AccountId: 011433970860
ContactId: 189ac283-32e6-4cdb-89fb-2ad007a2e395
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 378200 ms
Total Talk Time (AGENT): 192545 ms
Total Talk Time (CUSTOMER): 89911 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/189ac283-32e6-4cdb-89fb-2ad007a2e395_20250108T17:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yeah. I placed a claim, um, like, oh, about a month ago, or maybe just a few weeks ago. And um
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I, yesterday I sent in the itemized thing that I got from the hospital.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I just received an email that said that.
[CUSTOMER][NEUTRAL] I needed to send an itemized statement providing the listing and diagnosis code, and I thought that's what I said.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yeah, it might have been. I'll, I'll double check, of course, but that might have been like an older thing that was sent to you before it was received, um, especially if you had just sent it yesterday, um, bear with me just a moment and we'll check that out. What was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, and [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Probably. Hold on.
[CUSTOMER][NEUTRAL] I had it pulled up, or I had.
[CUSTOMER][NEUTRAL] Something pulled up on the computer.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can start using your social if that's easier.
[CUSTOMER][NEUTRAL] I do know my social.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, I'm just gonna verify some information really quick. [PII], can I get your date of birth please?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address we've got on file for you. uh, looks like it is uh through an organization.
[CUSTOMER][NEUTRAL] Um, then it'd be [PII].
[AGENT][POSITIVE] Perfect. Alright, thank you so much for verifying that. Alright, and was this claim for you, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK give me just a moment.
[AGENT][NEUTRAL] And may I ask how, how did you submit that itemized statement you said you sent in yesterday?
[CUSTOMER][NEUTRAL] Um, I uploaded it.
[AGENT][NEUTRAL] You did through the uh online portal?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's take a look here.
[CUSTOMER][NEUTRAL] And it says process now.
[CUSTOMER][NEUTRAL] Earlier I just had received.
[AGENT][NEUTRAL] Oh, was this for your accident policy?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, OK, give me just a moment.
[AGENT][NEUTRAL] OK, so I do see that um.
[AGENT][NEUTRAL] Yes, I my statements listing the diagnosis codes. Do you know if that's what you uploaded? I know you said it was an autoized statement, but we do need those diagnosis codes.
[CUSTOMER][NEUTRAL] So what, what is the difference between
[CUSTOMER][NEUTRAL] Cause it says code.
[AGENT][NEUTRAL] The code
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] But what are
[AGENT][NEUTRAL] The diagnosis codes essentially show us, of course, what the diagnosis was and that helps us determine what we can pay um and most of it, it depends on the provider of course sometimes the itemized statements will show them with it other times you might have to ask for it separately, but it doesn't look like that's what we received was with those diagnosis codes.
[AGENT][NEUTRAL] If you give me one moment, I will pull that up and we'll take a look.
[CUSTOMER][NEGATIVE] This is the 3rd time I've asked the hospital for this, and this is all they've given me each time.
[AGENT][NEUTRAL] Oh, I'm sorry, yeah, again it really does depend on each provider there's they operate so different.
[AGENT][NEUTRAL] Give me just a moment here, let me take a look.
[AGENT][NEUTRAL] OK, it does have the CPT codes, but.
[AGENT][POSITIVE] OK, so this is good and we definitely do need this, but we need those diagnosis codes so I would ask them specifically for that, the diagnosis codes and if they are confused or they're not sure or you know, they act like they just wanna send you this again, you can always give them our phone number and they are more than welcome to talk to us and we can explain it to them uh what we need so that you don't have to worry about this anymore.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry you've been dealing with the run around.
[CUSTOMER][NEUTRAL] And this is the first time I've tried to do this, and I'm like, this is
[AGENT][NEGATIVE] It shouldn't be this much of a mess.
[CUSTOMER][NEUTRAL] Almost more of a job than than my job is doing this.
[AGENT][NEUTRAL] It
[AGENT][POSITIVE] Right. And it should not be that way. I apologize. I, it's really does with, especially things like this, wherever you go for treatment. Sometimes it's clear cut and dry. They give you one single document that has everything that we need on it. And other times, you know, it's like this. So I'm so sorry you have to deal with it. But again, if there are any confusion or pushback or anything like that, they are more than welcome to call us and we can explain it to them.
[CUSTOMER][POSITIVE] OK, thank you very much.
[AGENT][POSITIVE] You're very welcome. Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Um, maybe later.
[AGENT][POSITIVE] Well, definitely give us a call if you need anything else. I hope you have a great rest of your day, [PII]. Of course bye bye.
[CUSTOMER][POSITIVE] OK, thank you very much.
[CUSTOMER][NEUTRAL] You too bye.