AccountId: 011433970860
ContactId: e40b74f0-363c-4fd8-8bbb-da627eb54e62
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 838489 ms
Total Talk Time (AGENT): 570840 ms
Total Talk Time (CUSTOMER): 226411 ms
Interruptions: 2
Overall Sentiment: AGENT=1.6, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/e40b74f0-363c-4fd8-8bbb-da627eb54e62_20250430T12:04_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. Um, I'm calling in regards to um a claim that we process, um, online through the portal and, um, the status currently right now it says processed, so I was just wondering what that meant like it's just being processed like being entered that nothing is complete yet.
[AGENT][NEUTRAL] OK, are you the insured and you're wanting to check claim status on a claim that you filed, is that correct?
[CUSTOMER][NEUTRAL] Well, it's under my husband's and the children, the dependents, uh, the claims were for them, so I'm, I was doing the processes for him. Um, I have here the policy number, the claim number if needed.
[AGENT][NEUTRAL] OK. And you are covered on this policy, is that correct?
[CUSTOMER][NEUTRAL] Um, well, I used to have the, the account with them, but mine's been lapsed since I don't work there anymore and I don't have it anymore, but it's under my husband [PII].
[AGENT][NEUTRAL] OK, so what I can do is just I can try and help you, but first I will need to pull up the policy information first to verify some things with you for security, and then I'll be able to further tell you how much information I can give you at this point. OK, so who am I speaking with please?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] End of the [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Can you please spell your name for me?
[CUSTOMER][POSITIVE] Oh yes, of course. [PII]
[AGENT][NEUTRAL] OK, and could you pronounce your last name one more time for me or the office?
[CUSTOMER][NEUTRAL] For a
[AGENT][POSITIVE] [PII]. OK, thank you.
[CUSTOMER][POSITIVE] What I feel, yeah, I say you're welcome.
[AGENT][POSITIVE] OK, thank you. um
[AGENT][POSITIVE] And Miss [PII], what is a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And what is the policy number?
[CUSTOMER][NEUTRAL] OK, let me see here, it is 248, sorry, I'm driving uh [PII].
[AGENT][POSITIVE] OK, thank you. Give me just a couple of moments please to get this information pulled up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And I'm about to pull up at home too, so my husband will be here since the policy is under him in case you need to speak to him.
[AGENT][NEUTRAL] Yes, ma'am. I probably will need to do that, but if you'll give me just a moment to get all this information pulled up first.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] You got it.
[AGENT][NEUTRAL] OK, so we can go ahead uh with the verification process, Ms. [PII]. So first off, if you'll please verify your husband's name and date of birth.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yes, [PII] then [PII], and then [PII].
[AGENT][NEUTRAL] OK, thank you and then your children's names and dates of birth?
[CUSTOMER][NEUTRAL] Sure. [PII], and he's [PII], and then there's [PII] [PII] and he's um [PII].
[AGENT][NEUTRAL] OK, and what was, what was [PII]'s date of birth one more time? I'm so sorry.
[CUSTOMER][NEUTRAL] For [PII] or for [PII]?
[AGENT][NEUTRAL] Uh, for [PII], for the child, [PII].
[CUSTOMER][NEUTRAL] For [PII]. Oh, OK. [PII].
[AGENT][POSITIVE] OK, thank you so much. And also the home mailing address, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we would have on file for your husband?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What is the phone number that we would have on file for your husband?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you very much for verifying the information. OK, so because you are not listed on this policy, Miss [PII], I will have to speak to him in order to be able to get his approval for this one phone call in order to go over these with you.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure, let me, let me have him. He's right here. Hello?
[AGENT][POSITIVE] OK, oh, great. Thank you. Hi, good morning, [PII]. How are you today?
[CUSTOMER][NEUTRAL] Good and yourself?
[AGENT][NEUTRAL] I'm fine thank you. So my name is [PII] and I'm with APL and uh Miss [PII] was calling to check on claim status for a couple of claims for your dependents, but because she is not on this policy, we cannot discuss anything related to the policy without your permission. So do you give me verbal consent for this one phone call only to speak to her?
[CUSTOMER][NEUTRAL] Absolutely I do and is there any way possible to add her on so she can uh just like call in and be an authorized user on this account?
[AGENT][NEUTRAL] Yes, actually, if you'll verify your email address for me, please.
[CUSTOMER][NEUTRAL] Sure, uh, the letter [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, so thank you. So yes sir I can email you a third party authorization form that you can complete, and then you may email that back to [PII] at the same email that you're going to receive it from, which will be care team [PII] and we'll be happy to get that on file for future.
[AGENT][NEUTRAL] But make sure to include that it's for both children and if you, it's for yourself, you can also include that. Um, if there's not a specific space for names, you can just write everyone's name and date of birth on the authorization that you're giving approval for.
[CUSTOMER][POSITIVE] Perfect. Thank you.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Perfect. Thank you.
[AGENT][NEUTRAL] OK, so once, uh, yes sir, you're welcome. And so once I get off the phone with her, I will send that again it will come from care team at [PII] and I will put APL in the subject line for you.
[CUSTOMER][POSITIVE] Awesome, thank you.
[AGENT][POSITIVE] OK, well, you're welcome so thank you for getting on the line with me and I hope you have a very nice day.
[CUSTOMER][NEUTRAL] Likewise, I'm gonna pass my uh my wife on to the phone now.
[AGENT][POSITIVE] Perfect. OK, great. Thank you.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Alright bye bye.
[AGENT][NEUTRAL] Bye-bye. Hi, OK, Mr.
[CUSTOMER][NEUTRAL] Hi [PII].
[AGENT][NEUTRAL] Listen, thank you so much um so as I, I don't know if you heard that or not but I am going to be emailing your husband an authorization form for him to complete, and he can email it back to the same email that he's going to receive it from, um, so that we can get you on file as a you know an authorized contact so that we don't have to get his verbal permission each time. Alright, so are there claims for both children?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Oh, good.
[CUSTOMER][NEUTRAL] Uh yes, ma'am.
[AGENT][NEUTRAL] OK, so let me, I'm going to look first at his, at, uh, actually I'm going to look at [PII]'s first.
[AGENT][NEUTRAL] So give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, I just wanted to see if you guys are missing any information so that the claim doesn't get like denied. I don't know if you guys needed like an itemized bill, that way I can request that from the hospital or something like that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, OK, and actually because um [PII]'s listed first, your son [PII], I'm going to look at his first. So we do have one claim on file for him. This is for a [PII] data service.
[CUSTOMER][POSITIVE] Of course, no problem.
[AGENT][NEUTRAL] And yes ma'am, that claim for him has been denied at this point. Now you probably cannot see this explanation of benefits in the portal yet with the remark code that I will read to you.
[CUSTOMER][POSITIVE] Oh, correct.
[AGENT][NEUTRAL] However, it should be available later this afternoon. Those claims just went through processing or that claim specifically went through last night, so it does take a little time um to get that there, but you will be able to see this. OK, so for him for [PII]'s claim, one of the remark codes.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] States and I'm just going to read it to you it's kind of long, but receipt of your claim is acknowledged. 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.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Super bills, office notes, hospital admission and discharge summaries, and or diagnostic testing results. So essentially, we need the diagnosis on that. We also will need
[AGENT][NEUTRAL] It states we have received the primary explanation of benefits that's your primary insurance, OK, explanation of benefits that was submitted with your claim. However, the explanation of benefits received does not list the amounts applied to the deductible.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Co-pay or co-insurance, please submit a more detailed explanation of benefits that shows these amounts for further consideration of your claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, there's another code also the same as the first one that I read you.
[CUSTOMER][NEUTRAL] I just
[AGENT][NEUTRAL] And then the last one is to, it just states to please provide copies of your explanation of benefits from your primary insurance carrier. So we're needing diagnosis code, um, an itemized bill essentially, and a more detailed primary EOB showing co-pays, deductibles, and co-insurance amounts.
[CUSTOMER][NEUTRAL] Understood. OK.
[AGENT][NEUTRAL] So when you get that information you can upload it into the portal just like you did the claims initially. Now there's not a way the start to tie to like select that claim number that's already in the system.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And add this information so you'll just click the submit claim or file a new claim and upload that needed information and then our system will recognize that for this data service that's information we were missing.
[CUSTOMER][NEUTRAL] So we'll have to submit new ones.
[CUSTOMER][NEUTRAL] OK, understood. So I need an itemized, an itemized bills, the coding of the diagnosis of the children from that day, and my um basically a breakdown of uh our primary insurance, you said?
[AGENT][NEUTRAL] Does that make sense? OK.
[AGENT][NEUTRAL] Correct, a more detailed EOB because the one we received just did not have, since this policy helps you with your co-pays, deductibles and co-insurance amounts of coverage services, we have to be able to see those amounts on the explanation of benefits.
[AGENT][NEUTRAL] So we just need a more detailed EOB. Now, that is for [PII]'s claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So basically an explanation of benefits, you said, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Well, it, it's probably gonna be the same thing because I, I basically uploaded the same information for [PII], so.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so let me just look at his to make sure um of what exactly we need. Now, it looks like.
[AGENT][NEUTRAL] OK, so 1 2nd.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so on [PII].
[AGENT][NEUTRAL] I can get my screen to do what I need for it to do. Uh, yes, ma'am. It's essentially, yes, it's gonna be the same things.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um, I have a question. So when you say the codes of the diagnosis, is basically that form that basically of the result of, of uh from the hospital.
[CUSTOMER][NEUTRAL] Like, the results, basically.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Well, it may not necessarily the procedure codes or the testing codes. This one needs to include the diagnosis of what exactly was wrong with them. Yes. Uh-huh. Um, now, usually an itemized bill.
[CUSTOMER][NEUTRAL] The diagnosis, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I knew I wouldn't.
[AGENT][NEUTRAL] Would have that information on there, but again.
[AGENT][NEUTRAL] If you speak to someone to try and get that, make sure that they know that you would need.
[AGENT][NEUTRAL] The diagnosis code to be included on that bill if it's not. Mhm.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] I'll ensure that.
[AGENT][NEUTRAL] Yes, and again, you, oh, you're welcome. And again, um, you should be able to see both of these explanation of benefits in your portal, uh, later today so that you could look on page 2 and just have all of that that I read to you they are viewable for you.
[CUSTOMER][POSITIVE] Oh thank you so much Ms. [PII]. OK.
[AGENT][NEUTRAL] And then I'm going to email that form that I was telling your husband about. I'm gonna email on that in just a couple of minutes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Wonderful. Thank you so much for your help today. You've been very informative.
[AGENT][POSITIVE] Oh, yeah. Oh well, it was my pleasure in helping you. And is there anything else at the moment that I could help you with?
[CUSTOMER][POSITIVE] Oh no, ma'am, that's all. Thank you.
[AGENT][POSITIVE] OK, well then thank you for calling APL and I hope that you have a wonderful day.
[CUSTOMER][POSITIVE] Thank you. Bye bye.
[AGENT][POSITIVE] Yes ma'am, thank you too bye bye.