AccountId: 011433970860
ContactId: bc876a4a-7c2b-45dd-b3a0-d4b568eb1c6f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 521308 ms
Total Talk Time (AGENT): 281798 ms
Total Talk Time (CUSTOMER): 201500 ms
Interruptions: 3
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/bc876a4a-7c2b-45dd-b3a0-d4b568eb1c6f_20250110T18:19_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, I'm sorry, let me take you off speaker because I can barely hear you. Did you say your name was [PII]?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] It's [PII], [PII]
[CUSTOMER][NEUTRAL] Oh [PII] hi [PII], uh, my name's [PII]. I was just calling for to see if there was an update on my claim.
[AGENT][NEUTRAL] Yeah, I'd love to help you check on that claim status today, [PII], and do you happen to have the claim number handy or not the claim number I'm sorry, the policy number?
[CUSTOMER][NEUTRAL] Sure, um, it's 02.
[CUSTOMER][NEUTRAL] 369.
[CUSTOMER][NEUTRAL] 465.
[CUSTOMER][NEUTRAL] M as in Mary, L as in liberty, and then either 7 or 8.
[AGENT][POSITIVE] Perfect thank you and.
[CUSTOMER][NEUTRAL] I think I used to 8.
[AGENT][NEUTRAL] [PII], can you verify for me, pretty please, your last name and your date of birth?
[CUSTOMER][NEUTRAL] Yeah, my last name is [PII] and my date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you, one second.
[AGENT][NEUTRAL] And I am just gonna verify a few more bits of information if you could verify with me, please, your mailing address?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And can you verify for me, please, your email address?
[CUSTOMER][NEUTRAL] You probably have my uh work email [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Perfect thank you so much and then just lastly is that phone number on file.
[CUSTOMER][NEUTRAL] No problem. [PII].
[AGENT][NEUTRAL] Is that a good number to call you back if we got disconnected, sir?
[CUSTOMER][NEUTRAL] Uh, the same [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect, thank you, thank you and.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] All right. It looks like.
[AGENT][NEUTRAL] We had a recent claim come in for you, oh my gosh, hold on, I'm not sure when it came in, uh, yesterday.
[AGENT][NEUTRAL] No, 2 days ago? Is that the one we're calling about?
[CUSTOMER][NEUTRAL] Um, I didn't submit a claim.
[CUSTOMER][NEUTRAL] I don't know who submitted the claim. Did, uh, so no, it was from the I can give you the date of service.
[AGENT][POSITIVE] Yeah, that'd be wonderful. What was the date of service for the claim you're looking at?
[CUSTOMER][NEUTRAL] That it's about.
[CUSTOMER][NEUTRAL] Uh, there were two, let's see, it's either [PII] of last year or [PII], I believe it's gonna be um.
[CUSTOMER][NEUTRAL] It's not Doctor [PII], that's the [PII], so this is for Doctor [PII] and it was [PII] of last year.
[AGENT][NEUTRAL] Alright, I do want to let you know I actually do not see any claims on file with the date of service of [PII]. So it looks like we just need one submitted to us so we can process it for you.
[CUSTOMER][NEUTRAL] No, this has been going on, it's in there. It's just I must be giving you the wrong date then. Do you see something for [PII] of last year?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I do see quite a bit for [PII], yes.
[CUSTOMER][NEUTRAL] OK, so I'm sorry, that must be the correct date then.
[AGENT][NEUTRAL] OK, yeah, no worries. So it looks like.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Again there was a few of them. I wanna make sure.
[AGENT][NEUTRAL] No, OK, so there's actually only 2 claims with that date of service. Um, there's one it looks like it says the facility was skin cancer and associates.
[AGENT][NEUTRAL] Um, from [PII], I don't know if that would be it, or the other one says that it was from actually the same place.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, the first one was rejected because there were no codes.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So then I resend it
[CUSTOMER][NEUTRAL] Uh, I, I obtained the codes from the uh.
[CUSTOMER][NEUTRAL] The skincare
[CUSTOMER][NEGATIVE] Provider and resubmitted it and then they said they didn't receive it so I sent it again they and that was.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] In January actually I sent it again and they told me we should be 7 to 10 days so it's only probably been a week now since I submitted it again.
[AGENT][NEUTRAL] OK. Um.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] So it's all the same claim just the first time it was rejected.
[AGENT][NEUTRAL] OK, the second one, it said.
[AGENT][NEUTRAL] OK, so then the one I have, you said like you sent it. I do see that one where it was rejected saying that we needed the diagnosis code.
[AGENT][NEUTRAL] And then I see where they reprocessed it with the diagnosis code and it had, and this is for the 7-19-2024, it says, um, the first one office visits are not covered by the above numbered policy, and then the next two have the same denial code saying this service is not covered when it's performed in a doctor's office or clinic. I am seeing that a claim was submitted on in the start of January. So if you mailed it in.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, the date we, we got it up into our system was [PII], and it could have been the one you mailed out at the beginning of January, um.
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] And so on that one though, what I'm seeing is it has dates of service on it for [PII] and not dates of service of
[AGENT][NEUTRAL] Uh, the [PII], and that one is at the very end stage of being processed, and I would likely have more information for you by tomorrow, I would say 24 to 48 hours at the most, um, but it's in the final stages of being processed.
[CUSTOMER][NEUTRAL] OK, so that'll be Monday.
[AGENT][NEUTRAL] Oh yeah, because it's, yeah.
[CUSTOMER][NEUTRAL] So that would be Monday or Tuesday because you know yeah.
[AGENT][NEUTRAL] I forgot it was the weekend almost.
[CUSTOMER][NEUTRAL] OK, so now,
[CUSTOMER][NEUTRAL] That that's OK. Um, so is it the same office? Is it Doctor [PII] because I'm a little confused. I mean, maybe.
[CUSTOMER][NEGATIVE] I, I don't know, it doesn't make sense. I'm not aware of uh.
[CUSTOMER][NEUTRAL] And what I didn't submit another claim and.
[CUSTOMER][NEUTRAL] Maybe skincare and associates submitted the claim because they were supposed to and they didn't. This is what you told me your office told me.
[AGENT][NEUTRAL] OK, yeah, so I do see the doctor [PII] here and it that, but the facility name is the skincare and Associates, and I can't tell like who physically sent the claim, um, but I can just tell that it came into us, by the time we put it into our system, it was, uh, marked as received on the [PII].
[CUSTOMER][NEUTRAL] So I end up doing it all myself.
[CUSTOMER][POSITIVE] That's correct, yeah.
[CUSTOMER][NEUTRAL] OK, so, oh, so you can't tell me who sent it, but, but it was entered yesterday.
[AGENT][NEUTRAL] I can't tell you when it was received, um, but we got it, yeah, 2 days ago. So, um, whether they sent it, the only time I can really tell is like when um it will say like notes next to it like insured submitted, um.
[CUSTOMER][POSITIVE] Oh my gosh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But this one just says
[AGENT][NEUTRAL] It doesn't say insurance submitted, so it probably came from the facility, but I would hate to just tell you, I knew for a fact when I, when I didn't, yeah.
[CUSTOMER][NEUTRAL] Mm, wow. Right, right. You don't know.
[CUSTOMER][NEUTRAL] OK, alright, no problem, uh, alright, so I'll call back next week and what was your name again?
[AGENT][NEUTRAL] Yeah my name is [PII] and then did you know that we have an online portal where you can like track and check your claim statuses and upload everything online instead of like waiting for the mail? Do you want any information on that?
[CUSTOMER][NEUTRAL] Well, here's the thing, we, um.
[AGENT][NEUTRAL] Oh, I don't think your policy is active anymore. I think that was it.
[CUSTOMER][NEUTRAL] Uh, so
[CUSTOMER][NEUTRAL] That's the problem, yeah, and so I, I.
[AGENT][POSITIVE] Yeah, it is. I'm sorry.
[CUSTOMER][NEUTRAL] That's OK. Yes, so it's probably just gonna be easier for me to call back and uh go about it through email. I've been emailing you stuff and I keep getting messages how unsafe email is, but at least I'm doing it so.
[AGENT][NEUTRAL] I thought it'd be helpful.
[AGENT][NEUTRAL] Yep.
[AGENT][NEUTRAL] Yeah, it's not secured but um OK well I definitely appreciate you giving us just a couple more days to finalize the latest claim we have going on on file and then if there's anything else you need help with, you know, please let us know and then.
[CUSTOMER][NEUTRAL] Um
[AGENT][POSITIVE] We'll do our best to help you, my friend.
[CUSTOMER][POSITIVE] OK, OK, [PII], thank you very much. I appreciate your help today.
[AGENT][POSITIVE] Hey, it's my pleasure. You take care, [PII].
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][NEUTRAL] Bye bye.