AccountId: 011433970860
ContactId: 1439ec3e-3290-4a0a-91ef-c1fdf6fe4968
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 389920 ms
Total Talk Time (AGENT): 152712 ms
Total Talk Time (CUSTOMER): 170947 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/1439ec3e-3290-4a0a-91ef-c1fdf6fe4968_20250416T15:40_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling, and I just got a uh mailing.
[CUSTOMER][NEUTRAL] Uh, regarding a claim that I filed first son who had an emergency room date in February.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I tried to go online and get in, but I wasn't able to with my member number but do in fact, do you need that? Do you need the member number or what do you need?
[AGENT][NEUTRAL] Yeah, if you need, yeah, let's pull that up so I can check the claim.
[CUSTOMER][NEUTRAL] OK, it's 683.
[CUSTOMER][NEUTRAL] 539.
[CUSTOMER][NEUTRAL] 721.
[AGENT][NEUTRAL] OK [PII], give me just a second to pull this up here.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, [PII], that's kind of long for a policy number. I thought maybe it was your social. I tried it as that, um.
[CUSTOMER][NEUTRAL] No, that's just on the, um, I mean uh not insurance but the um plan card has the member ID and that's what I asked for on the website, but I also have a group ID and then I also have a claim number.
[AGENT][NEUTRAL] Yeah, if you have the claim number, I can.
[CUSTOMER][NEUTRAL] If that'll help. Oh, I have a policy, OK, and I see a policy number on the claim, um, due.
[AGENT][NEUTRAL] OK, so you can give me the claim number, what's the claim number?
[CUSTOMER][NEUTRAL] Maybe
[CUSTOMER][NEUTRAL] OK, it's 358.
[CUSTOMER][NEUTRAL] 78, excuse me, 76.
[AGENT][NEUTRAL] 76. OK.
[AGENT][NEUTRAL] Because I can get the policy info from that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so then on the policy, I will need um a name and date of birth for somebody insured. It doesn't matter who.
[CUSTOMER][NEUTRAL] OK, um, so for me it's [PII].
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] All right, thank you. And then if I could just verify lastly, the physical address and email address.
[CUSTOMER][NEUTRAL] Mhm, physical is [PII].
[CUSTOMER][NEUTRAL] And then the uh email address is [PII].
[AGENT][POSITIVE] Perfect, thank you. OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it looks like it's saying that no diagnosis code was provided. In order to provide further consideration,
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Uh, we're gonna need documentation to the evidence of the accident or sickness. Supporting documentation may include an itemized bill with a diagnosis code, office notes, or a hospital admission or discharge summary.
[CUSTOMER][POSITIVE] OK, which I like on the bill for example that I did send in.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It lists each thing, but it must not have a diagnosis called IV therapy, laboratory, pathological laboratory.
[CUSTOMER][NEGATIVE] Uh, computed tomographic scan, so all those things listed, but it, it, that's not sufficient and then the drug.
[AGENT][NEUTRAL] Yeah, so those would be.
[CUSTOMER][NEUTRAL] So do I contact
[AGENT][NEUTRAL] I'm, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] I just didn't know since I haven't had to do this before, um, uh, do I contact Cleveland Clinic and say I need diagnosis codes then for each like whatever do you tell me what I need to do.
[AGENT][NEUTRAL] Yeah, so you would just contact the provider, whoever uh the patient saw the doctor facility and let them know that you need a diagnosis code for the date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, what you had submitted was like a receipt, it sounds like with procedure codes, like what was actually done at the place, but not a diagnosis of what they were being seen for. Hopefully that makes sense.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Yep, absolutely, uh, yep, he had to see this or OK.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and then you honestly [PII], you don't have to redo all the paperwork. You can just, once you get that information, you can, I didn't even look to see, I apologize, but you can upload it online or fax it however you originally sent it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I think I emailed it to I emailed it to [PII] [PII].
[AGENT][NEUTRAL] OK, yeah, you can do that um however you send it originally like you, we just don't need, um, you don't have to redo it all.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, and I see now, so should I resend when I.
[CUSTOMER][NEUTRAL] Re upload, do I need to send in the claim response that I received as well?
[CUSTOMER][NEUTRAL] Or no.
[AGENT][NEUTRAL] No, you don't, no, you don't need to, mm, no, if you want, when you send the doc the claim number you can write at the top, it's referencing, um, but that would, yeah, that would be it.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] The claim number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, OK, perfect, I'll get on the phone then with Cleveland Clinic in ER.
[AGENT][POSITIVE] It sounds good. Is there anything else I can do for you?
[CUSTOMER][POSITIVE] No, thanks so much for your help hope you have a happy [PII].
[AGENT][POSITIVE] You're welcome. You too. Take care.
[CUSTOMER][POSITIVE] Thanks, thanks, thank you.
[AGENT][NEUTRAL] OK