AccountId: 011433970860
ContactId: 8ac0766d-055d-40c6-957d-642c431e7b60
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 555690 ms
Total Talk Time (AGENT): 288640 ms
Total Talk Time (CUSTOMER): 243783 ms
Interruptions: 8
Overall Sentiment: AGENT=1.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/8ac0766d-055d-40c6-957d-642c431e7b60_20241230T18:13_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII].
[CUSTOMER][NEUTRAL] And I'm calling um regarding um.
[CUSTOMER][NEUTRAL] My claim, my claim number is 354-582-2.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] [PII], really quick, can I get a good call back number from you in case we're disconnected? Sorry.
[CUSTOMER][NEUTRAL] Now
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] OK, thank you, go ahead.
[CUSTOMER][NEUTRAL] And that's my work number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I was just just curious. I've never filed a claim with you guys before so um I didn't know exactly what.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, the processes or anything, but I'm on my web the website for you guys, but it says upload confirmation and it says no file, so I don't know whether or not you, I, I did send like 20 some pages to you guys, um, and then I just wanna make sure that you guys, you know, did receive them, um, obviously I think you did because there's a claim number here but I just just curious curious as far as looking to see what.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know how long it takes, you know what, you know, you know all that stuff so and then let's say let's OK.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Absolutely we could take a look at that claim uh huh.
[AGENT][NEUTRAL] Go ahead, uh, what, what was your question?
[CUSTOMER][NEUTRAL] Well, it might be for what you're gonna tell me, so I'll wait.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] No worries. All right, one moment.
[CUSTOMER][NEUTRAL] Don't wanna like jump the gun, OK?
[AGENT][NEUTRAL] absolute no, I get it I get it. OK, and really quick, [PII], if you don't mind, I'm gonna verify some information. Um, can I get your date of birth, please?
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] Mailing address is [PII].
[AGENT][NEUTRAL] OK thank you and then the last thing I need is the email address that we've got on file for you uh looks like it might be through your employer.
[CUSTOMER][NEUTRAL] Um, it should be [PII].
[AGENT][NEUTRAL] Perfect. OK, thank you so much for verifying all of that. OK, so from what I see we've got 3 different pieces of claim information that were received on the [PII], and it does not look like that it's completed processing. I do see one has generated a claim number, um, so that might mean that it's close to being finished, um, but if it's all right with you, I'm going to put you on a brief hold, [PII], and reach out to our claims specialist just to get confirmation on that.
[CUSTOMER][NEUTRAL] Oh it's OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] That's fine.
[AGENT][NEUTRAL] OK, one moment I'm just gonna put you on a brief hold. no, you're fine it's going around.
[CUSTOMER][NEUTRAL] Excuse me, sorry.
[AGENT][POSITIVE] Alright, one moment please thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[AGENT][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you today?
[CUSTOMER][NEUTRAL] I'm good, [PII]. How are you?
[AGENT][NEUTRAL] Doing well thank you. Alrighty, I've got an insured on the line um she said she's the submitted some claim information on, uh, [PII], and, uh, from what I'm seeing it shows the three pieces, uh, one shows a claim number but there's no information. The others just say 0 so I'm wondering if they're still processing or if they're just almost done, um, but there's no, yeah, it's uh 0246.
[CUSTOMER][NEUTRAL] You gotta be
[CUSTOMER][NEUTRAL] What's the policy number?
[AGENT][NEUTRAL] 326 7.
[AGENT][NEUTRAL] And it is for uh part one.
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Who created this me number?
[CUSTOMER][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] Well, I guess that book is [PII]. So let me see before I say that's [PII].
[CUSTOMER][NEUTRAL] Oh, that's [PII]. So that means [PII], she [PII] is working on it.
[AGENT][NEUTRAL] OK, so it's just almost done kinda like right now?
[CUSTOMER][NEUTRAL] Well, she's, well, just tell them that it's in the process of being, it's literally in process, in process now.
[AGENT][POSITIVE] OK, that's what I thought. I don't think I've ever caught it in between before where it showed a claim number but nothing you know what I mean? so she was kind of curious about that too, but I'll let her know. Thank you so much for your help.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] You're welcome. Have a good one. Bye.
[AGENT][POSITIVE] All right bye bye you too bye.
[AGENT][NEUTRAL] OK [PII], sorry about that wait are you still with me?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so yes, uh, I did get confirmation it is being processed right now, so it's just not quite finished.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'd say hopefully by the end of today if not um most likely tomorrow but um I just keep an eye on it.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, alright, and then just it doesn't, it's not gonna be like denied or anything like that or anything like that.
[CUSTOMER][NEUTRAL] But you can I can't tell me that, right?
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Not yet, no, as it's currently being processed, I will say most of the time that uh we get that they would be denied is if it is missing information. Um, it is possible it may not be something covered under your policy, but 9 times out of 10 when it's denied, it's simply missing information.
[AGENT][NEUTRAL] Um, so for these kinds of policies, biggest thing we would need is the itemized statement that shows diagnosis and procedure codes and then the explanation of benefits from the primary insurance essentially showing what they paid.
[CUSTOMER][NEUTRAL] Yeah, and that's what and that's what I, I because I called ahead and talked to someone they told me what it was that I needed, so I should have, shouldn't have any any process, but here's my next questioning I haven't used this the you used you guys before, does this cover like dental like, like, um, can you check my policy to see whether or not it it covers like dental like um like crowns and stuff like that too or no?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Got you, OK.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I don't believe so. Um, most of our secondary medical policies do not, um, but just for good measure while you're on the phone, I'll go ahead and get your policy pulled up and we will take a look.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You want me to give you my num policy because I've got that right in front of me too.
[AGENT][NEUTRAL] Oh, that's OK. I got
[AGENT][POSITIVE] Uh, no, that's fine. I actually got it from the claim number, so, but thank you.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[AGENT][NEUTRAL] Yes, all right, give me just a moment, let me get that pulled up here.
[CUSTOMER][POSITIVE] No, no, you're good.
[AGENT][NEUTRAL] OK. Yes, that is under the exclusions, um, dental or vision services including treatment, surgery, extractions, X-rays, um, so, unless it's due to a
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] congenital disease or anomaly of a covered newborn. That's very
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Specific, um.
[CUSTOMER][NEUTRAL] None of that. OK, OK, just curious because I just was like.
[AGENT][NEUTRAL] Um, while I've got you on the phone, of course, absolutely, um, now would you like me to, I don't know if you have a copy of your policy or not, but I can send this to you if you'd like, [PII].
[CUSTOMER][NEUTRAL] No, I don't no I don't mm.
[AGENT][NEUTRAL] OK, did you want me to go ahead and send that to you? It's very easy to read. It's not just a bunch of jargon, I promise. OK, did you want me to just email it to you?
[CUSTOMER][POSITIVE] Yeah, that would be great yep, that would be great.
[CUSTOMER][POSITIVE] Yeah, that'd be perfect.
[AGENT][POSITIVE] OK awesome let's see.
[AGENT][NEUTRAL] And did you want me to send it to the superior JT email or did you have a different one you send that to? OK.
[CUSTOMER][NEUTRAL] Yeah, why don't you, yeah, no, you can send it to that one because I'm at work and you can you can forward it to that one and I can print it out in that.
[AGENT][POSITIVE] Perfect
[AGENT][NEUTRAL] Alright, yeah, I'll go ahead and get that sent to you. Did you have any other questions for me?
[CUSTOMER][NEUTRAL] No, no, that's it. I just was just was curious as far as because I'm looking at it and I, and, and ironically I'm getting.
[AGENT][NEUTRAL] Oh yeah. Well, being honest, I've not seen that in that.
[AGENT][POSITIVE] I, I haven't seen that in between either where there's a claim number and they're still being processed so that was a learning thing for me too so.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Well, I ironically it's funny because I'm getting a piece of mail from you guys in the mail like it today, and I'm going, OK, by the time I get the mail, you guys are gonna be gone. I don't know whether or not you guys work tomorrow because it's the [PII], so I figured I was jumping the gun a little bit. That's what I was gonna tell you. I'm kind of jumping the gun a little bit because it, I don't know what it is in the mail that you sent me, so I mean.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, no, you're fine.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] You know, so I was just like, OK, are you telling me I need something else or is there any way you can tell to see?
[AGENT][POSITIVE] Right, oh yeah, it doesn't hurt to just call and ask for sure and just so you are, we are open tomorrow we will be closed [PII], but we will be open tomorrow so if it updates and you have any questions or anything, definitely feel free to give us a call.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, OK, perfect, thank you so much you have a wonderful day.
[AGENT][POSITIVE] All right, yeah. Thanks for calling [PII]. I hope you have a happy New Year. Yes, thank you. You too.
[CUSTOMER][POSITIVE] And happy new year. You too. All right, bye-bye.
[AGENT][NEUTRAL] Bye bye.