AccountId: 011433970860
ContactId: 163bc0dd-afae-468d-b27b-86ba0ccb9040
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 395339 ms
Total Talk Time (AGENT): 139928 ms
Total Talk Time (CUSTOMER): 155378 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/163bc0dd-afae-468d-b27b-86ba0ccb9040_20250321T16:57_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII]. I'm a broker. I'm just calling to check on a claim for one of our customers.
[AGENT][POSITIVE] All right, I'm happy to check on a claim today. What is the policy number?
[CUSTOMER][NEUTRAL] Uh, let's see if it's on here. I might have to scroll this other screen real quick. I got it right here. OK. It's, it's two claims, um, I'll give you the first policy number it is.
[CUSTOMER][NEUTRAL] 221
[CUSTOMER][NEUTRAL] 623-7
[AGENT][NEUTRAL] OK, let me.
[AGENT][NEUTRAL] And if I can get the insured's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And it's for [PII]?
[CUSTOMER][NEUTRAL] Correct. Well, her and her husband were in a car accident at the same time, unfortunately, um, so that you'll see some under her, her and her husband. I'm trying to see if you can tell me what was processed on her accident um claim for her.
[AGENT][NEUTRAL] OK. Let's see.
[CUSTOMER][NEUTRAL] Just trying to take notes for so I can call him and break it down.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Um, let me pull this.
[AGENT][NEUTRAL] So on hers, the first thing her claim was denied.
[AGENT][NEGATIVE] Uh, the first denial I see is it says incomplete claim. Claim information received, unable to process as copies could not be read.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh Jesus, OK.
[AGENT][NEUTRAL] And then it does
[CUSTOMER][NEUTRAL] All right, I was about to say this can't.
[AGENT][NEUTRAL] Go ahead. I'm sorry.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][MIXED] No, it's OK. Go ahead. No, no, I was gonna say this is as clean as they come. I, I put, uh, it was an accident with the UB40, which is the perfect form in the accident report, so it should have been like the cleanest clean, but I have terrible luck with this group, um.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] So they're, they kicked it back cause they're saying they can't see it, right?
[AGENT][NEUTRAL] And then the other denial on here was in order to complete processing of the claim, we need an itemized statement of services provided listing a diagnosis code.
[CUSTOMER][NEUTRAL] OK, and that's also on the UB40, uh, the UB04 which we included with the claim form.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, just because we do so many claims, we know how to make them perfect so they don't get held up. So we have on here the claim form, the UB04, the ambulance bill, and the accident report. Um, but they're having trouble viewing the it sounds like they're having trouble viewing the UB 04, so what I will do is I will try to print this and make it darker, so they can read. I can read it clearly, but I, I don't know how they can, but what I'll do is I will.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I will um attempt to darken it for them, no problem.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What about, so is this the same, so it's the same thing on the hospital plan and is it the same thing on her husband's claim as well?
[AGENT][NEUTRAL] I'm checking his claim here because it may have just been, let me see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm making the car.
[CUSTOMER][NEUTRAL] Sorry I got a [PII] that just got home from a half day.
[AGENT][POSITIVE] Oh, no, that's totally fine.
[AGENT][NEUTRAL] His is saying that we need the itemized statement with the diagnosis code, so I'm wondering if maybe the UB form was just missed on this one. I was trying to pull up.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] What was sent here.
[CUSTOMER][NEUTRAL] Be
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Comes in a bag.
[CUSTOMER][NEUTRAL] Hi
[AGENT][NEUTRAL] Yeah, so I get on his, I just don't see the UB 04. I don't see that on the attachment. I don't know. It's a lot of pages if it's just.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You don't not gonna do it just like that, you know.
[AGENT][NEUTRAL] got missed on it. But that's the only thing that's showing on his. It's just needing a diagnosis code.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK alright let's finish.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I will, uh, I will work on these.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'll work on these and get them resubmitted.
[AGENT][NEUTRAL] OK, sounds good. And then did you need me to check their indemnity policy for some claims, or?
[CUSTOMER][NEUTRAL] It's probably the same thing they're probably gonna say they can't read it, uh, but sure that'd be great on the hospital.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK. So for [PII] on the hospital, um, it looks like there is a denial stating ambulance is not covered.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then just needing diagnosis code, it looks like.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's the same for [PII] too.
[CUSTOMER][NEUTRAL] I will, uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][MIXED] No problem, I'll go work on this and get it reuploaded so they can uh see the uh one that they can read a little better, but the rest of the form is probably obviously clear. I think it's just a UB 04 that they're probably not able to read because it's a little bit lighter than the rest of the stuff.
[AGENT][POSITIVE] All right, sounds good.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Right, exactly. Yeah, absolutely. Is there anything else I could do for you?
[CUSTOMER][POSITIVE] That's it. I appreciate your time. Have a good day.
[AGENT][POSITIVE] Yeah, no worries. You too. Take care.
[CUSTOMER][POSITIVE] Thank thank you bye bye.
[AGENT][NEUTRAL] Bye-bye.