AccountId: 011433970860
ContactId: 5828d3a8-0878-4551-8234-23242ffee322
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 354730 ms
Total Talk Time (AGENT): 112499 ms
Total Talk Time (CUSTOMER): 65339 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/5828d3a8-0878-4551-8234-23242ffee322_20250523T19:37_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes ma'am. My name is [PII]. I was just online with you all, but for some reason the phone cut out. Uh, I got a claim, uh.
[CUSTOMER][NEUTRAL] About a month ago and then I received a letter in the mail two weeks later saying that you needed some additional information, but I had already sent the information that you were requesting.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Well, I can take a look at the claim and the documents, um, and take a look into everything and [PII], may I have a good contact number in case we're disconnected and your policy number?
[CUSTOMER][NEUTRAL] It is [PII] and my policy number is 716752.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] And I just need you to verify your um last name, your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] No, uh uh one team in North side have in [PII] 72342 at [PII] or [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And let me take, let me go to your claims. Hold on one moment.
[AGENT][NEUTRAL] And what's the claim number? Does it end in 500 or 332?
[CUSTOMER][NEUTRAL] Uh, claim number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, I, I would have to pull it up. It's the one that was filed in May if I'm not mistake, May.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] April or May, I can't remember.
[AGENT][NEUTRAL] It's OK. It's this one right here. Hold on one moment.
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] April, OK, here we go. And do you mind if I place you on just a brief hold so I can go over the documents that was received?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, hello, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Alright, thanks so much for holding. So I apologize for that wait. So I went through the documents that was received. So these are itemized bills, but like at the top where it says patient account detail. These are the this is the patient copy of the itemized bill. So this only tells us
[AGENT][NEUTRAL] Like the coding that you see here, these are codes, but these are procedure codes. So it's just telling us what treatment you received and how much you paid for it. But what we're asking for is why, which is the diagnosis. So, we need the hospital or the doctor's office itemized bill, not the patient copy, because that itemized bill has the diagnosis code, procedure codes, all the charges, um, dates and it has everything on it.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][POSITIVE] OK, I got you. I'll get this for you.
[AGENT][NEUTRAL] Alrighty, well, as soon as we receive it, since it's additional information, as soon as we we receive it, we'll go ahead and continue processing to get you a new decision.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No matter, yeah.
[AGENT][POSITIVE] Alright, well, thank you so much for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] 223.
[AGENT][POSITIVE] Thank you. Bye-bye.