AccountId: 011433970860
ContactId: 0a914cd9-7e1a-4012-a60f-5e8812bb4981
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 773500 ms
Total Talk Time (AGENT): 216728 ms
Total Talk Time (CUSTOMER): 272409 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/0a914cd9-7e1a-4012-a60f-5e8812bb4981_20250210T22:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] over on the care team. How are you today?
[AGENT][POSITIVE] I'm good [PII] how are you today?
[CUSTOMER][NEUTRAL] Doing alright, thank you. I've got an insured on the line, uh, calling regarding a claim that he filed for his meddling. Um, looks like he had filed before and it stated we're missing the diagnosis code. He said he sent that to us.
[CUSTOMER][NEUTRAL] I do see that it completed processing today um and it just says EOB don't put miscellaneous correspondence from insured and or provider um that is showing is denied and he is saying that that was the diagnosis codes so wondering if you could take a look and just make sure that's all good to go.
[AGENT][NEUTRAL] OK, what's that policy number?
[CUSTOMER][NEUTRAL] It is 258-675-2.
[AGENT][NEUTRAL] OK, I have that as 258-6752.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, [PII]. OK, this is for him. Alright, give me one second.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, he just got the declined state so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so he's calling in regards to both claims or just one claim?
[CUSTOMER][NEUTRAL] Well, the, the last claim that we received was supposed to be that missing information, um, so the first claim was stating that we were missing the diagnosis codes. He said that was what was sent. um I've just never seen this message before and I don't know if that's just because it's was just processed today or what's going on?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK alright thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, I'm ready for him thank you.
[CUSTOMER][NEUTRAL] Do you wanna, oh, OK, all right, thank you. Bye bye.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you for calling. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I'm not sure. I got transferred. I go, yes, hi.
[AGENT][NEUTRAL] Mr. [PII]?
[AGENT][NEUTRAL] Hi, OK, yes, sir, she was telling me you were calling in regards to a claim that we were asking for the diagnosis code and you say that you sent the diagnosis code. OK, so that's that.
[CUSTOMER][NEUTRAL] But I knew you guys had, I spoke to a woman earlier today. My concern is that I don't see that claim anymore on the portal, so I'm kind of trying to find out what happened to that one unless you're working off the first one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the date of service shows [PII]. I just wanna make sure that Mr. [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes, ma'am.
[AGENT][POSITIVE] OK, OK, thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He said it got processed and I don't see it so I don't know what you mean by process or what the outcome and what's my next uh excuse me, what's my next step?
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK, no problem, let's see here.
[CUSTOMER][POSITIVE] Oh. Good Lord.
[CUSTOMER][NEGATIVE] I don't know why this, the guy that owns this house, which is me, keeps, he's so cold in here. Good lord.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm sorry. Oh gosh, OK. Oh.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Well, I'm sorry. Well, listen, nobody's home during the day, so I don't, I don't pay for the heat, you know.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK 1 2nd.
[CUSTOMER][NEUTRAL] Mm mhm.
[CUSTOMER][NEGATIVE] I'm serious, I'm freaking cold.
[AGENT][NEUTRAL] OK, so this is the one you taking care of my medical care.
[CUSTOMER][NEGATIVE] I feel bad for the cats cause I know they're freezing their asses off.
[AGENT][POSITIVE] 00 my goodness yeah I don't, I don't particularly like to be cold either so it's like oh OK let's take care I'm out get this up, get pages this page.
[CUSTOMER][POSITIVE] You know what's crazy is during the winter time, we want it warm. In the summertime we want it cool. It's never that really that happy medium.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, it's not it's humans no we we don't know what we want.
[AGENT][NEUTRAL] Oh my gosh, you're right though, but personally I prefer warmer weather.
[AGENT][NEUTRAL] One climate.
[CUSTOMER][NEUTRAL] For sure, like during the summertime, I got the house at 67, right? But 67 in the winter, that's too damn cold for me.
[AGENT][NEUTRAL] OK, so that's 5. OK, so I'm gonna look at this system here here much.
[CUSTOMER][POSITIVE] It's a smooth.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Spanky, get off there.
[CUSTOMER][NEGATIVE] Stop with your claw. What are y'all doing?
[AGENT][NEUTRAL] 36 OK.
[AGENT][NEUTRAL] Oh I'm looking for this. Let me just.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] May I place you on a brief hold, Mr. [PII], please, please. OK, thank you, thank you.
[CUSTOMER][POSITIVE] Yes ma'am, yes ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hartste.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you so much for your patience, Mr. [PII]. OK, so for your visit on [PII], was it due to a heart stent? Is that?
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, um, so that was the actual procedure and the reason why you had to have the heart stent.
[CUSTOMER][NEGATIVE] So I have blockages in my heart.
[AGENT][NEUTRAL] OK, that, that is actually what we need. So we are still asking for the diagnosis code, yes, sir. So I did see what you wrote on the second piece of uh documentation receipt that does show heart stan on the right side, but she is asking for the.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I did exactly like I was told to do from the woman I spoke to about it, so I did exactly as she requested. We'll just put down we got a heart stamp put in, so I did. So now we are going another week.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh boy.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know how else to give you this code. Like I don't know what else to do.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So that is actually the procedure.
[AGENT][NEUTRAL] the desktop procedure that was done.
[AGENT][NEUTRAL] You can call the provider and once you have the information you can reference the claim number you can name the document that you upload.
[CUSTOMER][NEGATIVE] I'm a bit confused. I did exactly what your woman told me to do from your office, and now we're going another week and I have to do it again. I have to call a provider and then do this all over again. I'm, I guess I'm a little, I'm a little upset that.
[CUSTOMER][NEGATIVE] I, I gotta do this again. I mean, we're just delaying the, the inevitability here. Like, y'all just gonna deny the claim cause that's the way I feel right now. And look, I'm not taking it out on you, but understand my, my issue, you know what I mean?
[AGENT][POSITIVE] Yes sir I do.
[CUSTOMER][NEUTRAL] blockage.
[CUSTOMER][NEUTRAL] Like, y'all don't call them?
[CUSTOMER][NEUTRAL] I mean, wouldn't be easier? I sent you guys the, the information.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Um, yeah.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I don't even know. I, I just Googled this shit.
[CUSTOMER][NEUTRAL] And it says the ICD 10 diagnosis code for heart blockage simply referring to coronary artery disease, is 125.1.
[CUSTOMER][NEUTRAL] It's a simple Google. I, I hope that's the right code. Does that make sense to you? 125.1?
[AGENT][NEUTRAL] Um, no, sir.
[CUSTOMER][NEUTRAL] Or I 25?
[AGENT][NEUTRAL] I'm sorry, I 25?
[CUSTOMER][NEUTRAL] Yeah, I 25.1, which stands for, uh, heart disease of native coronary artery.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, however, I cannot take that over the phone, so I'm so sorry about that.
[CUSTOMER][NEUTRAL] OK. Do y'all have Google? I'm just saying. I just Googled this. I'm not a doctor. So I just Googled this and exactly what I came up with. I gotta redo this whole thing, right? With that code in it.
[AGENT][POSITIVE] Yes sir I I apologize, I can't take off the phone.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] I understand, but you, you know this is a little frustrating on my end, right?
[AGENT][POSITIVE] I do, yes I do.
[CUSTOMER][POSITIVE] All right, cool. It just seems odd that I Google it and I come up with a code, and here I am jumping through hoops, gotta, gotta jump through hoops to for y'all to just Google it, but that's cool. I mean, I'll do it.
[CUSTOMER][NEGATIVE] I just, I, I don't want to delay this like for another 3 weeks because you guys keep wanting codes. That's all I'm at.
[AGENT][POSITIVE] OK, yes sir, I'm sorry.
[CUSTOMER][NEUTRAL] So fill out that form again, put that code in there and send it back to y'all, correct?
[AGENT][NEUTRAL] You don't, you know, sir, you do not have to fill out the form again. We would just need to, if you could name the file the document that you upload to claim number.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] The initial claim number is 3559517.
[CUSTOMER][NEUTRAL] Yep, I see it.
[CUSTOMER][NEUTRAL] OK, uh, OK.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Yes sir and then just write down, provide the diagnosis code and I'll also put notes that.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] To reference claim number 3559517 initial claim form or claim number.
[CUSTOMER][NEUTRAL] OK, I just need you guys on your end though, like the woman I spoke to originally to understand that that's what she's looking for. She told me just to put you had a cent put in, so I did.
[CUSTOMER][NEGATIVE] So I was only following the all direction and to be honest with you, your form is terrible. It doesn't offer places to put stuff. You have to just kind of write it in somewhere.
[CUSTOMER][NEUTRAL] All right, I guess I'll, um, I'll take care of this tomorrow.
[AGENT][NEUTRAL] OK, yes sir.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] You're welcome, Mr. [PII], thank you.