AccountId: 011433970860
ContactId: ab87fbe4-efcc-4a57-9cbf-5edfb4989684
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 226800 ms
Total Talk Time (AGENT): 91727 ms
Total Talk Time (CUSTOMER): 118434 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/ab87fbe4-efcc-4a57-9cbf-5edfb4989684_20250429T13:03_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] Yeah, hi, good morning, [PII], uh, [PII] calling. Um, I had a some questions on a claim that I put in for a wellness visit. I did a, um, a tele visit with my doctor and I turned in the receipt and I don't know if I did the claim wrong, um, but it shows everything is completed, but there isn't any payout.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I can look at the claim with you. And [PII], may I have a good contact number in case we're disconnected and your policy number?
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII].
[CUSTOMER][NEUTRAL] And the policy number is 02579881.
[AGENT][NEUTRAL] OK, thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And I have you here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. Um, the, the address is uh [PII], it's [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So we did receive the claim, it was denied but denied requesting additional information. So we just need to know the diagnosis. Um, you can, you can present the
[AGENT][NEUTRAL] Itemized bill, the I don't know if this is a doctor's office or a hospital, but their version of the the itemized bill.
[CUSTOMER][NEUTRAL] It is it
[CUSTOMER][NEUTRAL] Yeah, so what it was was he, he, uh, I needed to get my prescription filled, so he wanted to talk to me and go over the vitals and everything, um, you know, before I could get my prescription refilled, and, and I hadn't talked to him in a while because I'm a commercial driver, so obviously, you know, I'm not there that often.
[AGENT][NEUTRAL] OK, you did say it was a televisit, so yes. Yes, it could be an itemized bill, it could be doctor's notes, just something that shows the diagnosis code from, uh, there's one here from [PII] and also [PII] of this year.
[CUSTOMER][NEUTRAL] So you guys need an itemized bill?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So if they have like their clinical notes.
[CUSTOMER][NEUTRAL] Well, it should
[CUSTOMER][NEUTRAL] It should be, should be just one. I mean, I, I, when I originally filled it out as my first time, I didn't include the um um the actual receipt. I, I filled it out. I'm like, oh, I gotta do the receipts so I came back again and it might have been a couple of days after the fact, you know, I, I don't remember, um, and, and, and put that in. I don't know why there were two, but yeah, I can call the office and see if they can email me something. Do I need to.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Refill out a new claim with with that document?
[AGENT][NEUTRAL] No, like you don't need to fill out like a new claim form, but when you, um, you're just gonna upload it onto the online service center like you did this one. Now when you submit it, it's going to look like it's a new claim every anytime you submit something, it's gonna look like it's a new claim. I just don't want you to be alarmed or anything. It's just a new entry. But when the examiner gets it, they'll see this is, you know, such and such from this claim and you only have the one claim on file, so.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Right, right, OK, alright, I'll uh I'll give them a call, um, and then, um, and then I'll, I'll go ahead and, and then re uh upload it, so, OK, alright, thank you.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today, Mr. [PII]?
[CUSTOMER][POSITIVE] No, that's it. Have a good day.
[AGENT][POSITIVE] You also, thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah, but.