AccountId: 011433970860
ContactId: 546102a5-98a4-4d34-8ac4-b751ea006f36
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 396420 ms
Total Talk Time (AGENT): 244877 ms
Total Talk Time (CUSTOMER): 133867 ms
Interruptions: 4
Overall Sentiment: AGENT=1.4, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/546102a5-98a4-4d34-8ac4-b751ea006f36_20250625T16:52_UTC.wav
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[AGENT][NEUTRAL] Afternoon, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] This is [PII]. I had tried to submit a claim online for a um sleep study that I had done.
[CUSTOMER][NEUTRAL] And um
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I think it did it 3 times because it when I tried to upload everything, it was like it wasn't freeze it was freezing up or something and when and I've been checking it every day and it's showing 3 pending for the same day and I wanted to see if you could check on that for me.
[AGENT][NEUTRAL] OK, so I'm so sorry. I heard your first name, but I wasn't able to understand your last name. You said your first name is [PII], right? [PII]? OK, thank you.
[CUSTOMER][NEUTRAL] I'm sorry, it's [PII], mhm, yes, [PII] and I have my policy number if you need that.
[AGENT][NEUTRAL] OK, I will, but first off, um, Miss [PII], if you could please give me your phone number, your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and now your policy number please.
[CUSTOMER][NEUTRAL] Sure it's 2006422.
[AGENT][NEUTRAL] OK, thank you. One moment while I get your information pulled up. Once I do miss [PII], I will have to verify several things with you first for security, and then also any information that is provided would be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Sure, no problem.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And the your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that is on file for you is the same as the one that you gave me, so that is your best contact number, is that correct?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][POSITIVE] Thank you and lastly Miss [PII], your email.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you very much for verifying all that. Now are the claims just to re-verify are they for you?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what, give me 1 2nd.
[AGENT][NEUTRAL] OK, and what is the date of service, Ms. [PII], that your claim was submitted for?
[CUSTOMER][NEUTRAL] Um, my gosh, I think it was like.
[CUSTOMER][NEUTRAL] I wanna say the [PII] maybe oh no that's when I sent it. Let me see if I have my papers in here. I'm sorry. I should have I should have pulled it up beforehand.
[AGENT][POSITIVE] OK. No, you're fine. No, ma'am, you're you're all right. No worries.
[CUSTOMER][NEUTRAL] I think I scanned it to my email. Let me just look.
[AGENT][NEUTRAL] Now, I can look, let's see, give me just a second. The most uh.
[CUSTOMER][NEUTRAL] OK, so just a second.
[AGENT][NEUTRAL] The most recent claim that was processed and it does look like there were 3.
[CUSTOMER][NEUTRAL] It was
[AGENT][NEUTRAL] Uploads for the same date? OK, so yes, ma'am, I'm looking at that claim. OK, so this is for Virto Inc. I'm not sure if I'm saying that provider correctly. Virtox, OK, they do have X. OK, so yes ma'am, I can see that that claim has now processed.
[CUSTOMER][NEUTRAL] It was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, virtualox, yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the claim has been denied at this point. I can read you the remark, the full remark, and you should also be able to see your explanation of benefits in your portal.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But the remark on here states receipt of your claim is acknowledged. However, in order to provide further consideration of the loss under this policy, we will need supporting documentation to evidence the accident or sickness.
[AGENT][NEUTRAL] Supporting documentation may include, but is not limited to, itemized bills with the diagnosis code, super bills, office notes, hospital admission and discharge summaries, and or diagnostic testing results.
[AGENT][NEUTRAL] So it appears that the diagnosis code is what we are in need of.
[AGENT][NEUTRAL] To further review this claim.
[CUSTOMER][NEUTRAL] OK, alright, so the itemized for the itemized bill, the office clinic note, and then the report from the sleep study.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And showing and any of those things would need to have the diagnosis code as to why you had to have that. Mhm. Yes, ma'am. For us to further review. So when, when you do get that information and I can give you the claim number that's associated with this first.
[CUSTOMER][POSITIVE] OK, I got you.
[CUSTOMER][NEUTRAL] OK. All right. OK. All right.
[CUSTOMER][NEUTRAL] Yes, please. OK.
[AGENT][NEUTRAL] And you should again be able to see this in your portal, but it's 36.
[AGENT][NEUTRAL] 11624.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And once you get that information, all you will need to do is to upload that into your portal. You cannot tie it to the to that claim number that I just gave you but internally once we receive that and see that data service, we will know that that was a missing piece of information that we had asked for, so you will just, it'll essentially look like you're filing a new claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right. Thank you so very much. I appreciate it.
[AGENT][POSITIVE] Oh, well, you're certainly very welcome. So is there anything else that I could help you with today?
[CUSTOMER][NEUTRAL] That's it. And now let me ask you, once you'll get that, how long does it take um before.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] It's usually about 7 business days. That can vary, but approximately 5 to 7 business days.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] OK, all right, thank you so much. I really appreciate it.
[AGENT][POSITIVE] Well, yes, ma'am, you're very welcome. And is there again, anything else I can help you with?
[CUSTOMER][POSITIVE] No. I think that's it. Thank you so much.
[AGENT][POSITIVE] OK, well then, thank you for calling APL and I hope you have a very nice afternoon.
[CUSTOMER][POSITIVE] All right thank you bye bye.
[AGENT][POSITIVE] You're welcome bye bye bye