AccountId: 011433970860
ContactId: f49d6e3c-62f7-4072-bf32-1e9c98b6c26d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 668599 ms
Total Talk Time (AGENT): 205345 ms
Total Talk Time (CUSTOMER): 253166 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/f49d6e3c-62f7-4072-bf32-1e9c98b6c26d_20250225T21:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, I have questions about two of my claims.
[AGENT][NEUTRAL] OK, I can help you with your claims questions. Can I please get your name and your callback number just in case our call is dropped.
[CUSTOMER][NEUTRAL] Yeah, my callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And my name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] INE.
[AGENT][NEUTRAL] OK, and [PII], are you calling for yourself or are you calling for a patient?
[CUSTOMER][NEUTRAL] Uh, this one specifically is for dependents for my daughter.
[AGENT][NEUTRAL] For your daughter, OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, can you please give me your policy number?
[CUSTOMER][NEUTRAL] Policy number?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Um, actually, you know what, I don't have a policy number. I have
[CUSTOMER][NEUTRAL] Clay numbers and I also have
[CUSTOMER][NEUTRAL] Outpatient benefit certification number, is that that's on my card.
[AGENT][NEUTRAL] Yes ma'am, give me if you can give me that outpatient cer cert number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's 025.
[CUSTOMER][NEUTRAL] 38
[CUSTOMER][NEUTRAL] 147
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][POSITIVE] Thank you
[AGENT][NEUTRAL] So much.
[AGENT][NEUTRAL] Let me look it up.
[AGENT][NEUTRAL] OK, and what is your daughter's name?
[CUSTOMER][NEUTRAL] My daughter's name is [PII].
[AGENT][NEUTRAL] OK. Thank you so much. And then, um, Miss [PII], can you uh please verify your date of birth for me, please?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you. And then what is your address and uh email address?
[CUSTOMER][NEUTRAL] Uh, home address?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK. So that's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the email, I don't know what you have on file. It's probably my work email. It's [PII].
[AGENT][NEUTRAL] It looks like I have a personal email address [PII].
[CUSTOMER][NEUTRAL] OK. So that's my first name, [PII].
[AGENT][NEUTRAL] OK, thank you, and then the phone number that you gave me to call you back on if we're disconnected, is that a good cell phone number?
[CUSTOMER][NEUTRAL] Yes, that's my cell number.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, thank you so much. And let me look and see.
[AGENT][NEUTRAL] Alright and um what is the claim number, the first one you want me to look at?
[CUSTOMER][NEUTRAL] All right. So the first one is uh
[CUSTOMER][NEUTRAL] Let's do this 1. 35.
[CUSTOMER][NEUTRAL] 67
[CUSTOMER][NEUTRAL] 238.
[AGENT][NEUTRAL] OK, let me pull that in.
[CUSTOMER][NEUTRAL] And I actually uploaded everything to the website for this.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, log me out.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh, in the website, I uploaded.
[CUSTOMER][NEUTRAL] The copy of an EOB from my primary insurance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And also a copy of the bill from this company called
[CUSTOMER][NEUTRAL] What is this? PA MD or something?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And then I saw the ELB. Let me make sure I'm looking at the right one. Hold on one second.
[CUSTOMER][NEUTRAL] The EOB says something like.
[CUSTOMER][NEUTRAL] Um, you need additional inform uh it says receipt and the receipt of the claim is acknowledged. However, in order to provide further consideration, we need supporting documents. What kind of supporting documentation do you guys need from me?
[AGENT][NEUTRAL] OK, let me look and see what it says, um.
[AGENT][NEUTRAL] It's gonna be just a second while.
[AGENT][NEUTRAL] OK, the supporting documentation would be from what it's saying from the remarks on the claim, it needs to support if it's an accident or sickness.
[AGENT][NEUTRAL] And it needs to be documentation, um, like, um, diagnosis codes, super bills, office notes, hospital admission and discharge summaries or diagnostic testing results.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] So I don't know what this, why do you need the testing results? I mean, so let me tell you what happened here. So my daughter was sick, she got sick and she couldn't breathe or whatever, so we took her to urgent care and then urgent care did whatever they do, and apparently they sent something to this past MD I don't know who these people are, but they, they did some work with her. I don't know what exactly.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then, uh, yeah, so this is the bill for that. So I guess I don't know what kind like.
[CUSTOMER][NEUTRAL] Supervis, I don't know what super bill do you mean. I didn't, I don't have a Super bill. Um, I did attach a copy of the bill that I received from them. So, is that it?
[AGENT][NEUTRAL] Does it have the diagnosis and procedure code on it?
[CUSTOMER][NEUTRAL] Let's see, let me go in there.
[CUSTOMER][NEUTRAL] And see if it does.
[CUSTOMER][NEUTRAL] Um, so let's look at what I uploaded.
[CUSTOMER][NEUTRAL] And diagnosis code.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Gosh, who knows? I don't know.
[CUSTOMER][NEUTRAL] Isn't that in the EOB anywhere?
[AGENT][NEUTRAL] I don't believe it is. I think it's only on the itemized statement, um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So you would need.
[CUSTOMER][NEUTRAL] Yeah, if you look at
[CUSTOMER][NEUTRAL] Do are you able to see what I uploaded?
[AGENT][NEUTRAL] No, ma'am, I can't see it. um, if you would like.
[CUSTOMER][NEUTRAL] So who, who can say?
[AGENT][NEUTRAL] If you would like, I can get a claims examiner to call you back and you guys can go over step by step what you're looking at compared to what's been received, OK, alright, so this.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, yes, that would be excellent.
[CUSTOMER][POSITIVE] That would be excellent because I feel like I feel like the note that they put in the claim is kind of a generic note that they put into everything. There may be something specific that they need from me and I don't wanna chase all these companies for something that you don't need. But yes, if you can connect me with someone from claims that would be excellent.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so what I'm gonna have to do is send in a request for for um somebody from the claims department and examiner to call you back um and I'm gonna have him call you back on this number that you provided for me is that OK to use that number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Of course, yes.
[AGENT][NEUTRAL] OK, and I'm going to um.
[AGENT][NEUTRAL] I'm, I'm writing up that request right now while you and I are on the phone together.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's gonna be just a second while I get it together.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim 13567238. OK, I've got that saved and sent.
[AGENT][NEUTRAL] To them so that they can give you a call back and it may be up to 24 hours um we close at [PII] central time and then open at [PII] central time so it'll be between those hours that they give you a call back.
[CUSTOMER][POSITIVE] OK, thanks.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry. Say that again. Uh, you were cutting off. Which hours?
[AGENT][NEUTRAL] I'm sorry, we close at [PII] central time and open at [PII] Central time, so you should be receiving a call back within that time frame.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] OK, sounds good thank you.
[AGENT][POSITIVE] OK, you're very welcome. I hope you have a wonderful day and we appreciate you calling APL, Miss [PII].
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.