AccountId: 011433970860
ContactId: 08cbf4e3-49b8-4f99-a3c0-fe4ecfa202ef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 720280 ms
Total Talk Time (AGENT): 154091 ms
Total Talk Time (CUSTOMER): 184580 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=-1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/08cbf4e3-49b8-4f99-a3c0-fe4ecfa202ef_20250428T18:51_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII], and I am a member with Coverage, and I just had a question. I have tried to submit some um doctor's office copays a couple of times and it hasn't gone through and I just wanted to check and see if I'm doing something wrong, if they're really not payable, or what the status is.
[AGENT][POSITIVE] OK, well, I can definitely help you with your um claims. May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yep, I'll give you my cell phone. I'm calling from work, but I'll give you my cell phone. It's [PII]. 0, excuse me, take that all back. I combined two numbers.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, no, I didn't. OK, [PII].
[AGENT][POSITIVE] Thank you for that. And it is a whole Monday.
[CUSTOMER][NEUTRAL] It's a Monday, sorry.
[AGENT][NEUTRAL] And may I have your policy number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Sure, um, policy er number is 01897857.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] OK, and I'm here and I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Sure, my date of birth is [PII], and my mailing is [PII], and that's [PII].
[CUSTOMER][NEUTRAL] And what did you want my email?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And now do you have like the claim numbers you want me to look at for like the denied claims or do you have the dates or how you want to do it?
[CUSTOMER][NEUTRAL] Um, I thought maybe you were gonna be able to see him. I hadn't even opened the website, but I can real quick here. I'm sorry.
[AGENT][NEUTRAL] Oh, OK. No, no, no, it's OK. You don't have to. No, that's totally fine.
[CUSTOMER][NEUTRAL] I had submitted like there was like 10 or 12 of them um all together and I had initially submitted them from the doctor's office um.
[CUSTOMER][NEUTRAL] Um, statements and the message I got back was you needed the explanation of benefits and then I sent all those in and they still got denied. Let me, I'm sorry, let me get to the right place and I can look with you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh, take your time.
[CUSTOMER][NEUTRAL] Here we go.
[CUSTOMER][NEUTRAL] OK, and I think it is the one.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] There were multiple claim numbers on it. Let me get to where did I see that?
[AGENT][NEUTRAL] Or
[AGENT][NEUTRAL] So let me ask you this, is it for you or your spouse or dependents?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's my dependent. His name is [PII].
[AGENT][NEUTRAL] OK, hold on one second.
[CUSTOMER][NEUTRAL] I thought I saw one that had multiple claim numbers on it.
[AGENT][NEUTRAL] Multiple claim numbers. Hold on, I'm going, I'm going to [PII] now.
[CUSTOMER][NEUTRAL] I thought so.
[CUSTOMER][NEUTRAL] Yeah, I'm I'm seeing them all individual now yeah.
[AGENT][NEUTRAL] Oh, here we go.
[AGENT][NEUTRAL] So it's like all the ones that were received on [PII], or I'm sorry, all the ones that were submitted, we received it on [PII] and then there's some here from [PII]. So you want to know why these claims are not being processed.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I just didn't know if I was submitting them wrong or if you're getting the wrong info from me because I've done it two different ways.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So if you don't mind, I'm just gonna place you on a brief hold, look at these claims because there's different reasonings, but some of them have the same, so I'm gonna look through each of them and then see what what's going on.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that's great. Thank you.
[AGENT][NEUTRAL] You're welcome. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, hello [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for that wait. OK, so I went through all the claims. So there's only one claim that was um there was one claim that was denied differently than the others. So all the claims that were submitted are asking you to submit additional. So basically the diagnosis, the diagnosis was not received. So we need to either itemized bill with the diagnosis code, office notes, um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you have maybe the admission date or a discharge date, if it was just something showing what the diagnosis is, um, that could be a a a clinical note.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that'll suffice for all of them? OK. And do I need to submit them?
[AGENT][NEUTRAL] Mhm. And there was only one.
[CUSTOMER][NEUTRAL] Individually or just submit it once?
[AGENT][NEUTRAL] You could just submit it once because it's the same thing for all of the claims except for claim number 3581953, which was denied because office visits aren't covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I saw that one. OK. It's mainly those athletico, those were all physical therapy co-pays. So you need the diagnosis on that in order to get those rolling.
[AGENT][NEUTRAL] Right, that's correct. And then once we receive the diagnosis, they can continue processing the claim.
[CUSTOMER][POSITIVE] OK, got it. All right. Well, I thank you for the help.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] Nope, that's it. Thank you so much.
[AGENT][POSITIVE] All right. You're welcome. Thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, thanks. Bye-bye.