AccountId: 011433970860
ContactId: c64f0f9d-49b0-4dc5-bc4e-8362f2e1acb5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 334600 ms
Total Talk Time (AGENT): 100732 ms
Total Talk Time (CUSTOMER): 192555 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/c64f0f9d-49b0-4dc5-bc4e-8362f2e1acb5_20250307T20:07_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, hello there. I had a question about my claim.
[AGENT][NEUTRAL] OK, I can verify claim status for you. And may I ask who's calling?
[CUSTOMER][NEUTRAL] My name is [PII] Last name is [PII]
[AGENT][NEUTRAL] OK, and do you have your policy number?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, I have my card. Would it be payer ID or group number?
[AGENT][NEUTRAL] Do you see a policy certificate number, probably start with 01 or 02?
[CUSTOMER][NEUTRAL] Uh, in hospital benefits certification number, is that it?
[AGENT][NEUTRAL] Yeah, in hospital outpatient.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, it is.
[CUSTOMER][NEUTRAL] The outpatient one you said? OK. 02.
[CUSTOMER][NEUTRAL] 473-3
[CUSTOMER][NEUTRAL] 11
[CUSTOMER][NEUTRAL] M as in Mary. L as in Larry 8.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And verify your, excuse me, date of birth, mailing address and email address, please.
[CUSTOMER][NEUTRAL] Uh, [PII], uh [PII]. Email address was [PII].
[AGENT][POSITIVE] Awesome, thank you so much. Give me one moment. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][POSITIVE] [PII]. Awesome thank you so much. And you say you're calling for claim status?
[CUSTOMER][NEUTRAL] So I
[CUSTOMER][NEUTRAL] I I filled out a claim, um.
[CUSTOMER][NEUTRAL] I guess a week or so ago, and then I guess they just
[CUSTOMER][NEUTRAL] Well, I don't, I don't think it's, it was denied. I guess it just needed more information. So it shows this process but for zero amount and then it said that I needed to provide some EOBs.
[CUSTOMER][NEUTRAL] So, I submitted those just now. I just want, it looks like it's almost putting it in as a new claim. I just wanted to make sure that they know that it's in relation to the first claim that I did last week.
[AGENT][NEUTRAL] OK. Well, uh, what claims are, yes, sir, I understand. Like when claims are submitted, um, with the OSC if it's already a claim has been received or it's already been processed, it won't let you add additional information on there. And when the examiner processed the claim, they go by the dates on the information received like billing or EOB. So they'll um be able to show or see that it was in relation to the other claim.
[CUSTOMER][NEUTRAL] Does that make sense?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Did you just do this one a few moments ago?
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Yeah, I just, um, what I did is
[CUSTOMER][NEUTRAL] Uh, I'm trying to get reimbursed for a CPAP machine that I had to pay out of pocket. So, initially, I had sent all the, the bills and I I sent the receipt showing the $1200 and something dollars that I paid.
[AGENT][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So they asked for EOBs.
[CUSTOMER][NEUTRAL] So I just pulled all the ELBs for the company Carecentrix uh for the machine. Um, so I just put all those and then I guess they also asked for um the sleep well, I, I included uh the sleep study also. They didn't ask for that, but the EOB for the sleep study. And then, um, I, I looked up the doctor's notes. They didn't have much of anything, but I kind of screenshotted that. It's pretty much just them saying.
[CUSTOMER][NEUTRAL] You know, you have obstructive sleep apnea and you need uh a machine. So I kind of uploaded all that stuff just now, but since, you know, I just wanted to make sure that they knew that it was, you know, cause it, none of these things have any, I guess it, it doesn't really show the receipts or anything like that, so.
[CUSTOMER][NEUTRAL] Just wanted to make sure that uh they just wanna make sure that I guess they don't have an excuse to, to, you know, prolong it any longer.
[AGENT][NEUTRAL] OK, well, I do show the claim has come through, but I'm not able to actually view it. Usually it takes a while for us to see it, but I do show a confirmation number and that it's been received, so it will be placed on process.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK. All right.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK. And is there anything else that Mr. [PII] that I can assist you with today?
[CUSTOMER][NEUTRAL] No, no, um, I, I think that should probably take about a week or so again for them to review.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Usually takes about 7 to 10 business days.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, I guess they just, they don't cause I.
[CUSTOMER][NEUTRAL] I guess um
[CUSTOMER][NEUTRAL] I, it would have been, I would have preferred if they had, you know, like maybe said, hey, can you send the additional information versus just kind of closing it out and, you know, just, it seems just like just a lot of extra work, uh, I don't know.
[AGENT][NEUTRAL] Oh, I understand.
[CUSTOMER][NEUTRAL] I guess that's not really a question.
[AGENT][POSITIVE] Just statement, but it's OK. Um, well, thank you for calling APL. You have a great day and weekend.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] All right bye bye.
[AGENT][NEUTRAL] Bye.