AccountId: 011433970860
ContactId: c9c57667-e32f-4ff2-ac0c-f374cd823418
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 506410 ms
Total Talk Time (AGENT): 174580 ms
Total Talk Time (CUSTOMER): 92367 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/c9c57667-e32f-4ff2-ac0c-f374cd823418_20250214T14:21_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][POSITIVE] Hi, good morning. Yes, I need some assistance with the claim.
[AGENT][NEUTRAL] Sure, I can assist you with claims and you're calling from a provider's office or this is your personal account, personal policy?
[CUSTOMER][NEUTRAL] No personal personal policy.
[AGENT][NEUTRAL] OK, um, may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII] [PII].
[AGENT][NEUTRAL] And Miss [PII], uh, do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 2203929.
[AGENT][NEUTRAL] OK, thank you. Let me pull that information.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, for security, may I have your date of birth, mailing address and email address?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, email is [PII].
[CUSTOMER][NEUTRAL] And my address is [PII].
[AGENT][POSITIVE] Perfect. [PII].
[CUSTOMER][NEUTRAL] Yeah, mama, yeah.
[AGENT][NEUTRAL] OK, thank you. All right. And you said you're needing claim status, and this is gonna be for what um member?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So it's for Darryl, uh, we filed it on data services was 210.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And it was for urgent care visit?
[CUSTOMER][NEUTRAL] I filed the receipt but I don't know that I did it correctly.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEGATIVE] Because it doesn't look like it got paid.
[AGENT][NEUTRAL] Yeah, it looks like it may be missing some information. Let me check and see exactly what's missing. Um, do you mind holding for me? I'm just gonna go through the claim, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, no problem.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Um.
[AGENT][POSITIVE] Thank you for holding and being patient for Ms. [PII].
[CUSTOMER][POSITIVE] Sure, no problem.
[AGENT][NEUTRAL] OK. So I went through the documents and it looks like you sent the receipts. Um, we're gonna need a fully itemized bill. Um, you can get this um through the urgent care. I'm not sure if they gave you like a discharge summary with the diagnosis code, but if they did not, um, you can go ahead and request one to be sent to you. Um, and also, uh, we're gonna need a copy of the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Indicating how much they applied towards the deductible co-payment and co-insurance.
[CUSTOMER][NEUTRAL] Oh yes.
[CUSTOMER][NEUTRAL] OK, so the benefits from the primary.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the itemized bill for the visit.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][POSITIVE] OK, perfect. And you said something about the notes too, like the aftercare summary, one of those?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, if, uh, if sometimes they give you like an aftercare summary and it has the amount that they charge plus the diagnosis code. If you have that, um, you sometimes you can send that in, um, but, um.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] If you don't, it's best to call them and have them to send it to you or either tell you how to get it online if you have their portal, um, and also, uh, I see that we don't have the claim form, um, and the claim form is in our website. So if you go to [PII], yeah [PII], um, you're gonna go to claims and forms and you're gonna look for the met claim form, um, the first page of that form.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For the what form, I'm sorry?
[AGENT][NEUTRAL] Metlings
[CUSTOMER][NEUTRAL] Main, OK.
[AGENT][NEUTRAL] Yes, and the first page is gonna give you instructions exactly the same information that we're requesting, OK?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And once you have all three.
[CUSTOMER][NEUTRAL] On the first page and when I go in.
[CUSTOMER][NEUTRAL] When I go in to submit the claim, I can put more than one file in the same submission or or file in each submit it each time.
[AGENT][NEUTRAL] Um, no, you can bundle bundle them together and send it in one submission. Now you can add to the one you already sent because we already view it, so it's locked. You cannot put any more documents into that one, but you can create a new one and you can just attach as many documents to that same, um, request, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. OK, I'll do it again.
[AGENT][NEUTRAL] All right. You're welcome, Ms. [PII]. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] Thank you so much for your help.
[CUSTOMER][NEUTRAL] Uh no, that's gonna be it.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.