AccountId: 011433970860
ContactId: 64dd3ffb-4c7d-4570-b808-0b91c61445bb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 394100 ms
Total Talk Time (AGENT): 161186 ms
Total Talk Time (CUSTOMER): 137885 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/64dd3ffb-4c7d-4570-b808-0b91c61445bb_20250212T15:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], um, I am calling because I'm confused. I had two claims in there. One was closed on the 3rd, the other one disappeared. You guys requested something that I sent back over now, and I just need to make sure that we expedite this.
[AGENT][NEUTRAL] Alright, let's take a look. Do we have your policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 258-675-52
[CUSTOMER][NEUTRAL] yeah they what from that.
[AGENT][POSITIVE] Great. And then if I could get your name, date of birth and address, please?
[CUSTOMER][NEUTRAL] [PII] date of birth [PII] and address [PII].
[AGENT][POSITIVE] Alright thank you so much I'll look.
[AGENT][NEUTRAL] OK, so I do see the original submission and then I see that you had submitted the EOB and then there was something else submitted. It hasn't been completely processed it's still in progress, it looks like.
[CUSTOMER][NEUTRAL] Maybe
[CUSTOMER][NEUTRAL] I talk to.
[CUSTOMER][NEGATIVE] Well, the second one I put through, they said they declined it because it didn't have the code. So I went on the Google and I found the code and so I had to resend again for the code because y'all won't take it over the phone, which.
[AGENT][NEUTRAL] But I do
[CUSTOMER][NEGATIVE] It's just a a really crazy policy. It's just really weird that way you guys are running things over there.
[AGENT][NEUTRAL] Yeah, let me
[CUSTOMER][NEGATIVE] There's nowhere to put notes online. I have to actually scan something and and resend it. There's nowhere to put it on the claim form either. I have to write it, handwrite it somewhere in a blank spots. It's weird.
[AGENT][NEUTRAL] Yeah, let me see.
[AGENT][NEUTRAL] Give me just a second, let me see if it was submitted, [PII].
[CUSTOMER][NEUTRAL] are.
[CUSTOMER][NEUTRAL] Call me [PII], please.
[AGENT][NEUTRAL] I'm sorry, one moment.
[CUSTOMER][NEUTRAL] Unless I'm in trouble, it's OK, it's OK unless I'm in trouble is when I hear that one.
[AGENT][NEUTRAL] OK, I see where you wrote the code on there [PII]. Alright, let me call over to somebody that processes claims to see if that's gonna work, um, and just have them look at all this to alleviate any other frustrations, so.
[CUSTOMER][NEUTRAL] Well, the problem is is that this is exactly what I was told to do at first, right? But what happened, so I did. The woman told me over there, just write it on there somewhere what you had done. OK, I did. And then I have to call to keep checking on this thing because it disappeared off the portal like the other one disappeared. And then she's like, oh well, they, they declined it because they don't have the code. So I jumped on the Google and I looked up the code and I said, so, um, does this sound familiar? She goes, it does, we can't take her on the phone. I said, y'all got Google? I didn't mean to be a dick, but seriously, like, do you guys have Google because that's where I found it.
[AGENT][NEUTRAL] Did you have
[CUSTOMER][NEUTRAL] And uh here I am still in delay and waiting so I just trying to get this thing going. I mean I'm about 60 grand at the moment.
[AGENT][NEUTRAL] Yeah, no, I mean I just I don't process claims. I see what you wrote and I just want I just wanna make sure that it's acceptable for them, so let me double check with them, OK? Alright.
[CUSTOMER][NEUTRAL] so
[CUSTOMER][NEUTRAL] Yeah, I understand.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] For sure, for sure. I appreciate you. Thank you. Thank you.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Bringing
[AGENT][NEUTRAL] I don't even know if this is right.
[CUSTOMER][NEUTRAL] This is [PII].
[AGENT][NEUTRAL] Hi, [PII]. This is [PII] in customer care. How are you today?
[CUSTOMER][POSITIVE] I'm great how are you?
[AGENT][NEUTRAL] Hey, I'm good. I have an insured on the line who has a question about a medli claim. Is this something that you could maybe look at with me and help?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, policy number whenever you're ready.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] Is 02586752.
[AGENT][NEUTRAL] Should come up for [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So he has two claims in there that were denied, um, and then my question is on this 3rd submission that he did on the [PII], I pulled it in Onase. We requested diagnosis codes and what he did is he wrote the diagnosis code on the statement of the insured.
[AGENT][NEUTRAL] And I don't know if that's sufficient for you guys or not.
[CUSTOMER][NEUTRAL] It is, it has to be in writing. We just can't take it over the phone.
[AGENT][NEUTRAL] OK, so if he wrote that on the claim form, then he should be good, right?
[CUSTOMER][POSITIVE] Correct. Yes.
[AGENT][NEUTRAL] OK, alright, alright, I will let him know that he was a little frustrated with the additional information, so I just wanted to make sure that was OK for you guys.
[CUSTOMER][POSITIVE] Yes, that is exactly what we need.
[AGENT][POSITIVE] OK, I will let him know that and just to give it a couple of days to process. Thank you so much.
[CUSTOMER][POSITIVE] You're so welcome. Have a great day. Bye bye.
[AGENT][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you so much for your patience and waiting [PII]. So I spoke with [PII] in the claims processing department she viewed the upload and said that was perfect, that that's what they needed. They're gonna start working on the claims, so just give it a little bit more time, OK?
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Cool.
[CUSTOMER][POSITIVE] Wonderful. Fabulous.
[CUSTOMER][POSITIVE] Perfect, thank you. I just wanna make sure that we're all good, you know what I mean? I wanna make sure there's nothing else you need from me, that's all.
[AGENT][NEUTRAL] That was the information conveyed to me that she looked at it, so it seems like we're good to go, OK?
[CUSTOMER][POSITIVE] I love it.
[CUSTOMER][POSITIVE] Fabulous, thank you so much.
[AGENT][POSITIVE] You're welcome, [PII]. Have a good one.
[CUSTOMER][POSITIVE] Have a great day you too bye.
[AGENT][NEUTRAL] Bye bye.