AccountId: 011433970860
ContactId: 0eec3d4e-797c-4ede-84e4-a93bed681ca0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 716250 ms
Total Talk Time (AGENT): 246898 ms
Total Talk Time (CUSTOMER): 166702 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/0eec3d4e-797c-4ede-84e4-a93bed681ca0_20250403T14:29_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I want to ask about a claim we sent to you.
[AGENT][NEUTRAL] OK, I can help you with your claim and are you the insured or you're calling with the provider's office?
[CUSTOMER][NEUTRAL] Uh, it's, uh, my husband, it's my husband's name, the insurance.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and may I have a good phone number and the policy number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The policy number is 7681639476.
[AGENT][NEUTRAL] 7681639476.
[CUSTOMER][NEGATIVE] No, no.
[CUSTOMER][NEUTRAL] No, no, ma'am. It's 68.
[CUSTOMER][NEUTRAL] 16
[CUSTOMER][NEUTRAL] 39
[CUSTOMER][NEUTRAL] 476.
[AGENT][NEUTRAL] And that's on your APL policy card?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] With my husband named [PII].
[AGENT][NEUTRAL] Because that's too many numbers for our policy. Do you see APL to the top left?
[CUSTOMER][NEUTRAL] APN
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, no, uh, uh, no. That's, that's not on the paper. That's, we write it in our hands. There is nothing on the ABL numbers, just the address and the phone number.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] And it's an [PII] number?
[CUSTOMER][NEUTRAL] What's that?
[AGENT][NEUTRAL] Um, that's the phone number
[CUSTOMER][NEUTRAL] Uh, your phone, yeah.
[AGENT][NEUTRAL] OK. Well.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, um, I can, can you spell your last name for me? I can look it up with your name or your husband's name.
[CUSTOMER][NEUTRAL] OK, Arush, his, his last name [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And that's [PII]?
[CUSTOMER][NEUTRAL] OK, ma'am.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And what is his first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alright, so I just found the policy. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I see you here. I just need you to verify your date of birth and the mailing address on file.
[CUSTOMER][NEUTRAL] OK, mine or his?
[AGENT][NEUTRAL] Um, your date of birth and then
[CUSTOMER][NEUTRAL] My husband, OK.
[AGENT][NEUTRAL] Yes, your date of birth and the mailing address.
[CUSTOMER][NEUTRAL] OK, my.
[CUSTOMER][NEUTRAL] OK. My date of birth is [PII].
[CUSTOMER][NEUTRAL] The address is [PII].
[AGENT][POSITIVE] Thank you for that and I'll
[CUSTOMER][NEUTRAL] If you want my
[AGENT][NEUTRAL] No, no, I'm OK. Um, all the information provided is a verification of benefits, not a guarantee of payment. Is the claim for you or your husband?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Both.
[AGENT][NEUTRAL] Both? OK.
[CUSTOMER][NEUTRAL] Both.
[AGENT][NEUTRAL] So let's see.
[AGENT][NEUTRAL] OK, so the claims were denied requesting the itemized billing?
[AGENT][NEUTRAL] Showing the diagnosis codes?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so for that, you would just reach out to whoever the doctor's office or hospital, whoever the provider is and ask them for the itemized bill or the universal bill, um, but make sure you
[CUSTOMER][NEUTRAL] We think, we think.
[CUSTOMER][NEUTRAL] We send for you automized bill.
[AGENT][NEUTRAL] So let me see what was sent in because it was denied as a duplicate, so hold on one moment.
[CUSTOMER][NEUTRAL] OK. I send them to me it at what time. I don't remember the date.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] We emailed them for you, to your email.
[AGENT][NEUTRAL] You said can you email them?
[CUSTOMER][NEUTRAL] We emailed them to your email care team and
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] Is that your email?
[AGENT][POSITIVE] Yes, um, so that is the correct um.
[CUSTOMER][NEUTRAL] We can
[AGENT][NEUTRAL] Was it on [PII]?
[CUSTOMER][NEUTRAL] I think so, yeah, last month.
[AGENT][NEUTRAL] Right, so I'm, I'm not saying that we haven't received it. What I'm saying is what was sent in is not what's asked. I'm getting ready to pull up the documents so I can see what they are.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment. And do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] OK, ma'am.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] A diagnosis codes, yes, OK.
[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.
[CUSTOMER][NEUTRAL] Uh yes, ma'am. I'm here.
[AGENT][NEUTRAL] All right, thank you so much for holding, [PII]. I apologize for that wait. So, I do see the documents that were received. So this is, this is itemized billing, but this is your patient version. The coding that it shows is only procedure code. So basically this shows
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] What you received and what you paid for it. We need to know why you received that treatment, which is the diagnosis, and that comes from the hospital or the doctor's office, their main bill that they generated your bill from, um,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So the
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] So the only other
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] So the only option would be to reach out to the, what is this Optum Primary Care, their billing department if that's that's what this is for, um, and let them know or request an itemized bill and it needs to be their version with the diagnosis, or you can say ICD like igloo, Charlie, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And the number 10, those are diagnosis code. It needs to have the diagnosis code.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I see
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Itemized bill or I see details.
[AGENT][NEUTRAL] Well, it's out of my.
[CUSTOMER][NEUTRAL] From the from the billing department?
[AGENT][NEUTRAL] It's itemized bill with ICD 10. The the coding is on the bill.
[CUSTOMER][NEUTRAL] Wait, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So from the uh billing department.
[AGENT][NEUTRAL] Yes, most likely the billing department will have to give that to you.
[CUSTOMER][NEUTRAL] OK. So the thing that we email you is not working?
[AGENT][NEGATIVE] Right, this is not this is not the correct document. It is an itemized bill, but it's not the provider version.
[AGENT][NEGATIVE] So it doesn't show why you received it.
[CUSTOMER][NEUTRAL] Uh, I have to say to them.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I see the uh I see the 10. I have to tell them I want itemized bill with ICD 10.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, ma'am.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] I would
[CUSTOMER][POSITIVE] Thank you so much. When I got these bills, I will send them to you, email it to you.
[AGENT][NEUTRAL] OK, now you can't email. We don't accept um claims documents through email. We just sent that last one as a courtesy to you. So you can fax it, you can mail it, or you can upload it on the online service center.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh. OK. OK.
[CUSTOMER][NEUTRAL] OK, ma'am.
[AGENT][POSITIVE] OK, was there anything else I can help you with today? You're welcome.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you so much. Thank you so much. Have a great day.
[AGENT][POSITIVE] Thanks for calling APL. Bye-bye.