I don't understand what is it that you need. I'm sorry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We need something from UnitedHealthcare that shows what they paid, how they process this exact claim.
[AGENT][NEUTRAL] So, have they, have you, have they processed this claim yet? United Healthcare?
[CUSTOMER][NEUTRAL] Well, no, because we didn't file a claim with them. Oh, you did? Oh, you did file a claim. Do you have that information then?
[CUSTOMER][NEUTRAL] OK, that's what they need. OK, now that I understand what they need, uh, we're gonna call um United Health and then get that document and then upload it to you guys. Do we have to uh open a new claim or is it a way for us to
[CUSTOMER][NEUTRAL] Uh, follow up
[AGENT][NEUTRAL] Yeah, just reference the claim, yeah, reference the claim that we've already processed that 3582921. You don't have to upload a new claim, but there's also one other piece of information that we need. We need the diagnosis. So what, what was, what was the diagnosis was there were, you know, that's what we're missing as well. We see what procedures were performed, but it doesn't have a diagnosis.
[CUSTOMER][NEUTRAL] Online
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So a diagnosis would be like there was, I was having pain or there was a lump or something like that. So we need the diagnosis information.
[AGENT][NEUTRAL] So there's 2 pieces of information.
[CUSTOMER][NEUTRAL] Right, but the diagnosis is.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That the diagnosis is given by the doctor, I'm assuming, or by whom?
[AGENT][NEUTRAL] Yes, so either from, yes, from the doctor or if they have an actual claim, that will be on the claim claim itself. But yes, we just need something that verifies what was the diagnosis, why she was seen.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK, give me, give me one second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] In the [PII] diagnosis is before the, the exam, right? Before, before the ultrasound in this case, right? Like diagnosis, the reason why she had to go and and perform that ultrasound, correct?
[AGENT][POSITIVE] That is correct. Yes, that's right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so we're gonna have to go and get the doctor. OK, awesome, um, alright, so those two documents you said I can upload them online, um.
[CUSTOMER][NEUTRAL] To the claim that I had already filed correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK awesome thank you very much for the information.
[AGENT][POSITIVE] OK, well, thank you for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye