AccountId: 011433970860
ContactId: 03053d4b-0581-47fb-82fb-465972d4b869
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 188699 ms
Total Talk Time (AGENT): 87367 ms
Total Talk Time (CUSTOMER): 68520 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/03053d4b-0581-47fb-82fb-465972d4b869_20250425T21:00_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I have a question about one of my claims.
[AGENT][POSITIVE] OK, I'm happy to take a look at claims. Do you have your policy number, the claim number?
[CUSTOMER][NEUTRAL] Um, let me see, I'm driving. Hold on a second, my policy number. The policy number I'm referring to is 2521734.
[AGENT][NEUTRAL] OK, thank you for that. Let me just pull this up here.
[AGENT][NEUTRAL] Can I get the first name, last name, and date of birth, please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Was the claim under your name?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, one of them that I'm talking about. I had several of them I did.
[CUSTOMER][NEUTRAL] I was inquiring about the specific one.
[AGENT][NEUTRAL] Is it the last one that you did on [PII]?
[CUSTOMER][NEUTRAL] Yeah, the one that was the thing was on 401. Yeah, I see there's no amount by it. I guess that means it's not getting any money, so I'm trying to figure out why it wasn't, um, there was no money by it.
[AGENT][NEUTRAL] OK, so,
[AGENT][NEUTRAL] It looks like we need a diagnosis code for the date of service.
[CUSTOMER][NEUTRAL] My diagnosis code.
[AGENT][NEUTRAL] Uh, that was, yeah, that was part of the denial. It says the receipt of your claim has been acknowledged, however, in order to provide further consideration.
[AGENT][NEUTRAL] We need supporting documentation to the evidence of the accident or sickness. Supporting documentation may include itemized bill with a diagnosis code, a hospital admission or discharge summary with the diagnostic results.
[CUSTOMER][NEUTRAL] OK, I'm gonna look for that, but see, you know, everything is digitalized. They don't even do um bills anymore. So let me see if I can even find anything cause that was a biopsy I had.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's everything that I had that was with the biopsy.
[AGENT][NEUTRAL] So, yeah, the, whoever performed the biopsy should be able to give you a diagnosis code for what the result was from the biopsy.
[CUSTOMER][NEGATIVE] Um, I don't like
[CUSTOMER][NEUTRAL] OK, well, let me ask you a question. I have the pathology report with that.
[AGENT][NEUTRAL] Yeah, a pathology.
[CUSTOMER][NEUTRAL] Would that be suffice?
[AGENT][NEUTRAL] That should have a diagnosis code on it.
[CUSTOMER][NEUTRAL] OK, I have it.
[CUSTOMER][NEUTRAL] OK. Well, I, um, can I add it to that or resubmit it over?
[AGENT][NEUTRAL] You can just go online and submit that individual piece of documentation and then they'll revisit that claim you don't need to resubmit everything.
[CUSTOMER][NEUTRAL] So go to that, so go to that one and just add to that one or do another one is what I'm saying.
[AGENT][NEUTRAL] You can add to it, yeah. I don't think it's gonna let you add to it. If it doesn't, you can just submit a new one with just that one piece of uh documentation and that's fine.
[CUSTOMER][NEUTRAL] You know what I mean?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Well, I'll do that, um, I have to do it Monday now. I'm already, I already left from work. I'll do it Monday.
[AGENT][POSITIVE] OK, not a problem.
[CUSTOMER][POSITIVE] All righty. Thank you.
[AGENT][POSITIVE] Thank you. Uh-huh, bye-bye.