AccountId: 011433970860
ContactId: c138b5d7-a146-4377-88d6-9207af285437
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 620799 ms
Total Talk Time (AGENT): 313064 ms
Total Talk Time (CUSTOMER): 142622 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/c138b5d7-a146-4377-88d6-9207af285437_20250327T16:55_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi, my name is [PII], and I had a claim in, and you guys received it on the [PII]. Um, I'm just wondering kind of the progress of it.
[AGENT][NEUTRAL] OK, [PII], so you're wanting to check claim status on a claim for yourself, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you. And your policy number, please?
[CUSTOMER][NEUTRAL] I'm sorry, I'm digging it out here quick.
[AGENT][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] 683 2.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 643-62.
[AGENT][NEUTRAL] OK, and that's, is that your member ID number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, and this has any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. I will need to verify several things with you first for security. So first off, if you'll please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address please?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that is on file for you is the same as the one that you gave me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you and then the last piece of information is your email address?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, send the test. I do see that there was a claim submitted and reviewed. You do have one claim on file with us. Um, is this for?
[AGENT][NEUTRAL] It's multiple dates of service. It was [PII] and [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Uh [PII]. I don't know about the [PII].
[AGENT][NEUTRAL] That may have been some information that was included with the information you submitted.
[AGENT][NEUTRAL] OK, so at this time the claim has been denied, Ms. [PII], and I will read you the remark on here. You should also be receiving this in the mail on your explanation of benefits, and I can also email you a user guide for our portal called the online service center where you can set up your profile and you can actually have access to this explanation of benefits and these remarks, OK?
[AGENT][NEUTRAL] But it states receipt of your claim is acknowledged. How in however, in order to provide further consideration of this loss under this policy, we will need supporting documentation to evidence the accident or sickness. Supporting documentation may include, but is not limited to itemized bills with the diagnosis codes, super bills.
[CUSTOMER][NEUTRAL] I sent all that I.
[CUSTOMER][NEUTRAL] I emailed
[CUSTOMER][NEUTRAL] Everything
[CUSTOMER][NEUTRAL] It has the data service, it has the codes, procedure codes and description.
[CUSTOMER][NEUTRAL] This is an $11,000 bill.
[AGENT][NEUTRAL] OK, give me just one moment.
[CUSTOMER][NEUTRAL] And I pay over $400 a month.
[CUSTOMER][NEGATIVE] For nothing, obviously.
[AGENT][NEUTRAL] OK, so I can see that the, what we received on this claim, it does, these are bills, but it doesn't have your diagnosis.
[AGENT][NEUTRAL] Codes on there.
[AGENT][NEUTRAL] It gives different testing and things that you had done.
[CUSTOMER][NEUTRAL] There's procedure codes, a reference code, so you want need, you need a diagnosis code.
[AGENT][NEUTRAL] But it doesn't give, yes, ma'am. Mhm, but it
[AGENT][NEUTRAL] Yes, ma'am. Mhm.
[AGENT][NEUTRAL] According to these remarks, that is what is needed.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Alright, I'll get that for you and can I send it back in then?
[AGENT][NEUTRAL] Now you
[AGENT][NEUTRAL] Oh absolutely, all you need to do is provide the additional information that's needed. So what I can do you have access to a computer, Ms. [PII], where you could upload this into the portal? OK, well I'm gonna email you the user guide for our online service center that I was talking about.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And it will give you instructions on how to create your profile and it will also explain about uploading documents.
[AGENT][NEUTRAL] For our review.
[AGENT][NEUTRAL] Gives you the instructions on how to do that. So the email that I'm gonna send to you in just so when we get off the phone, it will come from care team at [PII] and I will put APL and online service center in the subject line for you. It shouldn't go to your junk or spam mail, Ms. [PII], but you know if you don't see it in your regular inbox.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Within less than 10 minutes, uh, for sure. I would check one of those, more like 5 minutes really.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And again, you'll be able to see the remarks that I was reading to you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On the explanation of benefits under your claim that's in there and you only have the one claim currently on file with us.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] OK. Well, is there anything else, Ms. Has that I could help you with at the moment?
[CUSTOMER][NEUTRAL] No, so all I need are diagnosis codes, right?
[AGENT][NEUTRAL] Yes, ma'am. According to this remark that I was reading.
[AGENT][NEUTRAL] Mm. Give me just one second to get back to that.
[CUSTOMER][NEGATIVE] I tell you this is the worst insurance I ever had in my life.
[AGENT][POSITIVE] I'm very sorry for your.
[CUSTOMER][NEUTRAL] On the card it says I can go anywhere.
[CUSTOMER][NEGATIVE] I was lied to.
[CUSTOMER][NEUTRAL] It, it just
[CUSTOMER][NEGATIVE] This is ridiculous.
[AGENT][NEUTRAL] Have you reached out to the agent that you dealt with?
[AGENT][NEUTRAL] Or to member services is actually the company that provides us the enrollment information.
[AGENT][NEUTRAL] And that's who you would have enrolled through.
[CUSTOMER][NEUTRAL] Yeah, I
[AGENT][NEUTRAL] For this particular type of plan you have.
[CUSTOMER][NEUTRAL] I have been on the phone almost I've been on the phone almost every day last week with somebody from that company.
[AGENT][NEUTRAL] From member services.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And right on my card, it said I.
[CUSTOMER][NEUTRAL] That I can receive care from any licensed medical provider.
[CUSTOMER][NEUTRAL] Apparently a hospital emergency room isn't a medical provider.
[CUSTOMER][NEUTRAL] I know it's not your fault. I'm just.
[AGENT][NEUTRAL] Yes ma'am, so this association, you know, I don't know about all the different options that you all have. I can see where you did speak to someone here at APL most recently on the [PII].
[AGENT][NEUTRAL] And you know, she went over some information with you um.
[AGENT][NEUTRAL] And about contacting you know member services regarding other plan options that.
[AGENT][NEUTRAL] Could have possibly been available to you.
[AGENT][NEUTRAL] And did she give you their phone number or you already have that?
[CUSTOMER][NEUTRAL] Alright, I'm gonna resubmit.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] I am gonna resubmit all this. I'll have to get diagnosis codes and resubmit it. This is ridiculous. This bill is over $11,000.
[AGENT][NEUTRAL] Yes ma'am, I can see that.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][NEUTRAL] But I will send you this in just a moment. And again, is there anything else, Miss [PII] that I could help you with at the moment?
[CUSTOMER][NEUTRAL] Nope.
[AGENT][POSITIVE] OK, well thank you for calling APL. If you have any other questions, please give us a call and we'll be more than happy to to help you, OK?
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] Yes, ma'am. You're very welcome and I hope you have a nice afternoon.
[CUSTOMER][POSITIVE] Yep you too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.