AccountId: 011433970860
ContactId: 963a396d-be8e-4975-9925-a92e23443093
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 384059 ms
Total Talk Time (AGENT): 157440 ms
Total Talk Time (CUSTOMER): 110396 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/963a396d-be8e-4975-9925-a92e23443093_20250306T14:07_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], how are you? I'm calling to check on a claim.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, I'll be more than happy to help you with your claim. And may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII]
[CUSTOMER][NEUTRAL] And [PII]
[AGENT][NEUTRAL] Thank you, Ms. [PII]. May I have a good contact number in case we're disconnected and your policy number?
[CUSTOMER][NEUTRAL] Sure, let me give you my policy number. It's 5,047,565,250 hold on, I'm just pulling my, I have a claim number if that'll help you.
[AGENT][POSITIVE] Oh, yes ma'am. I can use the claim number.
[CUSTOMER][NEUTRAL] OK, well, it's two, I think they merged together because I had to send some additional documents in, but um it's 08C9046.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And 0, wait, no, that's a, I'm sorry, it's 0SC 94046 and 0SC 94,050.
[AGENT][NEUTRAL] So that might be with your major insurance. Um,
[AGENT][NEUTRAL] I can look your policy up with your
[CUSTOMER][NEUTRAL] Wait, no, OK, that's, that was the policy number. Let me give you the claim number. I'm sorry, it's um 357.
[AGENT][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] 1687.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, here we go. So I have you here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] [PII] date of birth [PII].
[CUSTOMER][NEUTRAL] And it's, it's um a claim I filed on behalf of my husband.
[AGENT][NEUTRAL] OK, let me go to him. Hold on one second.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] All right, so I have it here, it's coming up now. Hold on one moment. And all the information provided is a verification of benefits, not a guarantee of payment. So I'm just waiting for the claim to populate.
[AGENT][NEUTRAL] OK, so I do see the claim here and it looks like it's on hold, medical records have been requested um to the doctor.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's as of [PII].
[CUSTOMER][NEUTRAL] that's
[AGENT][NEUTRAL] Oh, that was yesterday. Sorry.
[CUSTOMER][NEUTRAL] So y'all so y'all requested medical records yesterday?
[AGENT][NEUTRAL] Yes, that's when it was, the request was sent out yesterday. So they finished processing yesterday and then the explanation of benefits um generates and then it's sent out to the provider and then to you.
[CUSTOMER][NEUTRAL] and then the explanation.
[CUSTOMER][NEUTRAL] So they're not saying, I mean, so we don't, when will we know something?
[AGENT][NEUTRAL] So once, so the request for the medical records just went out yesterday. So once we receive the medical records back because in the request it asks for like a particular date range. So once we get it back from the doctors, then they'll continue processing. Um, a typical claim takes we usually say 7 to 10 business days, um, but now that this one is kind of on hold a little bit until we get those records. So if you want to give your doctor a call, I don't know if they, well, I'm pretty sure they haven't received it just sent out yesterday.
[AGENT][NEUTRAL] But you can give them a call and let them know that that we're requesting the explanation of benefits. Let me see if I can get the date range for you.
[AGENT][NEUTRAL] That they're looking for.
[CUSTOMER][NEUTRAL] What about, can I go pick up the medical records?
[AGENT][NEUTRAL] Yes, ma'am, you can. Um, usually, well, it depends. Since they, since we've already requested it for the claim, I would say to just go ahead and let them send the records to us, because if you request it, most likely they're gonna like put it on a disk.
[AGENT][NEGATIVE] And there's no way to send that disk in.
[CUSTOMER][NEUTRAL] OK, what's the, what's the date range?
[AGENT][NEUTRAL] Um, hold on one moment. I'm trying to access the documents so I can get to it.
[AGENT][NEUTRAL] I'm trying to see if I see if I can access the documents that were sent out.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK, I just found it. It's coming up now.
[AGENT][NEUTRAL] OK, so it looks like office visit notes from [PII] to present and then diagnostic testing results from [PII] to present, and it was sent to Dr. [PII].
[CUSTOMER][NEUTRAL] OK. All right. I may just go get him to speed process up.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK. Um, all right, I'll get back. 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.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] OK, bye-bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] What order to.