AccountId: 011433970860
ContactId: 139e7895-e6f9-40a5-97ee-d27b6f445086
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 756929 ms
Total Talk Time (AGENT): 394571 ms
Total Talk Time (CUSTOMER): 289539 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/139e7895-e6f9-40a5-97ee-d27b6f445086_20250121T19:51_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], it's [PII]. How are you today?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][POSITIVE] I'm doing fine, thank you. I haven't talked to you in a while, so happy [PII].
[AGENT][NEUTRAL] Happy [PII]. It's 9 degrees here. I'm freezing.
[CUSTOMER][NEUTRAL] Yeah, oh, it's, uh, uh, you know, I'm in [PII]. It's not 9 where I am, but it's plenty cold for around here, OK.
[AGENT][NEUTRAL] I talked to [PII] this morning. It was 4 degrees where she was, where she is.
[CUSTOMER][NEUTRAL] Yes, I mean, it feels like our real so right now is 19 and so that's cold enough. I mean, I'm good, you know, I'm good.
[AGENT][NEGATIVE] Yeah. I can't handle it. My, my body's not built for this mess.
[CUSTOMER][NEUTRAL] Ah.
[CUSTOMER][POSITIVE] Right, mine either. I would like to look in the Christmas story when I take my fur baby outside. I'm steadily telling her to her.
[AGENT][NEGATIVE] You should see me too. I'll be looking, my, my neighbors probably think, what is wrong with this lady and I don't care.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Me either. Well, I have an insured on the line. Um, her policy number, [PII], is 2442603. [PII].
[AGENT][NEUTRAL] Mm, I have no clue who that is. What? OK, what's going on?
[CUSTOMER][NEUTRAL] OK, so on M track on the 2.
[CUSTOMER][NEUTRAL] The last two claim numbers that are listed?
[CUSTOMER][NEUTRAL] Claim number 355-0367.
[CUSTOMER][NEUTRAL] She says it's all the medical information. We denied that needing a diagnosis code.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Then on the 355-3598.
[CUSTOMER][NEGATIVE] That's just like a one-page document that she wrote the diagnosis code on which she had been told by someone would be acceptable. But it's denied, they're denied the same reason.
[AGENT][NEUTRAL] OK, yeah, we can't take written diagnosis codes. We have to have it printed. I don't know who told her that, but we can't accept those.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um, can I not with Medin?
[AGENT][NEUTRAL] Mm mm, not with anybody.
[CUSTOMER][NEUTRAL] Oh, see, we've been told that you could, yes, we've been told that uh written is fine. You just cannot take them verbally.
[AGENT][NEUTRAL] Mm is it has to be from the provider, um.
[CUSTOMER][NEUTRAL] Yeah, we've been told that you can write them on EOBs and send them in mhm.
[AGENT][NEUTRAL] Oh, yeah, I, when I process claims.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][MIXED] As long as it's written, it's just um you, we cannot ver you know used to to let them verbally give them over the phone, but that stopped, but yes, handwritten was fine.
[AGENT][NEUTRAL] Um, OK, I'm looking at the 67 now. Give me just a second.
[CUSTOMER][NEUTRAL] So just yeah that's why I'm transferring her there, but she's fully verified and the phone number in the system is the one she's calling me from or calling us from.
[AGENT][NEUTRAL] Oh dear God.
[AGENT][NEUTRAL] OK, yeah, you can transfer over. Let me see what's going on with this. I got, I got the 67 pulled up now. Let me see what's going on.
[CUSTOMER][NEUTRAL] OK. Um, you want, I mean, are you ready for it or you won't need a second?
[AGENT][NEGATIVE] Yeah, you can send her through on base it's just sticking, so I have no clue what it's, it's been sticking all day.
[CUSTOMER][NEGATIVE] It is slow. It is as slow as molasses.
[AGENT][POSITIVE] Yeah, you can send her through it's fine.
[CUSTOMER][POSITIVE] OK, all right then. Well, thank you so very much and stay warm.
[AGENT][POSITIVE] Yes, ma'am. You too.
[CUSTOMER][NEUTRAL] OK. All right. Talk to you later. OK, bye-bye.
[AGENT][NEUTRAL] All right, bye.
[CUSTOMER][NEUTRAL] Well, just one second for me to release the call. OK, here we go.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hey [PII], this is [PII] in the clients department. How are you?
[CUSTOMER][POSITIVE] Hi, I'm good, thanks. How are you?
[AGENT][NEUTRAL] I'm good. I'm just kind of going over your claims here for a second, so bear with me. Um, I'm going over, um, the one ending in 0367 right now, so just bear with me every all my documents are trying to pull up for me so just.
[CUSTOMER][POSITIVE] No problem, take your time.
[AGENT][NEUTRAL] Give me just a second here. I think it's a Monday and I think my computer is as cold as I am.
[CUSTOMER][NEUTRAL] I, the documents I uploaded I think were big, um, so it took a while for another woman to open them too so I don't know if that could be causing the problem or not.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Well, I think the lady that you just spoke with, Ms. [PII], um, I think she just stayed over from where I am and I'm 9 degrees here where I am and she's [PII] is what she told me, so.
[AGENT][NEUTRAL] She's 19 degrees. I think everything is just a little cold honestly.
[CUSTOMER][NEUTRAL] Yeah, maybe that could be it.
[AGENT][NEUTRAL] And a lady I spoke with that I work with as well, I tell her this morning she's 4 degrees.
[CUSTOMER][POSITIVE] Oh my gosh.
[AGENT][NEUTRAL] Yeah, I'm not built for this cold weather.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] My body's just not made for it.
[AGENT][NEUTRAL] OK, so I looked over um do you have your claim numbers in front of you? Have you, um, OK.
[CUSTOMER][POSITIVE] Yeah, yep, I've got everything pulled up.
[AGENT][NEUTRAL] OK, so let me pull up this remark code just to make sure I'm looking at it correctly here. I don't wanna kinda go off anything incorrectly. So the one ending in 0367 in order to complete processing of your claim, we need itemized statements of services provided listed in the diagnosis code. OK, so we have the itemized statements. I see everything I see everything that was completed. I do.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] However, we do not have the diagnosis code on these statements.
[CUSTOMER][NEGATIVE] So the diagnosis code that I uploaded on [PII] is not gonna work.
[AGENT][NEUTRAL] Um, I'm missing to go to that other claim. Give me just a second. My system, like I said, is running extremely. It's not pulling up like it normally does, so bear with me here for just a second. Um, so does that diagnosis code go with this claim as well?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Yes, it's on so the woman I spoke with at APL when I found out that the itemized bill that I uploaded had procedure codes and not a diagnosis code, she said I could call the hospital and get it, uh, verbally over the phone and write it down on the first page of my bill um and sign it and that's what I did. So I wrote the code I signed it and it's on the first page of my statement so that's the only part that I uploaded a second time. I didn't upload the whole itemized bill a second time.
[AGENT][NEUTRAL] OK. And you spoke with her, um, it looks like you spoke with someone on 113 and they advised you that the diagnosis code was needed.
[CUSTOMER][NEUTRAL] Correct and that probably was um.
[CUSTOMER][NEUTRAL] I, I honestly, I'm, I'm sure everybody runs into this. You probably get this a lot. I have no idea what I'm doing. So when I'm calling the the hospital and going back and forth between you guys, I'm, I'm asking for things that I'm just not, I guess I'm asking for it in the wrong way. So, um, I just asked the hospital for a diagnosis code. She, they checked my file and they gave me what's written down on this paper. So I'm assuming that's correct.
[AGENT][NEUTRAL] OK, so give me just a second here, let me take a look.
[AGENT][NEUTRAL] Sorry, um, I'm pulling this up but I was also looking back at your notes here, so bear with me.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Let me pull up this diagnosis code. K 350.
[AGENT][NEUTRAL] So you had acute appendicitis?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] I, I, I really don't know how to say this, but I'm just gonna have to say it, and I'm sorry. I see that you made that phone call on [PII].
[AGENT][NEUTRAL] And then I see that you did write this on this document and you signed it on [PII].
[AGENT][NEUTRAL] Unfortunately I'm sorry that you did receive and I'm in the claims department so I do process these claims um I'm sorry that you did receive this misinformation.
[AGENT][NEUTRAL] We cannot take handwritten diagnosis codes. Used to we could take diagnosis codes over the phone and unfortunately handwritten diagnosis codes are not allowed unless they're from the provider's office.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] I'm in the claims department so this is what needs to happen.
[AGENT][NEUTRAL] Whenever they send you the itemized bill.
[AGENT][NEGATIVE] That itemized bill typically at the top of them will come before the itemization even starts. The diagnosis code will be printed at the top. Unfortunately on this itemized bill, they did not print the diagnosis code.
[AGENT][POSITIVE] And I, I understand your frustration, um, and I'm so sorry for this. I'm sorry for the misinformation and I'm sorry that you're having to do this. I do apologize. I apologize on APL's behalf, um, and I'm sorry.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, um, so whatever you call the hospital back, and I know that they're hard to deal with, um, believe me, I have to do it personally, so I know that they're hard to deal with.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Call the either the billing department. I'm not sure which one you have to deal with here. I have to call those billing and medical records. It's like a fight to get one of them to do it, um, call them, let them know that you need a printed document from their office or they're from their facility with you can either get medical records. Do you have a, let me ask you this, do you have a MyChart or something like that?
[CUSTOMER][NEUTRAL] Um, I do the app, but it's not through the hospital that I went to. Can they upload to that app anyways?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Some of them can, some of them, um, like if they're on the same system.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Some of them actually have access where you can see everything. Like here, the hospitals we go to, they're all on like the same billing system and the same medical record system, so I can see everything for myself, my husband and my kids.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So if you have medical records or discharge sum summaries showing what you were saying for that day.
[AGENT][NEUTRAL] It all it has to say is what you were being seen for.
[CUSTOMER][NEUTRAL] OK. Um.
[AGENT][NEUTRAL] So if you still have that, you can upload those documents.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'll see if I have any of that. All right, I will.
[AGENT][NEUTRAL] If you don't, just contact them and let them know you need a printed document with the diagnosis code on it.
[AGENT][NEUTRAL] Or just a copy of your medical records or your discharge summary from that data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Do you know, does going up to the hospital do me any good?
[CUSTOMER][NEUTRAL] If I were to walk in there and ask for this stuff, are they gonna do, do you, do you know if they would just turn me around and say go home and get online?
[AGENT][NEUTRAL] No, because you can actually go straight to the medical records department. All you have to do is say, hey, where's the medical records department? They will point you in that direction and you can go straight there, fill out the form, and they can hand them straight to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] I think I will do that. I at this point I feel like that's probably gonna be easier, so, um, I'll try and get over there, OK? And then my last question for you is this obviously happened back in November. I have filed the claim. I've started the process. There's no time limit at this point, right? I mean, I'm not gonna drag my feet on foot. I'm not gonna run out of time.
[AGENT][NEUTRAL] No.
[AGENT][POSITIVE] There's no timely filing since you've already filed it um you've already started the process we know you were there um we know everything's in motion we're just waiting on this one piece of documentation from you and honestly you've been given the run around and like I said I'm so sorry. I'm sorry on our behalf that you were given that misinformation.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, it's OK, it's not your fault.
[CUSTOMER][POSITIVE] I appreciate that. All right, well you've been a great help. I really do appreciate it and I will get this information and get it uploaded and go from there.
[AGENT][POSITIVE] OK, um, if you need anything give us a call and if there's anything I can do I'm the only [PII] in the claims department just ask for me and I'll help you any way I can.
[CUSTOMER][POSITIVE] All right, [PII], I appreciate that thank you so much.
[AGENT][POSITIVE] You're welcome. Well thanks for calling API and I hope you have a great day.
[CUSTOMER][POSITIVE] Thanks
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Alright bye bye.