AccountId: 011433970860
ContactId: 139ab45c-c8db-4907-991d-e85eeed3bb63
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 585580 ms
Total Talk Time (AGENT): 156647 ms
Total Talk Time (CUSTOMER): 215288 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/139ab45c-c8db-4907-991d-e85eeed3bb63_20250310T15:53_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Look
[CUSTOMER][NEUTRAL] Yes, ma'am, so I'm calling because I had filed a claim um with some medical bills I have, whatever, and you are requested more information so I'm trying to see if the information that I just re in is the information that was requested because I'm getting confused.
[AGENT][NEUTRAL] OK, may I have your name and a callback number?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. Call back number is [PII].
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] Oh shoot, I keep doing that. Oh my [PII], hold on, let me see.
[CUSTOMER][NEUTRAL] I think, yeah, I had it then I pull it up and pull it back, pull it up, pull it back.
[CUSTOMER][NEUTRAL] I should be remembering it by now. Hold on, let me find it.
[CUSTOMER][NEUTRAL] That ain't it.
[CUSTOMER][NEGATIVE] I think it's too much.
[CUSTOMER][NEUTRAL] That's just look.
[CUSTOMER][NEUTRAL] OK, let me, hold on.
[CUSTOMER][NEUTRAL] Let me find it. Oh Lord. OK, hold on.
[AGENT][NEUTRAL] Would you, would you like me to pull it up via your social?
[CUSTOMER][NEUTRAL] Uh uh that's too much. Hold on, I'm about to give it to you right now. I'm pulling it up.
[CUSTOMER][NEUTRAL] It won't take me long, hold on.
[CUSTOMER][MIXED] OK. It's 2, I know it's 2 star with a 2, OK.
[CUSTOMER][NEUTRAL] 244-73993
[AGENT][NEUTRAL] And [PII], could you please verify your date of birth and the mailing address listed please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And it does look like we have an email address on file. Could you verify that for me?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Just.
[AGENT][POSITIVE] And thank you so much [PII] for verifying your policy. You're calling in regards to submission that you submitted and let me pull that up for you.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] So it looks like we were requesting the diagnosis code and the primary EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I what.
[AGENT][NEUTRAL] Are these new dates of service that submitted in for 10:10?
[CUSTOMER][NEUTRAL] Say uh they knew what?
[AGENT][NEUTRAL] Dates of service cause it looked like the previous claim was 10:15 and 1/15.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, no. Both of them are 10:15. 1 is 10:15, 1 is 10:10.
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] Oh, I think.
[CUSTOMER][NEUTRAL] I think I sent, um, OK, so I've sent the 10:15, um, it's supposed to be something from.
[CUSTOMER][NEUTRAL] Image software.
[CUSTOMER][NEUTRAL] That has the diagnostic codes and that's the itemized bill with diagnostic codes on it, she told me.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Then I got the EOB.
[CUSTOMER][NEUTRAL] For both 10:15 and 10:10.
[CUSTOMER][NEUTRAL] Then I sent in the itemized bill from 10:10.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so I look, I see the dates of service of the 10:15.
[AGENT][NEUTRAL] And I'm checking to see if the diagnosis codes are listed.
[CUSTOMER][NEUTRAL] Hey.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I see something to say like on what I sent it say ICD. I called them back and I was like, I don't see nothing on here to say a code. And she said the ICD is beside the doctor's name.
[CUSTOMER][NEUTRAL] So let's say referring Doctor [PII], the doctor who did it, the procedure.
[CUSTOMER][NEUTRAL] And then I see ICD.
[CUSTOMER][NEUTRAL] M 76.
[CUSTOMER][NEUTRAL] Something 62 then M 77.32.
[CUSTOMER][NEUTRAL] right
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so I see the diagnosis that was submit in for the date of service of [PII].
[AGENT][NEUTRAL] Which you're indicating is the M76.
[AGENT][NEUTRAL] 62 and M 7732.
[AGENT][NEUTRAL] Now for the date of service of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm not seeing anything that's showing the diagnosis code.
[CUSTOMER][NEUTRAL] So that's an emergency room visit and I called them, she said they don't do a diagnostic on a, you know, on the itemized bills.
[CUSTOMER][NEUTRAL] I don't even know who the.
[AGENT][NEUTRAL] You would have to get the discharge paper. The discharge papers will show the reason of the visit.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] They didn't say they needed no no IED for that one.
[AGENT][NEUTRAL] Yes, it's showing they used the data service look like let me see.
[AGENT][NEUTRAL] Whatever the um statement date was.
[AGENT][NEUTRAL] I'm not exactly sure, but they have it for data service of 11525.
[AGENT][NEUTRAL] That is listed on that claim number.
[CUSTOMER][NEUTRAL] No, not now. I, I don't know what, what you talking about 1:15.
[AGENT][NEUTRAL] The statement that we received in.
[AGENT][NEUTRAL] For some reason, it's in our system it's 115 and that data service is requesting for the diagnosis code NEOB.
[CUSTOMER][NEUTRAL] No, that's
[CUSTOMER][NEUTRAL] I don't have, I, I haven't been to an emergency room on 1:15. All mine is from October. It's from [PII] and [PII].
[AGENT][NEUTRAL] Yes, I'm understanding that what I'm
[AGENT][NEUTRAL] That's not what I'm saying. I'm saying the system has it entered in as 115, but it should be for data of service of 1010.
[AGENT][NEUTRAL] But for that claim number that we processed, both of those lines denied for EOB and diagnosis.
[CUSTOMER][NEUTRAL] Ah.
[CUSTOMER][NEUTRAL] So what I'm saying is I just resubmitted information.
[AGENT][NEUTRAL] And as I stated on the submissions that you just submitted in for the date of service of [PII], it does not indicate a diagnosis code, so you would have to submit in the discharge papers to us to let us know what that diagnosis was.
[CUSTOMER][NEUTRAL] Alright, that's fine. I, I upload it so you have everything else.
[AGENT][NEGATIVE] For the data service of [PII], I do see the diagnosis code, but, but, but for [PII], there is no diagnosis code on this.
[CUSTOMER][NEUTRAL] I understand that you have everything yourself but but the discharge papers correct?
[AGENT][NEUTRAL] I have everything else except the diagnosis code.
[CUSTOMER][POSITIVE] Thank you, that's all I need. Alright, thank you.