AccountId: 011433970860
ContactId: dbab34fa-10a0-46d4-aa29-2dd630f592c6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 396920 ms
Total Talk Time (AGENT): 245415 ms
Total Talk Time (CUSTOMER): 104979 ms
Interruptions: 3
Overall Sentiment: AGENT=1.3, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/dbab34fa-10a0-46d4-aa29-2dd630f592c6_20250423T17:45_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] Hi [PII], my name is [PII], and I'm following up on a claim that I submitted. Um, can I give you that claim number?
[AGENT][NEUTRAL] OK. First off, Ms. [PII], are you the insured?
[CUSTOMER][NEUTRAL] Yes I am.
[AGENT][NEUTRAL] What is a good callback number for you first off?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And your policy number?
[CUSTOMER][NEUTRAL] Policy number is 02597280.
[AGENT][NEUTRAL] OK, thank you. Give me a moment please to get your policy information pulled up first.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, Ms. [PII], I will need to verify several things with you first for security purposes and also any information that I provide will be a verification of benefits and not a guarantee.
[AGENT][NEUTRAL] Payment. So first off, if you could please verify your date of
[CUSTOMER][NEUTRAL] I'm sorry, you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so I'm not sure how much you have.
[AGENT][NEUTRAL] OK, thank you. And also your home mailing address, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Your phone number that is on file is the same as the one that you provided for me. So that is your best contact number. Is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][POSITIVE] Thank you and lastly your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK. Thank you very much.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Alright, so I do see there is one claim on file is.
[AGENT][NEUTRAL] Um, this claim was just processed on the [PII]. OK, this is all for Quest Diagnostics. Is that correct?
[CUSTOMER][POSITIVE] Mhm. That's correct.
[AGENT][NEUTRAL] Alright, so just one moment.
[AGENT][NEUTRAL] So I can't see that it was denied.
[AGENT][NEUTRAL] Uh, there is a [PII].
[CUSTOMER][NEUTRAL] OK, and the reason?
[AGENT][NEUTRAL] Yes, um, and you will also have access to this explanation of benefits, Ms. [PII], in your portal, in your online service center portal, so you don't need to try to write all this down. You have access to that explanation of benefits with all these remark codes on it. So for the [PII], um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This one's kind of long. Receipt of the claim is acknowledged. However, in order to provide further consideration of this loss under the 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.
[AGENT][NEUTRAL] Super, excuse me, bills, office notes, hospital admission and discharge numbers, and our diagnostic testing. It appears that we are missing a diagnosis code for that data service.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Because I did upload, I did upload the explanation of benefits, is that enough or no?
[AGENT][NEUTRAL] But it would not have your, no, ma'am, it's not going to have the diagnosis code on it. So you just reach out to your provider.
[AGENT][NEUTRAL] who ordered your lab work, they provide that to you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and then I just call you back with the code?
[AGENT][NEUTRAL] And that's gonna be the same thing for Data Service January where you would just, they would send that to you. It is gonna have to be on there, you know, either a bill or an office note indicating the diagnosis for the [PII] and [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There was a [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Let me see something here.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Service data I only see.
[AGENT][NEUTRAL] There was
[AGENT][NEUTRAL] [PII] for CMS diagnostic Services.
[CUSTOMER][POSITIVE] Oh yeah I see it OK.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] And again, that is one that we, there was, we're needing a diagnosis code.
[CUSTOMER][NEUTRAL] OK, that one I didn't provide the um.
[CUSTOMER][NEUTRAL] The explanation of benefits. I still, so I should do that as well, correct? get diagnostic code and upload that, right?
[AGENT][NEUTRAL] You 22 data service. We're needing the same information and I'm so sorry um I don't know why it's doing that today, but um.
[CUSTOMER][NEGATIVE] I'm sorry, you keep breaking up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, for January
[AGENT][NEUTRAL] The [PII] and the [PII].
[AGENT][NEUTRAL] We use this codes for those dates of service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and I didn't hear what you said on [PII], do you also need the explanation of benefits or is that already received?
[AGENT][NEUTRAL] No, ma'am, it doesn't state that we need the EOB. It just states about the diagnosis. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. OK, let me call the that would be my doctor, correct?
[AGENT][NEUTRAL] Yes, ma'am, that ordered everything. Uh-huh. And then once they send you that information, you would, you can just upload it directly into your portal like you did this other documentation. Now, you will not be able to attach the information that you're getting to this specific claim number.
[CUSTOMER][POSITIVE] Perfect. OK.
[AGENT][NEUTRAL] So you're just gonna upload that like it's a new file or a new claim and then the system will recognize that as you know the information we were needing.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For these 2 days of service.
[CUSTOMER][POSITIVE] Perfect per.
[CUSTOMER][POSITIVE] OK, sounds great.
[AGENT][POSITIVE] OK. Well, yes, ma'am, you're welcome. Absolutely. Can I help you with anything else today, Ms. [PII]?
[CUSTOMER][POSITIVE] OK, thank you so much for your help. Thank you.
[CUSTOMER][POSITIVE] That's it for today. I appreciate your help.
[AGENT][POSITIVE] Well, you're very welcome. It was my pleasure and thank you for calling [PII]. I hope you have a wonderful afternoon.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you, bye-bye.