AccountId: 011433970860
ContactId: d8423db0-1411-45ea-a7d2-ceddac6e0bba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 555880 ms
Total Talk Time (AGENT): 207916 ms
Total Talk Time (CUSTOMER): 219153 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/d8423db0-1411-45ea-a7d2-ceddac6e0bba_20241230T18:23_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], my name is [PII].
[CUSTOMER][NEUTRAL] And I received a letter from APL dated [PII], stating that they received my claim and that it was being reviewed.
[CUSTOMER][NEUTRAL] I just wanted to know if I should continue to wait on you reviewing it or I received a past due notice from [PII] for $24,000 today.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah, let's definitely take a look at it and see what's going on. Do you have the claim number or your policy number?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Oh, for [PII]?
[AGENT][NEUTRAL] No, you had said, said that.
[CUSTOMER][NEUTRAL] No, I don't
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] OK go ahead.
[AGENT][NEUTRAL] Uh, you had said that you had submitted a claim with us on [PII] and you were just waiting to hear what the outcome was. Did you get a claim number for that or do you have your policy number with us?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, this was a, I received a letter from you on [PII]. Let me see, I got another letter from you. I can give you the policy number that's on the.
[CUSTOMER][NEUTRAL] That was on the um.
[CUSTOMER][NEUTRAL] The card
[AGENT][POSITIVE] OK, that would be great.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry, I got a lot of stuff here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] Let me just put you on. Can you hear me?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I just put you on speaker so that
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me see something else I received from, OK.
[CUSTOMER][NEUTRAL] From I received this from American from APL.
[CUSTOMER][NEUTRAL] And they have uh should I give you that policy number or reference number they have on this form?
[AGENT][NEUTRAL] The
[AGENT][POSITIVE] The policy number would be great, yeah.
[CUSTOMER][NEUTRAL] OK, the policy number on this form that APL sent me is 0.
[CUSTOMER][NEUTRAL] 227-096-7
[AGENT][POSITIVE] All right, [PII], thank you so much. Let me just pull this up here. Give me one moment please.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] All right. And then for security, I will need to verify please your date of birth and address.
[CUSTOMER][NEUTRAL] Um, my, my, um, birthday is [PII].
[CUSTOMER][NEUTRAL] And I live at [PII].
[AGENT][POSITIVE] All right, thank you so much and it looks like we have a Comcast email on file. Is that a good email for you?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, so the claim that was submitted, um, we're needing to process the claim we need an itemized statement.
[AGENT][NEUTRAL] And it needs to have diagnosis codes on it. Did they submit the claim on your behalf or did you do it?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I just nailed it in. They asked for it. I got the information from [PII] itemized itemized bill and something else that.
[CUSTOMER][NEUTRAL] Um, [PII] sent me and I mailed it to you.
[CUSTOMER][NEUTRAL] Well, I mailed it to
[CUSTOMER][NEUTRAL] Um, the insurance company and then that's when I guess they must have sent something to you all and then APL sent me this explanation of benefits and then they sent me that uh that letter.
[CUSTOMER][NEUTRAL] That said they received my claim and they will be reviewing it and they will get back to me.
[AGENT][NEUTRAL] OK, yeah, cause the claim was denied requesting the itemized statement with diagnosis code. So let me see what we have on here.
[CUSTOMER][NEUTRAL] Cause what I sent you is what they, what um the insurance company requested from me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I didn't even get in touch, you know, um, have anything to do with the American public. They just, um, when I, the girl that was helping me at [PII], she said, um, [PII] will be sending me a letter.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, yeah, so I mean the yeah the claim was processed back in November and I see what you had submitted so if you don't mind [PII], what I'm gonna need to do is get somebody on the line that actually processes claims um because if this is not what we needed, then they would be able to explain to you exactly what you would need to obtain to um.
[AGENT][NEUTRAL] Move forward in the claim process.
[CUSTOMER][NEUTRAL] So I have a question. Should I just go ahead and start paying this $24,000 or I should wait?
[AGENT][NEUTRAL] Honestly, ma'am, I can't advise you on what to do in that regard. That's a personal preference, um.
[AGENT][NEUTRAL] You know this particular like I said, this particular claim that was submitted I'm not saying that you're not eligible for any benefit payment on it, it just looks like it was requesting more information, but if the claim was processed in error, that's why we should reach out to claims because if it was processed, denied an error, then we need to get that fixed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Um, so let me get somebody on the line that works claims. Do you have any other questions or concerns before I reach out to them?
[CUSTOMER][NEUTRAL] No, I just want to know whether I should pay this bill and if you are taking care of, you know, checking things out for me.
[AGENT][NEUTRAL] OK, right, one moment please.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] Deferring.
[AGENT][NEUTRAL] I feel like that's what I don't know.
[CUSTOMER][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], this is [PII] over in customer care. How are you today?
[CUSTOMER][NEUTRAL] I'm well how are you?
[AGENT][POSITIVE] I am good, thank you. I have an insured on the line. Her name is [PII] and she has a claim that she has some questions on. I was hoping you could help her with.
[CUSTOMER][NEUTRAL] Sure, what's the policy number?
[AGENT][NEUTRAL] Policy is 02270967.
[CUSTOMER][NEUTRAL] And that's [PII].
[AGENT][NEUTRAL] Yes, ma'am, and I think there's just, it's just one claim in there, um.
[AGENT][NEUTRAL] So I did go into OnBase cause she says that she submitted like the denial was for diagnosis codes, and I did look at it. I'm not 100% if that was right when she submitted or not. So that's why I was hoping maybe you could help her.
[CUSTOMER][NEUTRAL] Let's see. This is uh for cancer policy?
[AGENT][NEUTRAL] Oh, no, this was a hospital indemnity. Sorry.
[CUSTOMER][NEUTRAL] Let me try.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Let me take a look if I can answer that because I don't process those that would be the HIQ but I can try to assist. Let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, did I call the wrong number? I'm sorry, girl.
[CUSTOMER][NEUTRAL] No, that's OK. Yeah. You came over to a cancer uh disability.
[AGENT][POSITIVE] Oh, I'm sorry.
[CUSTOMER][POSITIVE] You. But no, that's OK. Send her over. I'll uh do my best to assist her.
[AGENT][POSITIVE] All right. Thank you so much.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] Here she comes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], my name is [PII], and I was just calling um because I received the.