AccountId: 011433970860
ContactId: 9126a782-0116-4128-8be4-2202ab76a274
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 359660 ms
Total Talk Time (AGENT): 138727 ms
Total Talk Time (CUSTOMER): 193260 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/9126a782-0116-4128-8be4-2202ab76a274_20250327T14:38_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey there, I have a question um.
[CUSTOMER][NEUTRAL] I need information on how to resubmit a claim that's already been filed because there was information that they needed um the rejection code was like number 4 and it needed a copy of our explanation of benefits so how do I go about resubmitting a claim that already has a claim number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] To correct things that were already submitted I guess.
[AGENT][NEUTRAL] OK, wait, how do you?
[AGENT][NEUTRAL] So you're trying to see how, so the claim has already been submitted and you're trying to see how to resubmit it from what was missing for.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, and online you can I mean I don't, it doesn't have a place to check that says you know this is a resubmission or anything like that so how do we do it without being confusing when y'all get it?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] OK. Oh, I can definitely help you with the resubmission. Um, may I have your name and a good contact number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, this is [PII], and the number is [PII].
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have your policy number?
[CUSTOMER][NEUTRAL] Yes, it is 78413.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so that's bringing up a different member. What type of policy is it?
[CUSTOMER][NEUTRAL] It's, it's a cancer and the name on the policy is [PII].
[AGENT][NEUTRAL] You're calling from the provider's office?
[CUSTOMER][NEUTRAL] But it's
[CUSTOMER][NEUTRAL] No, no, no, I'm his assistant and I'm filing the claims his claims.
[AGENT][NEUTRAL] OK, OK. I was just trying to see who I was speaking with so I know how to handle the call. OK. So,
[CUSTOMER][POSITIVE] Got you OK.
[AGENT][NEUTRAL] Can you verify the members, you already gave me his first and last name, the date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you for that. Hold on one moment.
[AGENT][NEUTRAL] All right, and I, and um also [PII], can you verify the mailing address on file?
[CUSTOMER][NEUTRAL] Yes, I think it's his house. Let's see, um, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So on the online service center, it's not going to give you an option to like identify that it's a a resubmission. Each time you submit something, you're going to receive a new claim number and confirmation number, but once the examiner gets it, they'll be able to see that that's the, um, you know, additional information or what was asked for from a previous claim, and they'll reprocess.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so I'll get a new claim number and a new verification number you said?
[AGENT][NEUTRAL] Well, yeah, so like at the end, it gives that confirmation, yes, ma'am, every time you upload your, cause it'll look like it's a new entry, but we'll know it goes with something previous.
[CUSTOMER][NEUTRAL] Or confirmation
[CUSTOMER][POSITIVE] OK, OK, OK, all right, thank you so much OK?
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Um, I don't, hold on, let me look at my notes here. Yes, can you tell me from that policy? I just got a copy of the policy. It's an old policy, uh, yesterday.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can you tell it looks like it's a C440 policy.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Do you, do you know what type of policy that is, um, because the reason I'm asking the, the people that sold us the policy years ago didn't have that information because it's so old and with that whatever number she said the type of policy it is she can help me because some of these claims.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] thinks he it should be covered, but she said if she knew the number the claim or the policy type she would be able to help say yes that's covered, no that's not covered and then I don't have to be the dead dog trying to keep resubmitting things that he says it's covered so is C 440 what you're showing?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Yes, but that's just like a that's wait a minute. So you said that you received a copy of the certificate, like the breakdown of everything that's paid?
[CUSTOMER][NEUTRAL] Right. Well, I
[CUSTOMER][NEUTRAL] I, um, I downloaded it from the website yesterday because she was wanting to know because we keep calling her going why was this kicked back it's supposed to be covered and she said she didn't know the type of policy she couldn't say but I think that's I got that number off the policy, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] The reason I'm asking
[CUSTOMER][NEUTRAL] So I, I think
[CUSTOMER][NEUTRAL] Yeah, go ahead.
[AGENT][NEUTRAL] The reason I'm asking is because the product type is, that's just, it's a cancer that just lets us know it's a cancer policy. What's more important is if you do have the breakdown with all of the coverage and the dollar amount that will be paid to that. That's what will help you determine what's covered and what's not because it shows you what the policy.
[CUSTOMER][NEUTRAL] OK, so C440 is just showing that it's a cancer policy.
[AGENT][NEUTRAL] Right, that's just like a product ID.
[CUSTOMER][NEUTRAL] Is that what you're OK.
[CUSTOMER][POSITIVE] Oh OK OK all right well thank you so much.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's it thank you so much bye.
[AGENT][POSITIVE] Alright, well, thanks for calling APL. You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] Alright you too bye bye.
[AGENT][NEUTRAL] Bye bye.