AccountId: 011433970860
ContactId: b98aca52-a99b-4f20-a6dc-7e791e186575
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 421619 ms
Total Talk Time (AGENT): 179772 ms
Total Talk Time (CUSTOMER): 120885 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/b98aca52-a99b-4f20-a6dc-7e791e186575_20250416T21:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APAL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I filed a claim and it said that it was processed, but I don't really know what that means. Is it processed that I'm gonna get payment? How is payment made and I just don't know anything about it, my first claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am, I understand. I can help you with your claim status. Uh, can I please get your name and your callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] My name is [PII] and the callback number is [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And then what is your policy number, please?
[CUSTOMER][NEUTRAL] Policy number, would that be the payer ID or the group number?
[AGENT][NEUTRAL] No, it may say inpatient or outpatient hospital certification number.
[CUSTOMER][NEUTRAL] OK, I, I have in in in hospitals benefit outpatient benefit cert number you which one do you want?
[AGENT][NEUTRAL] Either one, either one will work.
[CUSTOMER][NEUTRAL] 020249857.
[CUSTOMER][NEUTRAL] 3 M as in Mary, L as in Larry, 8.
[AGENT][NEUTRAL] OK, let me pull up your policy real quick so we can check the claim status.
[AGENT][NEUTRAL] OK, Ms. [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is your address, phone number and email address that we would have on the policy for you?
[CUSTOMER][NEUTRAL] [PII] 33444ila [PII] [PII].
[AGENT][POSITIVE] OK, thank you very much for verifying that information for me.
[AGENT][NEUTRAL] OK, let me look.
[AGENT][NEUTRAL] At your claims.
[AGENT][NEUTRAL] OK, I'm not showing that any claims have been filed on this policy. Uh, this policy lapsed on [PII].
[CUSTOMER][NEUTRAL] OK, I
[CUSTOMER][NEGATIVE] That doesn't make any sense. I, I have a confirmation number. Do you want that?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] It's OSC 96416.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Huh.
[AGENT][NEUTRAL] Yeah, that's the only policy I'm showing on file for you. Um, let me look real quick.
[CUSTOMER][NEUTRAL] It said it was processed and everything was uploaded and it says status processed.
[AGENT][NEUTRAL] Yeah, that's one of our confirmation numbers.
[AGENT][NEUTRAL] Let me pull in by your social and see if there's any other policies that's not pulling in for me. Um, can you give me your social?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Well, it says, hold on one second, hold on one second. There's a policy number on under my coverage.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It says 2502469.
[AGENT][NEUTRAL] OK, let me look up that number.
[AGENT][NEUTRAL] Aha, there we go.
[CUSTOMER][NEUTRAL] I don't know why that other the card itself has got the wrong number but.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yeah, that policy number you gave me is the active policy.
[AGENT][NEUTRAL] Alright and and then now I see the claim that you're talking about also.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it's just asking for more information, um, and let me read to you what it says. We are unable to use payment receipts to process your claim, please submit a fully itemized bill with diagnosis and procedure codes.
[AGENT][NEUTRAL] And the primary carrier explanation of benefits.
[AGENT][NEUTRAL] So you'll need your EOB from your major medical and an itemized statement with your procedure and diagnosis codes to be submitted so they can finish the claim.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Hold on one second because I need to write that down. Hold on 1 2nd. You said you my email.
[AGENT][POSITIVE] Yes, ma'am. Yes, go ahead and take your time.
[CUSTOMER][NEUTRAL] I need my EOB. What is that?
[AGENT][NEUTRAL] That stands for explanation of benefits and in short it's EOB.
[AGENT][NEUTRAL] And that is, you get that from your primary insurance, your major medical.
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then you'll need
[CUSTOMER][NEUTRAL] And then what else do I need?
[AGENT][NEUTRAL] An itemized statement.
[AGENT][NEUTRAL] Or an itemized bill.
[AGENT][NEUTRAL] You both are the same.
[AGENT][NEUTRAL] Um, with your diagnosis and procedure codes.
[AGENT][NEUTRAL] And that is, you'll get that from the facility that you went to to have the services done at. That's where you get that from.
[CUSTOMER][NEUTRAL] OK, alright, and then I could and then do I just.
[CUSTOMER][NEUTRAL] Upload it on the what do I do?
[AGENT][POSITIVE] Yes, you can upload it.
[CUSTOMER][NEUTRAL] Upload more documents.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, I appreciate your help and then it, OK, thank you very much.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You're welcome. Do you have any other questions that I can help you further with?
[CUSTOMER][POSITIVE] Um, no, I think that's it for now. Thank you.
[AGENT][POSITIVE] OK, Ms. [PII], I hope you have a wonderful night and thank you for calling APL.
[CUSTOMER][POSITIVE] Yep thanks bye bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] guy
[CUSTOMER][POSITIVE] Let's take a walk, honey.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.