AccountId: 011433970860
ContactId: a9f80848-2c5e-4f62-bada-db7aa7e62b05
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 611750 ms
Total Talk Time (AGENT): 197911 ms
Total Talk Time (CUSTOMER): 165123 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/a9f80848-2c5e-4f62-bada-db7aa7e62b05_20250113T18:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling UPL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Um, I have a, a question on a claim I keep submitting and it keeps getting kicked back to me. The first time I sent it was back in November, and I had sent an itemized bill, uh, for a hospital stay. Then I was told I needed to submit a summary of the admittance and discharge. So I did submit that on December, then I got kicked back.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Telling me it has to be followed up with an itemized bill again so I was like, OK, I already sent that. So then at the end of December I sent both the itemized bill and the summary of admittance and discharge and again it got kicked back to me telling me I need to send that again.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Hmm, OK, let's take a look. What is your uh policy number or if you have the claim number, either will work.
[CUSTOMER][NEUTRAL] OK, my policy number is 0232.
[CUSTOMER][NEUTRAL] 9682.
[CUSTOMER][NEUTRAL] And then I have the 3 different claim numbers too.
[AGENT][NEUTRAL] OK, let's see here.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right. And then if I could just verify your first name, last name, date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you, [PII] and then I will need to verify please the address on file with your email address as well.
[CUSTOMER][NEUTRAL] [PII]. Email is [PII].
[AGENT][POSITIVE] All right, thank you so much. So let's see here.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] OK, so I see a claim, [PII]. It looks like that was submitted online. Um, it shows a reported date of the [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let's see, yeah.
[CUSTOMER][NEUTRAL] For which I have 3 different claims for this particular instance. One is gonna be.
[CUSTOMER][NEUTRAL] November.
[CUSTOMER][NEUTRAL] 6
[CUSTOMER][NEUTRAL] Another time I submitted was [PII] and then [PII].
[AGENT][NEUTRAL] OK. Why don't you give me the
[CUSTOMER][NEUTRAL] I mean, I have the
[AGENT][NEUTRAL] Yeah, why don't you give me the claim numbers, that way I can, yeah.
[CUSTOMER][NEUTRAL] The claim.
[CUSTOMER][NEUTRAL] OK, yeah, so the first clean number I submitted was 352-6904.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This was the first one.
[AGENT][NEUTRAL] OK, and then what was the 2nd 1?
[CUSTOMER][NEUTRAL] So then the second one was to follow up what they requested for that first one, which is 353-683-1.
[AGENT][NEUTRAL] 831. OK.
[AGENT][NEUTRAL] And then the final one that you submitted.
[CUSTOMER][NEUTRAL] Yeah, the final one would be everything together again, which is 3543734.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me go to the last one.
[AGENT][NEUTRAL] So I see what you're talking about on the first couple. So on this last one, there were.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So part of it was denied saying that the diagnostic and prevention benefit had been exhausted for the year.
[CUSTOMER][NEUTRAL] Yes, yes, that I understand.
[AGENT][NEUTRAL] OK. And then,
[AGENT][NEUTRAL] Not really.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me pull up the claim because it's not giving a whole lot of details just saying incomplete so let me see if I can figure out what's what the.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, there are there are additional notes, yeah, that they made too on top of that, which is what I submitted that's why I was confused.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] I'm just double checking the forms to make sure I don't see anything that's like.
[AGENT][NEUTRAL] Um, I don't see anything that's missing.
[AGENT][NEUTRAL] OK, um, yeah, I mean even looking at this claim, [PII], I don't see that you were missing anything on the claim form, so what I can do.
[AGENT][NEUTRAL] I reach out to the claims department.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And have them re-review this and then reach out to you directly um and speak to you because I don't.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not a claims examiner. I don't process claims and but I don't see anything that you missed, you know, I look at, I'm looking at everything that you uploaded, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So is this [PII], is that a good call back number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so yeah let me reach out to the person that processed the claim and just have them look at this again and let them know that you need to call back um if it was denied like that way you know exactly what can be submitted and I'll let them know that you've done this multiple times now um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And, uh, have somebody call you back. So, um, hopefully it'll be by the end of today. Did you have any other questions or concerns?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, I do. I noticed that my cancer insurance is being lapsed and um I know it was uh tingent on um my premiums being covered because I was on disability. Um, I did get my disability paperwork in in December, but I think I got in a little later than usual. So I, I just want to ensure that that, I know I was waived my premium for cancer till this month, but it's still showing lap.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I may not just be updated, yeah, let's see.
[CUSTOMER][NEUTRAL] Oh OK I just wanna verify.
[AGENT][NEUTRAL] Yeah, let's see.
[AGENT][NEUTRAL] Yeah, I just don't see that it looks like it's been updated yet.
[CUSTOMER][NEUTRAL] So I, I'm not, I'm still active, correct, then?
[AGENT][NEUTRAL] Yeah