AccountId: 011433970860
ContactId: 140726cc-1007-41ee-8c2f-5bf1b49bdcb9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 548630 ms
Total Talk Time (AGENT): 200384 ms
Total Talk Time (CUSTOMER): 200387 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/140726cc-1007-41ee-8c2f-5bf1b49bdcb9_20250312T17:11_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. I'm sorry, good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, um, my name's [PII]. Um, I have a question about a claim that I filed. I've been kind of going back and forth on the online kind of I submit what I think needs to be submitted, and then a couple of days or a week later I get back from APL that I need to upload another document which I believe I had already uploaded, but then I uploaded again.
[CUSTOMER][NEUTRAL] It's kind of gone back and forth for a few weeks now and then finally I received information that says it's like a duplicate claim so I figured my best course of action is probably just to call you guys and figure out what it is that you guys need on your end so I can see if it's covered.
[AGENT][NEUTRAL] OK, uh, Mr. [PII], what's that policy number, please? I can verify your claim status.
[CUSTOMER][NEUTRAL] Let me see if I have the policy number. Hold on one second.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Policy number is 024677847.
[AGENT][POSITIVE] OK, thank you so much. And do you have a callback number in case the call drops?
[CUSTOMER][POSITIVE] Yeah this is a good number [PII].
[AGENT][NEUTRAL] OK, and verify your date of birth, mailing address and email address for me, please.
[CUSTOMER][NEUTRAL] Uh, yeah, my date of birth is [PII]. My mailing address is [PII].
[CUSTOMER][NEUTRAL] And my email address is you guys probably have on file [PII].
[AGENT][NEUTRAL] Yes, sir. And who was the claim for?
[CUSTOMER][NEUTRAL] The claim is for my wife, [PII].
[AGENT][NEUTRAL] [PII]. OK, one moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what was the date of service?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Do you have the data of service?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, sir, can you hear me?
[CUSTOMER][POSITIVE] Yeah, I can hear you. I'm sorry about that.
[AGENT][NEUTRAL] No, no, it's fine. I was hoping my internet didn't go out again.
[AGENT][NEUTRAL] Let's see, do you have that data service?
[CUSTOMER][NEUTRAL] Uh, I don't know. I, I have like a picture of what you guys had sent me in the mail, so I knew which phone number to call. It's whatever the most recent one is in there.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][POSITIVE] Sorry about that.
[AGENT][NEUTRAL] No, no, you're fine.
[AGENT][NEUTRAL] Uh, this latest one was for [PII]. Let me look and see.
[CUSTOMER][NEUTRAL] Yeah, I think that's the 1211.
[CUSTOMER][NEUTRAL] I haven't submitted very many things with you guys because to be honest with you, you know, you're the secondary insurance I have, but every time I try and upload something and file a claim, it always either gets denied or maybe I'm missing something, but I've never tried to call you guys before. This is like $500 something dollars, so I figured I'll start with this and maybe I can kind of figure out what's the key to get these things approved.
[AGENT][NEUTRAL] I got you. Alright, let me look and see on this 1. 669-75.
[AGENT][NEUTRAL] Uh, looks like we're needing the itemized bill showing diagnosis and procedure codes.
[AGENT][NEUTRAL] And let me see what we received.
[AGENT][NEUTRAL] Let's see, I see the claim form.
[AGENT][NEUTRAL] OK, it looks like what we received um was just the EOB, but we're needing the um like the itemized billing, showing the diagnosis code for this um service.
[CUSTOMER][NEUTRAL] OK, I uploaded quite a few documents. I saw one of them because the um.
[CUSTOMER][NEUTRAL] The the hospital where she got the procedure done I called them and asked them for that and that's they sent me a document that I also uploaded like I think secondary like the initial thing I I sent you guys I think was the the form whatever that you need to fill out to start the claim and then the EOB and then I think the overall bill from the hospital and then I sent the one with the procedure code.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] In a separate attachment like, you know, after the first one was they asked me that question, can you see if you have that because I'm pretty sure I uploaded it.
[AGENT][NEUTRAL] Uh, let me one moment, I'm just looking through each one for this date.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] look at this other client.
[AGENT][NEUTRAL] I see where it looks like um billing has been received, but there's no diagnosis codes, um.
[AGENT][NEUTRAL] Let me look at this one.
[AGENT][NEUTRAL] Oh, I do show one. like for the same date, looks like it's for a physician's portion.
[AGENT][NEUTRAL] And what let's see how this process.
[AGENT][NEUTRAL] OK, I'll um ask the examiner to go back and reprocess that one because I do show you send in a bill. It looks like for the physician's charge and that does have the diagnosis code and so um I'll ask them to go back and reprocess the one for the facility, but the one for the physicians, they are, they do need the EOB for this one because we have the EOB for the facility charge, but not for the physician's charge.
[CUSTOMER][NEUTRAL] OK, so who would I reach out to for that, you know, because like United is my primary insurance and so they send me when they send me an EOB that's what I upload to you guys. So would I receive two EOBs from them, one from the facility and one from the, the doc like the actual doctor or the office that requested it.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh, yes, sir.
[AGENT][NEUTRAL] It will be, um, unfortunately, anytime you have any service, if you're getting charged from the physician from the facility or even for lab work, uh, those are all different separate providers, so they will file their own claims and so your primary should have that EOB for the physician's charge. Uh, looks like it was over 3000.
[CUSTOMER][NEUTRAL] So that's what we need is for the physician.
[AGENT][NEUTRAL] Correct. And this other one for the facility, I'm gonna send a request to have the examiner review and go back and reprocess it because on the billing that you sent for the physician's charge, it does have the diagnosis code.
[CUSTOMER][NEUTRAL] OK, so the only thing really missing that you see is the EOB from the physician.
[AGENT][NEUTRAL] Correct, yes, sir. Uh, looks like.
[CUSTOMER][NEUTRAL] OK and if I just go on the website later and and just upload it, you know, as like I've uploaded the other ones, it'll be you guys will kind of connect the dots that it's related to this particular claim.
[AGENT][NEUTRAL] Yes, sir, and I apologize for that because usually uh when claims are sent, even it's just like a new claim, they would check history and see what was previously needed, but um like I said, I'll send this to claims and have them reprocess the facility one and if you can submit that um EOB for the.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Lord can't talk today for the surgeon, then they can go back and reprocess this claim.
[CUSTOMER][POSITIVE] OK perfect I'll um I'll work on uploading that uh this afternoon.
[AGENT][NEUTRAL] OK. And is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, I think that's it. I'm just trying to you know see if this is gonna be covered by you guys, so that's helpful.
[AGENT][NEUTRAL] I understand, yes, sir.
[CUSTOMER][POSITIVE] All right have a great day.
[AGENT][POSITIVE] Alright, you too, and uh thank you for calling APL.
[CUSTOMER][POSITIVE] Take care bye.
[AGENT][NEUTRAL] Mm bye.