AccountId: 011433970860
ContactId: 52e60fe3-f7f8-4ecd-b208-16ebd5a4c650
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 435500 ms
Total Talk Time (AGENT): 114822 ms
Total Talk Time (CUSTOMER): 137470 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/52e60fe3-f7f8-4ecd-b208-16ebd5a4c650_20250416T14:23_UTC.wav
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[AGENT][POSITIVE] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling to know if my medical provider, um, already sent in a claim. I wanted to know, um, the status of the claim, if it was approved or not, please.
[AGENT][NEUTRAL] I'm sure [PII] I can assist you with claim status. Um first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] OK. Thank you. Now I need your policy number, please.
[CUSTOMER][NEUTRAL] Policy number is 01813054.
[AGENT][NEUTRAL] And please verify your name again and verify your date of birth.
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And please verify your mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And what's the date of service on the claim you're calling about?
[CUSTOMER][NEUTRAL] It would be [PII].
[AGENT][NEUTRAL] OK. I'm still waiting on my system, one moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the claim is for you and not one of your dependents, right?
[CUSTOMER][NEUTRAL] No, it's for one of my dependents. Her name is [PII].
[AGENT][NEUTRAL] OK. And her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then, again, that date of service was [PII].
[CUSTOMER][NEUTRAL] Yes, or [PII]. There were two dates.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Cause, you know, ma'am, I'm not showing the claims on file with that date of service. There is one claim on file for the hospital charges for [PII], and that claim denied because we're requesting additional information, um, but that's the only claim I'm showing on file for her.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so that's the one I guess, yeah, that's that's the one that I'm referring to because it was around the time of these dates, right? And they told me that they resubmitted it last week because I had called previous to last week and they told me, well, [PII] told me that it was denied for some reason, so they resubmitted it last week. Do you have any no claim? Like how long does it take to get to you?
[AGENT][NEUTRAL] Yeah, we received this claim on [PII] and the new one we haven't received yet. If they submitted it last week, we just ask that you allow 7 to 10 business days for it to be entered into the system and processed.
[CUSTOMER][NEUTRAL] Oh, OK, so the last one you received was [PII], correct?
[AGENT][NEUTRAL] Right. Yes, ma'am.
[AGENT][NEGATIVE] And that's the one that we denied because we need an um EOB with more detailed information.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so perhaps you haven't just received the other one, from last week. Yeah, it was [PII] that I called them, so.
[CUSTOMER][NEUTRAL] Today is [PII]. It's been eight days. Do you think you'll get it soon?
[AGENT][NEUTRAL] Um, I'll give it a couple of more bus, um, couple of more business days. I'll check again around next Wednesday. It should be in the system by then if they have resubmitted it.
[CUSTOMER][POSITIVE] OK, great. And I have another um claim. This one is for myself.
[CUSTOMER][NEUTRAL] Um, it date of service is [PII].
[CUSTOMER][NEGATIVE] And this one, I had spoken to someone in APL back on, back in February and they told me that the check was already sent to uh the medical provider. They gave me a check number and all, but I have not received a refund from them, so I just wanna make sure that they did receive payment.
[AGENT][NEUTRAL] OK. And what's the date of service on that claim again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And what's the check number?
[CUSTOMER][NEUTRAL] 202-2004
[AGENT][NEUTRAL] OK. Yes, ma'am. I'm showing that that check was sent to the provider, but it's showing that it's still outstanding, so they haven't cashed it yet, but the check was sent to the provider.
[CUSTOMER][NEUTRAL] It was, OK, for what amount?
[AGENT][NEUTRAL] Um, $713.80.
[CUSTOMER][POSITIVE] Yeah, that's, that's what I'm pending here as well. OK, um, let me call them back then and see what's, what's the hold up. Thank you so much for your help.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, that's it. Thank you.
[AGENT][POSITIVE] Mhm. Thank you again, [PII] for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Mm