AccountId: 011433970860
ContactId: beb1665e-3753-4156-a86b-a62ce0f9a4a3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 312200 ms
Total Talk Time (AGENT): 107035 ms
Total Talk Time (CUSTOMER): 135564 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/beb1665e-3753-4156-a86b-a62ce0f9a4a3_20250502T21:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], good afternoon. My name is [PII], and I'm trying to uh see the uh claim that I sent on the [PII] online, but it says that it's having technical difficulties to contact you guys directly. So I don't know if you can help me with that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have your policy number?
[CUSTOMER][NEUTRAL] I do, it's no longer active, it's, it has lapsed, but the benefits are from [PII]. The policy number is 1912737.
[AGENT][NEUTRAL] OK, and is it a claim for yourself?
[CUSTOMER][POSITIVE] It's for myself, correct.
[AGENT][NEUTRAL] OK. Can I verify your birth date?
[CUSTOMER][NEUTRAL] Of course, it's [PII].
[AGENT][NEUTRAL] And then what is the address on the policy?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, and do you have a good uh callback number in case we're disconnected there?
[CUSTOMER][NEUTRAL] Yes, of course, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then so you had created an account before online?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yes, I do have an account online, yes.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And I submitted the claim, I have a claim number. I did that on the [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Uh [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It typically takes about 2 to 3 working days to upload into our system, so I don't see it on my end yet. Um, I would check back Monday it should be loaded by then and, and we can make sure that we've received it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I see it here, it says processed.
[AGENT][NEUTRAL] OK, um,
[CUSTOMER][NEGATIVE] I just cannot open it to see what happened with it.
[AGENT][NEGATIVE] Oh, hold on, I'm on the wrong thing. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Sorry about that.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] OK, I see the claim, um.
[AGENT][NEUTRAL] And that was for 11-172023, is that right?
[CUSTOMER][POSITIVE] Correct. Yes, that is correct.
[AGENT][NEUTRAL] OK, let me pull up what we received. It looks like it.
[AGENT][NEUTRAL] We're needing more information, but let me see what we need.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] The center was supposed to send it to uh the insurance I had back then, which it was Humana and then APL, but apparently they never send it to you guys. So I received a bill for $300 so that's why I submitted it to you guys to see if you were gonna pay something. If not, then I will have to pay it out of pocket.
[AGENT][NEUTRAL] OK, let me see what we got.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so do you have the explanation of benefits from Humana?
[AGENT][NEUTRAL] That's one thing we'll need.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] So you do need the EOV. OK. I can pull that out. Definitely. EOB. Where can I send it?
[AGENT][NEUTRAL] OK, we
[AGENT][NEUTRAL] Um, you can send it to, do you want our fax number?
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[AGENT][NEUTRAL] OK. Uh, fax number is 877365.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] 942 2.
[AGENT][NEUTRAL] The other piece of information, so the statement that was received, it does show us that, you know, what type of services was rendered, but there's not a diagnosis on it. Um, is there some type of documentation you could provide that shows us the diagnosis for the services you received on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't have any documents because that's from [PII] and usually when you, whenever you're gonna get this type of service, you need to turn in the prescription from the doctor, but I can definitely call the center and have them send it to me or
[CUSTOMER][NEUTRAL] I'll see what I can do.
[AGENT][NEUTRAL] OK, yeah, if you can get those two pieces of information, um, then we can reconsider the claim.
[CUSTOMER][NEUTRAL] I do
[CUSTOMER][NEUTRAL] Beautiful. OK. Let me get to work on it. So the fax number [PII]. There is no way that I can send it um in your website, correct? It has to be done by fax?
[AGENT][NEUTRAL] No, you can upload it to the portal.
[CUSTOMER][POSITIVE] I can? OK, perfect. OK, that's easier for me. Perfect. Let me get to work on it and um and I'll contact you guys again. Thank you so much, OK?
[AGENT][POSITIVE] OK, thank you for calling APL. I hope you have a good weekend.
[CUSTOMER][POSITIVE] Thank you. You too. Take care. Bye-bye.
[AGENT][POSITIVE] Thank you, bye bye.