AccountId: 011433970860
ContactId: ff9a7429-cbfe-47a7-935e-734a01c79332
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 762409 ms
Total Talk Time (AGENT): 359445 ms
Total Talk Time (CUSTOMER): 323619 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/ff9a7429-cbfe-47a7-935e-734a01c79332_20250212T15:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Where is that?
[CUSTOMER][NEUTRAL] Uh yeah, hi there, good morning, um, I have a quick question. Um, my fiance, uh, his name is [PII], uh, he has a claim in for help with some medical bills, um, if I get this, OK, um, I'm just wondering where, uh, where it's standing right now, um, how much longer until he, uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know, here's here's from, from you guys.
[AGENT][NEUTRAL] OK, so you're just needing claim status for [PII]?
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Right, please, uh huh.
[AGENT][NEUTRAL] OK what is your um call back number ma'am just in case call is disconnected?
[CUSTOMER][NEUTRAL] My number.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK and then what is the number please?
[CUSTOMER][NEUTRAL] I'm sorry, what was the policy did you say?
[AGENT][NEUTRAL] Yeah, with the policy number.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, that would be.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It would it be the same policy as exact science say this policy number? Uh, no, it's the, uh, the hospital 10, you just put them away. I said I wanted to call. Um, I have a policy number, but it's, it's for.
[CUSTOMER][NEUTRAL] I think it's for a different um.
[AGENT][NEUTRAL] That's fine if you wanna give me that one it'll pull in all of his policies for me.
[CUSTOMER][NEUTRAL] Yeah, there's a couple of things.
[CUSTOMER][NEUTRAL] It'll pull it all in. OK, alright, well, the policy number I have in front of me is 024.
[CUSTOMER][NEUTRAL] 18418
[AGENT][NEUTRAL] OK, let me look that up and then what is your what is your name please?
[CUSTOMER][NEUTRAL] Yeah, because there's also a reference number, so alright, thank you.
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] OK, Miss [PII], let me pull in that policy real quick.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] That's, that's not my insurance.
[CUSTOMER][NEUTRAL] That's for your old insurance. This is what you want your policy number for this.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, is Ms. [PII] is [PII] available for me to verify that it's OK to discuss the claim over the phone with you, Miss [PII], since you're not on the policy?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII], you can hear me?
[CUSTOMER][NEUTRAL] Yeah, yeah, that she is.
[CUSTOMER][NEUTRAL] I can hear you, yeah.
[AGENT][NEUTRAL] OK, thank you. OK, I just need to verify your account with us. Can you please give me your date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Thank you sir I'll need your address, your phone number and your email address please sir.
[CUSTOMER][NEUTRAL] OK, my address is [PII].
[CUSTOMER][NEUTRAL] My phone number is [PII].
[AGENT][NEUTRAL] And then one last verification, yes.
[CUSTOMER][NEUTRAL] And my email is.
[CUSTOMER][NEUTRAL] Is [PII]
[CUSTOMER][NEUTRAL] [PII] around [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK thank you [PII] I verifying your policy with me now I'm showing that you only have one policy with us and that's the policy number that you gave me which is your policy plan um.
[AGENT][NEUTRAL] I do show that.
[AGENT][NEUTRAL] We've had 2 claims reported for you for January.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Do you know um which one that you're wanting to information about I show one is paid and one was paid.
[CUSTOMER][NEUTRAL] One was paid and one was what? I'm sorry you broke up.
[AGENT][NEGATIVE] One was denied.
[CUSTOMER][NEUTRAL] Oh really? OK, well, there's a hospital bill, OK, um, and the hospital bill was a total of $131,000 that's, that's the one he needed help with.
[AGENT][NEUTRAL] OK, let me, um
[CUSTOMER][NEUTRAL] The other one's for, yeah, the other one was for through exact sciences and.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The exact sciences um claim was paid $50.
[CUSTOMER][NEUTRAL] Yeah, OK, well that.
[AGENT][NEGATIVE] To, yeah, that was paid the $50 and that after that $50 was paid, the calendar year maximum for the benefit was exhausted.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And then the one for the hospital, I'm gonna assume is the one that was, yeah, for 15,500 and
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Wait, 15,534, yeah, I see that 1 $155,000342.14. That one was denied and let me give you the reason why.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, this is the statement for the remarks. It says in order to complete processing of your claim, we need itemized statements of the services provided listing the diagnosis code.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, all right. Right and I I did I emailed that.
[CUSTOMER][NEUTRAL] And that went right here.
[CUSTOMER][NEUTRAL] Out to.
[CUSTOMER][NEUTRAL] Well this was exact that's exact sizes you want the big hold on hold on, yeah, I have emails here just.
[CUSTOMER][NEGATIVE] I don't wanna
[AGENT][NEUTRAL] Now the itemized statement would come from the facility itself if you can get a cop.
[CUSTOMER][NEUTRAL] Yeah, let me
[CUSTOMER][NEUTRAL] Right, right, and I.
[CUSTOMER][NEUTRAL] Yeah they mailed it to me. My daughter scanned it for me and emailed it with the uh.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, claim form to the phone.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] We don't accept claims by email that's, that's where the problem is um we don't accept claims by email you'll have to fax it in, send it through the online service center or mail it in.
[CUSTOMER][NEUTRAL] Medical benefits.
[CUSTOMER][NEUTRAL] OK, so fax it to.
[AGENT][NEUTRAL] Are you signed up?
[CUSTOMER][NEUTRAL] Yeah this was uh [PII] was the person that I spoke to. She gave me the address for my glasses.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so let me give you our fax number. Let me give you all the information that you need to be able to resubmit that claim with your claim form and your itemized statement.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Fax number is 1877.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 177.
[AGENT][NEUTRAL] 9
[AGENT][NEUTRAL] 1877.
[CUSTOMER][NEUTRAL] Alright, let me start over. I was looking for a pen.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, sir. Go ahead. Take your time.
[CUSTOMER][NEUTRAL] Go ahead
[AGENT][NEUTRAL] OK, it's, yes, sir. It's 1877.
[CUSTOMER][NEUTRAL] I have it now.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] OK 1877.
[CUSTOMER][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 942-3 and that's a fax number.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] That's so you can fax it in. Let me give you the mailing address.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 248.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 248
[AGENT][NEUTRAL] 950, yes, 248,950.
[CUSTOMER][NEUTRAL] 95.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's in [PII].
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] [PII]. I think something.
[CUSTOMER][NEUTRAL] Well it came from there already.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then
[AGENT][NEUTRAL] [PII] is for the claims.
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And then we have an online service center that you can actually submit it through you can see your policy you can get confirmation on your claims you can see that um like this uh statement that I read to you about um sending in the itemized statement you can get those statements that tell you what you need to do next, um, that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Website is secured [PII]
[CUSTOMER][NEUTRAL] Website [PII].
[AGENT][NEUTRAL] No, SE.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] The word secured.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] AM [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, if you go and sign up on there, um, it's a direct portal to your policy.
[CUSTOMER][NEUTRAL] OK, and then that's somewhere I could scan these uh copies in that I, I, I emailed these too.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, yeah, this [PII] claims supervisor.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Or mini [PII] her name was sorry yeah.
[AGENT][NEUTRAL] OK, so if, if you're filing claims with APL we do not accept them by email.
[AGENT][NEUTRAL] So you'll have to use one of those 3 ways that I just gave you and resubmit your claim with your itemized statement that has your diagnosis code on it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Right, OK.
[CUSTOMER][POSITIVE] Alright, yeah, I have all those options right here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] And then refill out that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The claim form.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] If you've already got the claim form filled out you can just scan it in through the online service center or fax it in either way.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'll just have to change the date on it, OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, because that one alright.
[AGENT][NEUTRAL] All right, well, [PII], is there anything else that I can help you with before we go?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, so, so the form, yeah, the one that I, I.
[CUSTOMER][NEUTRAL] Uh, email there on the [PII] or so [PII], a month or so ago, yeah, that one is the one I have to do over.
[AGENT][NEUTRAL] Yes, the one that has the big bill on it from the hospital.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And if you get stuck or you need help while, while you're doing all this, just call us and we'll help you, OK?
[CUSTOMER][POSITIVE] All right, very good.
[CUSTOMER][NEUTRAL] OK, right, so I have a fax number I can scan these and fax them right to.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh, that number [PII] and I don't have to put attention anybody on there.
[AGENT][NEUTRAL] You can put attention claims and let me give you the claim number that you're going to be um resubmitting you could just refer back to the claim number.
[AGENT][NEUTRAL] Because we've already got it numbered for you, it's going to be 355.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 355
[AGENT][NEUTRAL] 03.
[CUSTOMER][NEUTRAL] 03
[AGENT][NEUTRAL] 98.
[CUSTOMER][NEUTRAL] 98 OK.
[CUSTOMER][POSITIVE] OK, very good.
[AGENT][POSITIVE] Alright, well you have a blessed day, [PII], yes sir.
[CUSTOMER][NEUTRAL] Yeah, that'll be the
[CUSTOMER][POSITIVE] Yes, you too, yeah, that'd be the quickest way to fax it over.
[AGENT][POSITIVE] Thanks for
[AGENT][POSITIVE] Yes, sir, that is a, a, a quick way to get it taken care of for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you [PII], you have a blessed day and thanks for calling APL.
[CUSTOMER][POSITIVE] Yeah you too thanks bye.
[AGENT][NEUTRAL] Bye-bye.