AccountId: 011433970860
ContactId: 6706833a-220e-4c51-9bb3-f0c7d96413fd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 681770 ms
Total Talk Time (AGENT): 363943 ms
Total Talk Time (CUSTOMER): 325488 ms
Interruptions: 21
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/6706833a-220e-4c51-9bb3-f0c7d96413fd_20250529T19:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, yes, I submitted two claims, um, both electronically and paper version, and I've not heard anything yet. Are you able to provide an update for me?
[AGENT][NEUTRAL] OK, so you're wanting to check a claim status for yourself, is that correct?
[CUSTOMER][NEUTRAL] to
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you. And who am I speaking with?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] What is your
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] Oh, I don't have that handy.
[AGENT][NEUTRAL] And you're the subscriber on this policy?
[CUSTOMER][NEUTRAL] I am.
[AGENT][NEUTRAL] OK, and what is your full social security number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. One moment, [PII], while I locate your information.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and you said it was [PII], is that correct?
[CUSTOMER][NEUTRAL] it was
[CUSTOMER][NEUTRAL] Friday
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes ma'am, uh huh, [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I'm not pulling your information with APL under that and you said that you're, I'm gonna try with your name. It's [PII] is the last name, is that correct?
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] No, [PII]
[AGENT][NEUTRAL] [PII] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, and Ms. [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. I will need to verify several things with you first for security. So if you could first please verify your date of birth.
[CUSTOMER][NEUTRAL] information.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then also your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that is on file for you is different than the one you gave me. What is another phone number that we could have?
[CUSTOMER][NEUTRAL] if you're back on the one we have the phone number that we can.
[CUSTOMER][NEUTRAL] Well, I gave the preferred number is what I'm calling on [PII]. My cell, which I don't want you to use, is [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so we'll come back to that in just a moment and lastly your email address please?
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] OK, thank you. So Miss [PII], on your enrollment information that we received, it has your cell phone number on there. I will be happy to change that to the other number that you're calling from today, but I do wanna let you know that there is a possibility that the system will override my change and change it back to your cell phone number. Now you may want to call the enrollment company that you enrolled with.
[CUSTOMER][NEUTRAL] OK, on your enrollment information that we it has.
[CUSTOMER][POSITIVE] I would be happy to change.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] But I do wanna let you know that.
[CUSTOMER][NEUTRAL] There's a pass that the system the change and change that.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] To have that updated so that that will not occur.
[CUSTOMER][NEUTRAL] OK, just leave it as it is.
[AGENT][POSITIVE] But I'll be happy to change it.
[AGENT][NEUTRAL] You wanna just lay that with your cell number?
[CUSTOMER][NEUTRAL] You wanna look at that.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] So I do see Ms. [PII] that we did receive a claim that did go through. It was received on the [PII] and it was processed, uh, actually went through processing last night.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And what is the date?
[CUSTOMER][NEUTRAL] OK, so just stay tuned.
[AGENT][NEUTRAL] Uh, yes, ma'am. Actually, I can tell you this claim has been denied. It was for two different dates of service. One was [PII] and one was [PII]. Is that correct?
[CUSTOMER][POSITIVE] Uh, yes ma'am actually.
[CUSTOMER][NEUTRAL] Because.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so give me just a moment to pull up the remarks.
[CUSTOMER][NEUTRAL] Give me just a moment
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, so the denial remarks states in order to complete the processing of your claim, we need itemized statements of services provided listing the diagnosis code.
[CUSTOMER][NEUTRAL] So the.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And that is the remark for both dates of service.
[CUSTOMER][NEUTRAL] And that is the one.
[CUSTOMER][NEUTRAL] OK, well that's what my provider from their billing department that's what they provided.
[AGENT][NEUTRAL] Yes, ma'am. So you would need.
[CUSTOMER][NEUTRAL] So I need to call them back and say that they need more information to be including the diagnosis codes.
[AGENT][NEUTRAL] Yes, ma'am. You just let them know and um that you would need an itemized statement including your diagnosis code. That is correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes ma'am, and um that you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Back to the drawing board.
[AGENT][NEUTRAL] Oh, I'm sorry. Yes, ma'am, but that's, that's one of the required pieces of um documentation that we have to have.
[CUSTOMER][POSITIVE] OK, that's that's one of the requirements of um documentation that we have. I understand. I appreciate you looking into this for me, and I'll get back to you ASAP.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, and I can give you your policy number, Ms. [PII], if you would like.
[CUSTOMER][NEUTRAL] OK, and I can give you your phone.
[CUSTOMER][NEUTRAL] Oh sure.
[AGENT][NEUTRAL] OK, so your policy number, let me just let me know when you're ready.
[CUSTOMER][POSITIVE] Alrighty.
[AGENT][NEUTRAL] It is 0258.
[CUSTOMER][NEUTRAL] 58
[AGENT][NEUTRAL] 9958.
[CUSTOMER][NEUTRAL] OK, 02589958.
[AGENT][POSITIVE] Yes ma'am, that is correct.
[CUSTOMER][NEUTRAL] Perfect so now see the problem is is that I don't have a copier at home, so I have to go out and pay for printed copies of these documents and then submit them to you so I'll have to do that all over again. Is there any way it can be provided electronically?
[AGENT][NEUTRAL] Now you have, OK, you do have the ability to set up your profile in our portal, Ms. [PII].
[CUSTOMER][NEUTRAL] Or is it straight?
[AGENT][NEUTRAL] Where you can actually upload your information into the portal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Where you can actually upload.
[CUSTOMER][POSITIVE] That's what I want.
[AGENT][NEUTRAL] Now the num OK so instead let me see how I wanna say this, I will email you a user guide to your email address. Now the instead of when it asks you for your social security number or member ID number.
[CUSTOMER][NEUTRAL] OK so.
[CUSTOMER][NEUTRAL] I will email
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In setting up your profile?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] You will use this number. I'm gonna give you the.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Member ID number.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] So the member ID number.
[CUSTOMER][NEUTRAL] And what's it called, the ID number?
[AGENT][NEUTRAL] Called a member ID.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That number is 651.
[CUSTOMER][POSITIVE] Ready.
[AGENT][NEUTRAL] 83.
[AGENT][NEUTRAL] 70.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] 14.
[CUSTOMER][NEUTRAL] OK, 651-837-014.
[AGENT][NEUTRAL] Yes ma'am, and the email that I'm going.
[CUSTOMER][NEUTRAL] And that's my member ID number that I will use to set up my profile.
[AGENT][NEUTRAL] Correct. And when it asks you for your phone number, you will need to use your cell phone number that we have on file because that's for security purposes, it will have to match, you know, our information that we have. If you have more than one email address, make sure that you use the [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because that will have to match as well, but if you'll give me just one moment, I'm gonna send you this user guide.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, Ms. [PII], so I have just sent that to you again. The email will come from [PII].
[AGENT][NEUTRAL] And I did put APL in the subject line for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So that that'll be easy to recognize. I don't think it will go to your junk or spam folder, but if in the event you have not seen that in your inbox within just a minute or so, you might wanna check one of those other folders, but once you set up your profile, you can actually upload that information directly in there.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] The last time I was given a form but it wasn't an active form. In other words, I couldn't just type into the document and then send it back. I had to print it out, write it in, scan it is is is the information that I'm going to have is it going to be able to be a user friendly document or is it?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] intended to be handwritten.
[AGENT][NEUTRAL] Well, for this circumstance where you're just submitting the expla I mean an itemized bill, you would just want your profile is set up and you log in.
[CUSTOMER][NEUTRAL] Well, for this circumstance where you're just submitted.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] There's a, it will walk you through the steps and uploading a document so you will just upload that itemized bill directly into your portal. There's not a claim form that you're gonna have to.
[CUSTOMER][NEUTRAL] There's a it will walk you through the steps and uploading the document, so you will just outline that itemized bill directly into your portal. There's not a.
[AGENT][NEUTRAL] Fill out.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] You just need to, you just need to submit that missing information.
[CUSTOMER][POSITIVE] I got you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, I think I've got it we'll um get back in touch with you and hopefully we can get this resolved quickly.
[AGENT][NEUTRAL] OK. Well, do you have any other questions or is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK do you have any other questions.
[CUSTOMER][NEUTRAL] Not at this time.
[AGENT][POSITIVE] OK, well then, thank you so much for calling APL Ms [PII], and I hope that you have a very nice rest of your day.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Oh, thank you very much. You too.
[AGENT][POSITIVE] Yes, ma'am. Thank you.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] But that.