AccountId: 011433970860
ContactId: 78052602-ac91-422e-ae0e-c1f9420fb107
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1267939 ms
Total Talk Time (AGENT): 467380 ms
Total Talk Time (CUSTOMER): 420445 ms
Interruptions: 7
Overall Sentiment: AGENT=-0.1, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/78052602-ac91-422e-ae0e-c1f9420fb107_20250203T17:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] with whom am I speaking and how may I help you?
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. With whom am I speaking and how may I help you?
[CUSTOMER][NEUTRAL] Hi, ma'am. Good morning. This is [PII]. I was hoping to get some assistance on trying to file a claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry, I couldn't catch your name. You're the provider?
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[AGENT][NEUTRAL] Please spell your name, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]?
[AGENT][POSITIVE] OK, that's good enough, mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's a good call back number for you in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what's the policy number you're calling about, [PII]?
[CUSTOMER][NEUTRAL] Um, I don't have that at hand.
[CUSTOMER][NEUTRAL] Can I give you my social, maybe?
[AGENT][NEUTRAL] Are you an insured or provider?
[CUSTOMER][NEUTRAL] This is my policy, uh, I'm insured.
[AGENT][NEUTRAL] Oh, you're the insured, yeah, you're the insured, OK, I thought you was a provider. OK, one moment, I can look it up for you. Give me one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What's your social?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that information. And what is your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] And what is your physical mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And what's your email address?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for verifying all that information. And do you need your policy number before we go forward?
[CUSTOMER][NEUTRAL] Um, I don't know. OK, policy number, I see mine now.
[AGENT][NEUTRAL] OK. All right. So, and you have a question about which policy today. You have a critical illness policy and you have an accident policy. Which one do you have questions about?
[CUSTOMER][NEUTRAL] Yes, it's a critical illness.
[AGENT][NEUTRAL] OK. And what are your questions?
[CUSTOMER][NEUTRAL] Well, I had, I got a like an alert that I got and it said, [PII], your, your claim has been uh viewed or is ready for view or something like that.
[AGENT][NEUTRAL] OK so you're calling to check the claim status so let me get that information for you I can help you with that today give me one moment.
[CUSTOMER][NEUTRAL] Now
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] So they, they test the uh claim that you submitted for your wellness benefit. It was denied because, wait a minute, no, it paid. It, it, it paid.
[AGENT][NEUTRAL] Wait a minute, let me go back. Let me go back. I'm not seeing what is this?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Let me put you on a brief hold and check with the uh processor on this, OK? One moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you. I don't know why it jumped on speaker.
[AGENT][NEGATIVE] And I tried to put it on iPhone and it wouldn't even go.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for patiently waiting, Ms. [PII]. So what someone is gonna have to return a call to you with the explanation as to what's going on with this claim. Uh, she stepped away from her desk, so, uh, either she will call you back or I'll call you back.
[CUSTOMER][NEUTRAL] Yes, I'm fine.
[CUSTOMER][NEUTRAL] Can you give me the claim number?
[AGENT][NEUTRAL] The claim number is 347-7635.
[CUSTOMER][NEUTRAL] And do I get to see that on my end?
[AGENT][NEUTRAL] I'm not sure, but let me check with her and see if this claim is supposed to deny or if it's supposed to make a payment because it has a denial code which is saying that it's not.
[CUSTOMER][NEUTRAL] OK, well, that's not the one I.
[AGENT][NEUTRAL] Uh-huh, go ahead. Oh, you have another coin?
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] That's not the time I'm calling about.
[AGENT][NEUTRAL] Well, that's the only one I see for um critical illness right now. I don't see any other claim. Did you file another claim?
[CUSTOMER][NEUTRAL] I have a claim number. Do you wanna look it up?
[AGENT][NEUTRAL] OK. Sure, what is it?
[CUSTOMER][NEUTRAL] 3554
[CUSTOMER][NEUTRAL] 174.
[CUSTOMER][NEUTRAL] So it's 35, hold on, let me put my OK. It is 355-4174.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's for you, OK, let's see. Alright, so I do see that. Give me one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] So that claim was denied because she stated she needs an itemized bill with procedure codes, dates of service and medical records. I'm sorry, she needs an itemized bill with procedure codes, dates of service or charge amounts or you can submit the medical records for review. That's what's needed to continue the processing of that coin.
[CUSTOMER][POSITIVE] OK. And then, um, uh, that's why I'm calling is to get assistance to get those records over to her.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I, I, I already requested these medical records.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, for [PII], and uh [PII] [PII], um.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] But I need help filing another claim.
[AGENT][NEUTRAL] OK, what help do you need? You just need to get the medical records first of all we need those medical records and the itemized bill. You gotta have both. So once you get those, it's the same way you file this claim is it wouldn't be anything different. It's the same way you file this claim. How did you file this claim? Did you mail it? Did you fax it or did you upload it?
[CUSTOMER][NEUTRAL] OK, well, I, I understand that.
[CUSTOMER][NEGATIVE] I uploaded it, but that's my question. I have uploaded something, it gave me a confirmation number, but it didn't give me a claim number, it didn't give me a coverage relationship, nothing. It just has my name and it says confirmation number.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] You will not get a claim number until we process a claim. So when did you upload this information just now today?
[CUSTOMER][NEUTRAL] No, it's, uh, it's been, it's been a while. Like I don't know, like 3 weeks.
[AGENT][NEUTRAL] When it, when it
[AGENT][NEUTRAL] Oh no, I don't see anything. I don't see anything. The only thing, uh, let me go back and look at this date here.
[AGENT][NEUTRAL] Hold on one second, let's see something was sent in on the [PII]. Let's take a look and see what that was.
[AGENT][NEUTRAL] Nope, she just paid a wellness exam for you. So I'm not seeing any uh other uh pending.
[AGENT][NEGATIVE] Documents that we've received from you from 3 weeks ago. The only thing we did receive, it was denied, which was [PII], and it was denied saying we need an itemized bill and medical records.
[AGENT][NEUTRAL] So, have you gotten the medical records from the uh provider?
[CUSTOMER][NEUTRAL] Uh, that's the
[CUSTOMER][NEUTRAL] I, I'm sorry, can you give me a chance, ma'am? I'm trying to ask you about the, you just said [PII]. What is that? [PII].
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] That was uh some information that we received from you for your claim.
[AGENT][NEUTRAL] And that would have been about 3 weeks ago. Mhm.
[CUSTOMER][NEUTRAL] On [PII]?
[AGENT][NEGATIVE] And we denied it.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. You say that like, I know this thing. I don't know anything about it. OK, you denied it. I get that. But what claim number is that?
[AGENT][NEUTRAL] That's claim number 3554174, the claim number you gave me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So what do I do to get these files over to you guys?
[AGENT][NEUTRAL] You will need to contact, um, you will need to contact, uh, your physician. You need to get the medical records for dates of service [PII] and for dates of service [PII]. You also need an itemized bill with procedure codes, dates of service and charge amounts.
[CUSTOMER][NEUTRAL] And can you slow down so I can write that down, maybe?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Sure, sure, mhm. So let me start over. You need an itemized bill.
[CUSTOMER][NEUTRAL] Is that, I already.
[CUSTOMER][NEUTRAL] Hold on, ma'am.
[AGENT][NEUTRAL] Well
[AGENT][NEUTRAL] Ma'am, I'm slowing down. I'm just starting over for you, OK?
[CUSTOMER][NEUTRAL] OK, but you start, you're going at 100 miles an hour. Hold on, I'm trying to write things down.
[AGENT][POSITIVE] OK, and I apologize and I'm starting over, so let me know when you're ready.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] You need an itemized bill.
[AGENT][NEUTRAL] With procedure codes?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] With what?
[AGENT][NEUTRAL] Procedure codes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Dates of service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And charge them out.
[CUSTOMER][NEUTRAL] And what?
[AGENT][NEUTRAL] Charge amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So there's no notes on this uh claim because I called uh prior, and the lady said, and we called the hospital and she, she asked for like itemized billing, EO, whatever.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] I don't know what she called it, but the hospital was supposed to send in that documentation.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And I haven't received anything on my email, so that's why I was trying to call in to see if y'all had received anything.
[AGENT][NEGATIVE] We have not received anything.
[CUSTOMER][NEUTRAL] OK, so I, I know you said they denied it, but they give me some amount of time to get these records to them, or how does that work?
[AGENT][NEUTRAL] Yeah, uh-huh, we don't have a timely filing limit, so it'll be fine when you get them you'll be fine just send them to us.
[CUSTOMER][NEUTRAL] OK, cause yeah, the, the hospital's been taking some time.
[AGENT][NEGATIVE] Yeah, they, unfortunately, they do, yeah.
[CUSTOMER][NEUTRAL] You know, but I, I, I already
[CUSTOMER][NEGATIVE] I already requested those records and they still haven't gone through. Now, I need a um
[CUSTOMER][NEUTRAL] On uh, so that day that I tell you that I sent, I have a confirmation number. Does that help you look up my paperwork?
[AGENT][NEUTRAL] We've already received that. That was the, that has to do with um we don't have any other outstanding documents to review for you. So that confirmation, no, it would not help me.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because everything we have for you, we've already processed it.
[CUSTOMER][NEUTRAL] But I
[CUSTOMER][NEUTRAL] OK, well this one just says uploaded confirmation number and my name and then it has the file that I, I sent. How do I get that file for you to see it?
[AGENT][NEUTRAL] And was that
[CUSTOMER][NEUTRAL] It's a different data service.
[AGENT][NEUTRAL] When did
[AGENT][NEUTRAL] When did you send that today?
[CUSTOMER][NEUTRAL] No, ma'am. Weeks ago.
[AGENT][NEUTRAL] What confirmation number, are you showing?
[CUSTOMER][NEUTRAL] So, the day that I was working on the
[CUSTOMER][NEGATIVE] I'm not showing one, that's my whole, that is my issue. You're not seeing it on your end. I'm not seeing it on my end, so I must have not done something right. It was [PII] [PII] was when I was doing this. It did upload, it's on my end and it says upload, but it does not have.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] And we have that. We received that. I remember I told you earlier in our conversation, we received a document from you on [PII].
[AGENT][NEUTRAL] Even though you didn't get a confirmation, we did receive it. That is claim number.
[CUSTOMER][NEUTRAL] But I need to file.
[AGENT][NEUTRAL] You just need to file
[CUSTOMER][NEUTRAL] That's claim number what?
[AGENT][NEGATIVE] That's the claim number you gave me 355-4174. It was denied.
[CUSTOMER][NEUTRAL] OK. OK, ma'am.
[CUSTOMER][NEUTRAL] Can we start over?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] On my end, on my end, I can see an upload, has a confirmation number and my name and the file. It does not show a claim number. I need to file a claim.
[CUSTOMER][NEUTRAL] This is the only reason I'm calling.
[AGENT][NEUTRAL] OK, so I wanna make sure you finish explaining before I start talking. Are you finished explaining that?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You will not receive a claim number when you upload information, OK? No one gets a claim number when they upload information. You're uploading the information for us to review and either pay.
[AGENT][NEUTRAL] Or deny your claim, that's when the claim then gets a claim number, OK? So you're never gonna get a claim number when you upload information.
[AGENT][NEUTRAL] That only happens once we process that claim. It's either gonna be denied or paid.
[CUSTOMER][NEUTRAL] So, how do I find out if it was processed?
[AGENT][NEUTRAL] If you uploaded some information, you have to wait for us to receive it. It can take 24 to 48 hours for it to be uploaded in the system to be reviewed.
[CUSTOMER][NEUTRAL] See, but I sent it on [PII] or [PII].
[AGENT][NEGATIVE] And this, this is what I keep telling you, Ms. [PII]. We already processed that what you sent on [PII]. I'm not, you keep saying I'm not understanding you but we already processed what you sent on [PII] and it was denied.
[CUSTOMER][NEUTRAL] No, ma'am, this, what I uploaded on the [PII] was a separate case. It was a separate, it was, it was about hospital stay and angiograms that were done to me on two different dates, not [PII], not [PII]. These were done [PII].
[AGENT][NEUTRAL] And it is claim number.
[AGENT][NEUTRAL] What was it about?
[AGENT][NEUTRAL] Give me one of those dates. Uh-huh.
[CUSTOMER][NEUTRAL] [PII], and [PII]. There's two different, there's 4 dates here.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so let me check and see if I see anything for those dates.
[CUSTOMER][NEUTRAL] And I
[AGENT][NEUTRAL] OK, so I'm not finding anything and that that was for yourself, right? Not for anybody else on your policy. OK, so I'm not seeing, I'm not seeing anything for those dates for you, which means we did not receive it, so you will need to resend that information for review.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] No, ma'am, just tell me.
[CUSTOMER][NEUTRAL] OK, that's where I wanna get to, ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I need to know. I need to know if I need to upload this document again cause I can see it on my end. It's 9 pages, it's on the file viewer, but like I said, it has a confirmation number, but it does not have a a process or any other number. It just says my name.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, it does not seem like it came through to us for review so just go ahead and upload it again, OK?
[CUSTOMER][NEUTRAL] So that's why I'm asking for help. How would I upload it? Just go to upload files on my claim, or?
[AGENT][NEUTRAL] Same way you filed that claim, you just start over, you need to start over, refresh the browser, log in again so that it's not hung up or you get any kind of error message you start all over again, log in with your username and password and you click file a claim and you follow the same process, upload the information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I just, I wanted to know because how I had already requested like the
[CUSTOMER][NEUTRAL] The, the charge amount, the itemized bill, the medical er the medical.
[CUSTOMER][NEUTRAL] I have medical uh records to upload or to send you guys.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] But I just haven't, I haven't been able to uh put it in.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] I have not
[AGENT][NEUTRAL] Well just upload it again and send it to us so we can uh review that information for you, OK?
[CUSTOMER][POSITIVE] OK, ma'am. Thank you.
[AGENT][NEUTRAL] OK, thank you for calling APL Miss [PII].