AccountId: 011433970860
ContactId: f388d941-ec16-4d45-8da8-fd0eba3cd300
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 513330 ms
Total Talk Time (AGENT): 237317 ms
Total Talk Time (CUSTOMER): 198014 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/f388d941-ec16-4d45-8da8-fd0eba3cd300_20250224T15:49_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEGATIVE] Yeah, I'm calling because um I have submitted 3 claims, um, and have received no money back and no, you know, notifications uh or any mail or anything like that about them.
[AGENT][NEUTRAL] Sure, OK, I can check those claims for you. um, what was your name?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Call the Valley.
[AGENT][POSITIVE] Alright, cool, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Alright, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yeah, uh well I have my um my ID numbers.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] 682.
[CUSTOMER][NEUTRAL] 980033-6
[AGENT][NEUTRAL] OK, one moment, please.
[AGENT][NEUTRAL] OK, um, I did not get a result with that [PII]. um, let's see, I could try searching using your social.
[CUSTOMER][NEUTRAL] Yep [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Alright thank you one moment.
[AGENT][NEUTRAL] Here we are. OK. I'm just gonna verify some information really quick. [PII], can I get your date of birth, please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] Uh, [PII], it's either [PII] or [PII].
[AGENT][NEUTRAL] OK, it's the [PII], is that correct?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Yeah, OK, um, and then last thing I need is the email address we've got on file for you. uh, looks like it is a Yahoo account.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it's called [PII].
[AGENT][NEUTRAL] Got it. OK, thank you for verifying that information. Just a moment. Let me check on this claim.
[AGENT][NEUTRAL] So I've just got one that we received on [PII].
[AGENT][NEUTRAL] Let me take a look at that.
[CUSTOMER][NEUTRAL] Yeah, apparently
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I may have uh sent um multiple claims in on the same day or something, but there's no I don't think that's I'm not sure.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, I know that I have, I just go ahead.
[AGENT][NEUTRAL] No, no, no, you're fine.
[CUSTOMER][NEUTRAL] Uh, I was just speaking to somebody over at like the main line and they said yes there were 3 different doctors' visits, uh, like the claim is for, although I think it was all like fit together maybe.
[AGENT][NEUTRAL] OK, I am just showing the one claim, um, and for this we are missing the itemized statement that shows diagnosis codes so once we have that information then we can continue processing it. Uh huh.
[CUSTOMER][NEUTRAL] OK, so my question is this, OK.
[CUSTOMER][NEUTRAL] Uh, my, my question is, so why haven't I heard that you guys don't have all the information?
[AGENT][NEUTRAL] Honestly I'm not sure I am showing that you received or I'm sorry that you filed this through our online portal um have you been looking there for updates?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, so our portal it does give um updates about the current status of submitted claims.
[CUSTOMER][NEUTRAL] Um, OK, but you're only showing there's one claim. The people I was just talking to to give your number said that they were showing 3 claims.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] What, um, who were you just speaking with? Was it um IMA or um Benefits and Accord?
[CUSTOMER][NEUTRAL] Bit, uh, hold on, let me see if I'll just pull up the number real quick. Hold on a second here, um, these guys, I can, you want me to tell you what the phone number is? Will that help?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, honestly, I'm not quite sure, um, because I know that these plans can be a part of, um, you know, like a multi plan, so it's possible that you filed claims with other organizations or providers or excuse me, carriers, um, but I'm just showing the one claim for us that we've received.
[CUSTOMER][NEUTRAL] I mean not
[CUSTOMER][NEUTRAL] OK, I don't really, so here's what the person said just a minute ago that it was all, um, like I think she's saying it was submitted all on the same date but that they had multiple dates with multiple doctor's visits.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Right, I'm just showing the one, the only instance I have here is from the date of service of [PII].
[AGENT][NEUTRAL] That's the only claim that I've got on file for you.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] That you can submit that informa go ahead.
[CUSTOMER][NEUTRAL] OK, look, so I
[CUSTOMER][NEGATIVE] But I'm off at work, like, you know, away from home out in the middle of fucking nowhere. I'm gonna need help walking myself through this because I have been trying to deal with this for months, for months, uh, and I keep getting the run around. People keep telling me different things. Like 10 minutes ago somebody told me something different than what you're telling me.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, again I'm not sure who you spoke with [PII] and I do apologize this is the only information I have for you um and again you can submit that information there's no timely filing limit so if you wanted to go back and hop back on the website on the online portal you can submit all of that information there. That's probably gonna be the quickest and easiest way to get claim information to us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, tell you what, what exactly is the website and maybe you know, anything else I know.
[AGENT][NEUTRAL] Sure, so our online portable website, it's the word [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Yes, so [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And I will say in order to upload claim sorry.
[CUSTOMER][NEUTRAL] Uh, all right.
[CUSTOMER][NEUTRAL] Yeah, go ahead.
[AGENT][NEUTRAL] Yeah, just so that you are aware, uh, in order to successfully upload claim information the website does have to be accessed on a desktop or a laptop computer it doesn't really have support for mobile devices.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. That's fine. Uh, and then let's see, what will I need to do? I just upload the doctor's bill or what?
[AGENT][NEUTRAL] Sure, OK, so yes, um, again, the current claim that we have is missing information, um, if you wanted to write it down, let me know when you're ready and I'll let you know the correct information that we need.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yeah, go ahead
[AGENT][NEUTRAL] OK, so it's going to be the itemized statement.
[AGENT][NEUTRAL] That shows diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] Statement on with.
[AGENT][NEUTRAL] Diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] Hold on.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] OK, uh, just those.
[AGENT][NEUTRAL] Yes, and then of course the correct claim form filled out which this plan is the hospital indemnity which that'll be on the website and yeah that's gonna be all the information that we need and wherever you went for treatment uh those providers will have this information.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, I'm sorry, so the correct claim form uh sorry what what did you say about that? The hospital indemnity, right?
[AGENT][NEUTRAL] It's OK, so the plan name it's, yes, that's it's called Hospital indemnity.
[CUSTOMER][NEUTRAL] Uh hold on one second.
[CUSTOMER][NEUTRAL] Hold on a second.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, so it's called the hospital indemnity, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Immity claim
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so I will need um to get the the bill from my doctors with the itemized uh statement diagnosis and procedure codes, right?
[AGENT][NEUTRAL] That's it. Yes, sir.
[CUSTOMER][NEUTRAL] And then on the website that you gave me I can I can grab the um uh hospital identity form right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, yes, you'll see that option to be able to fill out that claim form and then upload that claim information.
[CUSTOMER][POSITIVE] OK, OK, thank you very much.
[AGENT][NEUTRAL] You're very welcome. What did you have any other questions for me, [PII]? I know it's a bit confusing.
[CUSTOMER][POSITIVE] Yeah, no, it's all right, thank you very much.
[AGENT][POSITIVE] Yeah, OK, yeah, uh, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] All right bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.