AccountId: 011433970860
ContactId: 1b30053e-0519-4aa0-abf9-934b7b2d4c44
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 349089 ms
Total Talk Time (AGENT): 139611 ms
Total Talk Time (CUSTOMER): 155713 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/1b30053e-0519-4aa0-abf9-934b7b2d4c44_20250606T19:50_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Um, yes, I submitted a claim and I'm unable to pull anything up online. I'm hoping you can help me.
[AGENT][POSITIVE] I'd be happy to assist um so I can get a good call back number for you.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what is your policy number?
[CUSTOMER][NEUTRAL] 02478752 ML 7.
[AGENT][NEUTRAL] And if you can verify your name and date of birth.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that information and this is a claim for yourself or a dependent?
[CUSTOMER][NEUTRAL] Myself.
[AGENT][NEUTRAL] OK, it looks as though the claims were denied because we need the um diagnosis code.
[AGENT][NEUTRAL] For the dates of service.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, so how do I get a diagnosis code? It's for physical therapy following a knee replacement.
[AGENT][NEUTRAL] OK, so either the provider that's providing the physical therapy or the doctor that ordered it can give you the um information with the diagnosis on it.
[CUSTOMER][NEUTRAL] So what do they have to write it down and I send it to you or I just call you with a code?
[AGENT][NEUTRAL] No, we would have to have official medical documentation. So, I mean, that can be.
[AGENT][NEUTRAL] Um, just a copy of the order that they.
[AGENT][NEUTRAL] Wrote for, for you to get it or one of the claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Copy of, couple of copy of my original order.
[AGENT][NEUTRAL] Yes, anything that basically is stating the diagnosis for the um physical therapy.
[CUSTOMER][NEUTRAL] And one copy of that will be enough for all of these visits.
[AGENT][NEUTRAL] Right, because it would, it would be in line with.
[AGENT][NEUTRAL] The treatment.
[CUSTOMER][NEUTRAL] OK, so I have to get a hold of my, I have to ask them for like my original referral that has the diagnosis, is that what you're talking about?
[AGENT][NEUTRAL] Correct. Um, that's one of the things. I mean, you may have something else that has the diagnosis on it.
[AGENT][NEUTRAL] But that, that's
[CUSTOMER][NEUTRAL] Well, what else would have the diagnosis?
[AGENT][NEUTRAL] Um, I guess any of your medical, your visits, your, you know,
[AGENT][NEUTRAL] The, the surgery itself, the medical information from the surgery or from maybe a visit?
[CUSTOMER][NEUTRAL] So, so if, if I send you the, so if I send you the EOB that I had a knee replaced, is that good enough or does it have to be connected? I'm not sure I under.
[AGENT][NEUTRAL] The EOB
[AGENT][NEUTRAL] The EOB would not have the diagnosis on it.
[CUSTOMER][NEUTRAL] OK, so what would have the diagnosis be with the original referral from the doctor to the physical therapist would have the, OK, and, and if it doesn't.
[AGENT][NEUTRAL] It should, it should. Um, just to simplify things, just let your provider know. Just to simplify things, just let your provider know. I need the diagnosis for my physical therapy and then they can decide which document to give you to provide that.
[CUSTOMER][POSITIVE] OK, thank you and so then I send it to you and I don't have to resubmit all my visits correct?
[AGENT][NEGATIVE] No, no, no, don't send them back. No, we have enough. We, we just need the diagnosis.
[CUSTOMER][NEUTRAL] You, you have
[CUSTOMER][NEUTRAL] OK, I'll try to get that to you thank you. When was I gonna find this out? I can't get to my account online.
[AGENT][NEUTRAL] Well, you'll be getting a lot of, I'm sorry, go ahead.
[CUSTOMER][NEGATIVE] I haven't been able to get in for over a week.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] So the claims were just processed on [PII], so you should be receiving um several EOBs in the mail because we always send out we always mail out the explanation of benefits once we process a claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, so in the meantime, how do I access my account? Because I called a week ago and they said, they said a week ago that they were having problems that should be fixed within 24 hours.
[AGENT][NEUTRAL] Now, you will need to.
[AGENT][NEUTRAL] OK, so with the online service and you um you have to re-register.
[CUSTOMER][NEGATIVE] So I have to pretend I don't have an account and start a new account?
[AGENT][NEUTRAL] Right, you have to reregister.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Uh, how do I reregister? I go in there and.
[CUSTOMER][NEUTRAL] Let me see, uh, can you help me with this?
[AGENT][NEUTRAL] Sure, just go to um [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm on it.
[AGENT][NEUTRAL] Alright, and then after you go there.
[CUSTOMER][NEGATIVE] And now I have to create my account. I have to create an account, start over.
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] Right. Yes.
[CUSTOMER][NEUTRAL] OK, I guess then it's.
[CUSTOMER][NEUTRAL] It should be easy from here on out now that I know that I have to start over. How are people supposed to know we have to start over?
[AGENT][NEUTRAL] But I'm not sure if they sent anything out in regards to that. I'm not for certain.
[CUSTOMER][NEUTRAL] They didn't because I've been trying to get in over a week, so I appreciate you're telling me, but.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][MIXED] I think they're kind of could have been some better communication here. OK, thank you.
[AGENT][POSITIVE] Thank you for calling ACL. Have a good day.