AccountId: 011433970860
ContactId: 5083ad67-090d-4e95-bb1a-6354a0cd66ad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 319299 ms
Total Talk Time (AGENT): 57286 ms
Total Talk Time (CUSTOMER): 212385 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/5083ad67-090d-4e95-bb1a-6354a0cd66ad_20250618T19:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII].
[CUSTOMER][NEUTRAL] And I'm calling. I had called in a couple days ago, um, inquiring as to why a claim had not paid, and they told me that they still needed the diagnosis code and I sent all that over and I'm just wanting to make sure that got appended because it shows that that claim that's being considered has uh has been processed as $0 but I don't know if that's how it typically shows up on here.
[CUSTOMER][NEUTRAL] How can I help you help me? Do you need my member number? What, what would be best?
[AGENT][NEUTRAL] Uh, yes, your policy number?
[CUSTOMER][NEUTRAL] 262
[CUSTOMER][NEUTRAL] 631 8
[CUSTOMER][NEGATIVE] Some of them have a 0 at the very beginning.
[AGENT][NEUTRAL] OK, and then can you verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then what is your address?
[CUSTOMER][NEUTRAL] Uh, I believe it's gonna be the [PII].
[AGENT][POSITIVE] OK, thank you so much and then lastly, just a good callback number in case we're disconnected.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you, and that was a claim for yourself?
[CUSTOMER][NEUTRAL] Yes, so I sent it in on [PII]. Your the office there claimed they didn't get it until somewhere in June, um, but I.
[CUSTOMER][NEUTRAL] I went to the company that I had to submit it through and they confirmed that it was 3:25 that I submitted it.
[CUSTOMER][NEUTRAL] And uh I contacted them I think it was on [PII] and on [PII], on [PII], you all sent me a letter stating that more information was needed so I called in. I sent over part of the hospital records which included the ICD pin code, the diagnosis, um, that was needed in order to support that claim. I just need to make sure it gets appended to it so that that claim is processed right now because it's been.
[CUSTOMER][POSITIVE] With you all for nearly 3 months.
[AGENT][NEUTRAL] OK, now it's for [PII], is that right?
[CUSTOMER][NEUTRAL] Yes, that is the one and then you'll have records. I uploaded another claim the other day along with the in a separate submission from where I sent in the medical records.
[AGENT][NEUTRAL] OK, yes.
[CUSTOMER][NEUTRAL] For the hospitalization.
[AGENT][NEUTRAL] Uh, it looks like we received those and loaded them in our system on [PII], so they're currently in processing.
[CUSTOMER][NEUTRAL] So has that has the documentation been appended to that claim or is it still floating out there and we don't know what this is for land?
[AGENT][NEUTRAL] No, this will be, this is regarding, it's on your account, so we know where it goes.
[CUSTOMER][NEUTRAL] And do you show the separate one for 128 for um a doctor's visit?
[AGENT][NEUTRAL] Uh, yeah, it looks like we received two different.
[AGENT][NEUTRAL] Submission.
[CUSTOMER][NEUTRAL] Yes, so how long will this take since the company that I had to submit this to originally has on file and emailed me and I have on file that I sent it on [PII] and the literature that you all have says it takes a month. So how long can we expedite this so that it gets processed?
[AGENT][NEUTRAL] Uh, it typically only takes 5 to 7 working days if we receive everything we need, so, um, it should just be 5 to 7 working days.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK working days will be Monday, Tuesday, Wednesday are we working Thursday this week or no?
[AGENT][NEUTRAL] Um, Thursday this week, yes.
[CUSTOMER][NEUTRAL] OK, alright, so if you got it on the [PII], we're talking middle of next week it's gonna be the maximum probably.
[AGENT][NEUTRAL] Yes, it should be, yeah, sometime in mid next mid to late next week it should be uh determined.
[CUSTOMER][NEUTRAL] I can't see why it would not be determined as payable, but we'll see what happens uh because I'm willing to take it all the way to insurance commissioner. This has been a hideous experience from the minute we signed up for it.
[CUSTOMER][NEGATIVE] And uh and everything so hopefully they'll do what they say they'll do and what we purchased and we'll be in good shape and it it's not you trust me I know you're sensing frustration it's not you the whole beginning to now process it's been frustrating.
[AGENT][NEUTRAL] I apologize for that. We definitely don't want to hear that, so.
[CUSTOMER][NEUTRAL] Yeah, I'm sure not it just.
[CUSTOMER][NEUTRAL] You know, it, it just wasn't clear, and I, and I'm a healthcare compliance officer, so for me to get headwinked was pretty, pretty, uh, pretty false advertising from not your standpoint but from the company who, who initially sold the policy.
[CUSTOMER][POSITIVE] All right sweetie well thank you so much for confirming and I appreciate the help and I'll just be watching this steadily um through the middle of next week and then next week to see what it takes.
[AGENT][POSITIVE] OK. Thanks for calling APL. I hope you have a good afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] OK.