AccountId: 011433970860
ContactId: 1a34cdbe-7551-40aa-b20c-735f51d92e26
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 777179 ms
Total Talk Time (AGENT): 283226 ms
Total Talk Time (CUSTOMER): 197644 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/1a34cdbe-7551-40aa-b20c-735f51d92e26_20250415T21:55_UTC.wav
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[AGENT][NEUTRAL] For contacting APO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Oh yes, hi ma'am. Um, I have a question over my claim.
[AGENT][NEUTRAL] Uh, yes, what is your policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, yes, one second, because they had asked me for some information. I wanna see if you can help me with it. One second.
[CUSTOMER][NEUTRAL] Policy number is 2173202.
[AGENT][NEUTRAL] 3202. OK, thank you. And if I could verify your name, uh date of birth, and a phone number, please.
[CUSTOMER][NEUTRAL] [PII] [PII] [PII].
[AGENT][POSITIVE] OK, yes. um, thank you very much. And you said that there was a, a claim that I could help with? Is there any particular?
[CUSTOMER][NEUTRAL] Yeah, let me give you the claim number.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] One second, let, let's go ahead and go with 358-526-6.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And see, I, I, I submitted another one again, and all they're asking me is for a form that states that it is, I have the diagnosis code.
[CUSTOMER][NEUTRAL] And I'm giving you that claim number because when I submitted forms, uh, can you hear me?
[AGENT][POSITIVE] Yes, yes, I can.
[CUSTOMER][NEGATIVE] Are you there? Oh, OK. When I submitted forms for that claim, on the last certificate of medical necessity, it already comes with it. So I don't know why they ask, they keep asking me for it. I've been having problems to get anything that with it, because they told me that that is the diagnosis code, that it is in that form. So I'm just asking why do I keep me not having that claim if it's already been sent?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I don't know if you can see the files that were submitted. Maybe you go to certificate of medical necessity.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, yes, let me see what I can find um.
[CUSTOMER][NEUTRAL] And then if you go to the statement on medical necessity, it has the diagnosis type, and then it has it there checked E 11.9.
[AGENT][NEUTRAL] OK, let me just check, please.
[AGENT][NEUTRAL] And I apologize my computer is just a little bit lagging, but it should come up here in a second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Excuse me just one moment please. I'll be right back. Excuse me, just one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding. I'm just looking through the documents now. Now, you said, uh, where did you say that the uh diagnosis code is listed?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's in, let me get it in front of me one second. It says where it says statement of medical necessity physician use only says diagnosis code and then it says E [PII].
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] You see patient's information. This is where the certificate of medical necessity.
[AGENT][NEUTRAL] OK, I'm still checking for that. So what I, what I have, um, let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I have, so the first thing I have is an invoice from uh Medtronic, so that's the first thing that I'm looking at.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, so I've got that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then there's a
[CUSTOMER][NEUTRAL] OK, so it's gonna be the last one I.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The last one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If I submitted an order.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so let's see.
[CUSTOMER][NEUTRAL] And I just finished calling Metronics and they just told me that they had already submitted me that and they'd already had the code there, so that it should be, uh, there's that there was something that y'all can use. So I was like, oh my gosh, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the last thing that I have here, let's let me go through the, the pages that I've gotten and then we can see what we, what we have here. Um, so the very first page that I have, uh, is the Medli claim form, um, that you filled out and that you signed, and then the next page is the med link, uh, is also the Medli claim form. It just talks about, uh, what the, the form is.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, that's also the 3rd page, uh, again signed. Uh, the, uh, 4th page that I have and there's 12 pages altogether is the Medtronic invoice. Um, OK, so there's, there's that. The 5th page that I have is the Medtronic invoice, um, it's a, I think the 2nd page is the Medtronic invoice, um, then I have the, uh, uh, mini med distribution core.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, your Blue Cross Blue Shield Texas plan has negotiated cost savings for you, and I believe this is probably your claim details, um.
[AGENT][NEUTRAL] Uh, that, uh, lets you know, uh, you know, what, how much was charged and what, uh, what goes towards your deductible, co-payment or co-insurance. Um, in this case, uh, it looks like it goes towards your deductible. So there's, that's, that's the 7th page. The 8th page that I have is the detailed cost breakdown, and this is the financial breakdown of each service in this claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and that's, uh,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's also, I believe, from Blue Cross and Blue Shield. Now, the, the 9th page that I have, uh, it says claim details. This is again is from Blue Cross Blue Shield of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, that goes through your, uh, the health, uh, benefits and, and what each thing is for.
[AGENT][NEUTRAL] Um, the summary of costs, uh, there's that. Now, the 10th page is just a continuation of, of that summary of costs from Blue Cross and Blue Shield.
[AGENT][NEUTRAL] Um, the 11th page is a medical supplies breakdown. The cost of, again, um,
[AGENT][NEUTRAL] What your deductible co-payment or co-insurance. This is all part of the Blue Cross and Blue Shield explanation of benefits, and then the 12th page is just the end of that. So I think probably um when it was being sent through, we just didn't get what what you have there that shows that the uh.
[CUSTOMER][NEUTRAL] Let me see, one second. Let me see if I can.
[CUSTOMER][NEUTRAL] OK, 1 2nd.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Now you, sure.
[CUSTOMER][NEUTRAL] One second, because is, is this, because I know I did, I submitted it twice.
[CUSTOMER][NEUTRAL] So if you don't have it, let me just one second.
[CUSTOMER][NEUTRAL] Maybe I can upload it as we're speaking.
[AGENT][POSITIVE] That's great, yes.
[CUSTOMER][NEUTRAL] Because I know I've already done it, yeah, so one second, let me try just to submit it, 1 2nd.
[CUSTOMER][NEUTRAL] Next, let me get the file.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Because what we can do is we can uh submit it back to the uh to the examiner and see what we can do about getting that uh processed.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] If, if I wanna see if you can see it just so we can go from there because I've already been, I'm talking to them and
[AGENT][NEUTRAL] Sure. That's.
[CUSTOMER][NEGATIVE] They just already told me now that I've already, they've already sent it and that it should, that should be worth it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it already I'm trying to some of it. I'm just waiting for it to go through.
[AGENT][NEUTRAL] Sure. Absolutely. Well, I've, I've got your policy pulled up.
[CUSTOMER][NEUTRAL] OK, it's been uploaded?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Let me check here. I'll just refresh my uh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Page here for us and then we can see what's going on.
[AGENT][NEUTRAL] OK. It does look like I have received that. So what will happen is um they will put that with the paperwork that you have already submitted, um, and then we can see what we can do about getting this taken care of. So it does look like it's come through. That's great. Um, uh, so, uh, that's what we're, you know, so, uh, I will go ahead and, uh, we can get that, uh, submitted to the examiner and see what we can do about getting that processed. Normally it takes, um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] About 8 to 10 business days for that to, to be processed even though we just got it. Uh, it usually takes about that long, if not, but, um, but yes, that's wonderful. I, I guess it just didn't go through that very first time, but now that uh we do have those documents, we can see what we can do about getting that processed.
[CUSTOMER][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now there, is there any other claims you need to look at?
[CUSTOMER][POSITIVE] OK, ma'am. Thank you very much.
[CUSTOMER][NEGATIVE] No, I, it was just that one because the other thing that is there, because I submitted it twice, and I guess they keep asking for something like that and it's, you know, it's so it was sentenced the first time but I guess if it wasn't received the second time I did not submit it because I believe I had thought that since they received it the first time they didn't need it or it wasn't good enough or I don't know, but this is all just trying to get that claim filed and, and checked.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, absolutely. Um, yeah, that's, uh, so what we'll do is, uh, like I said, we'll just get that uh back to the examiner and see what we can do about getting that taken care of.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, ma'am. Thank you very much. I'll go ahead and wait then.
[AGENT][POSITIVE] OK, well thank you for contacting AP have a good day.