AccountId: 011433970860
ContactId: 214b1758-2059-4c96-83fb-5702f17cbae7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 709479 ms
Total Talk Time (AGENT): 223840 ms
Total Talk Time (CUSTOMER): 252555 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/214b1758-2059-4c96-83fb-5702f17cbae7_20250312T18:36_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]. I'm hoping you can help me with uh my claim. Um, I, it seems to have
[CUSTOMER][NEUTRAL] I don't know if it's been denied or it looks like it hasn't been paid out um what information do you need from me?
[AGENT][POSITIVE] Yeah, I'm happy to take a look at a claim. What's the policy number? Do you have that?
[CUSTOMER][NEUTRAL] Sure. It is 2473311.
[AGENT][NEUTRAL] OK, thank you. Let me pull this up here.
[AGENT][NEUTRAL] All right. And then if I can get the name and date of birth on the policy.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you, dude, and then if I could verify please the address and email address.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Email is [PII].
[AGENT][NEUTRAL] OK, let's see here. So let me take a look.
[AGENT][NEUTRAL] The most recent claim in here and see what's going on.
[CUSTOMER][NEUTRAL] Well, it's all related to the same claim, right? So, um, it's a CPAP machine, so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, um, I think it's, I forget the exact name, but, um, CPAP machines are supposed to be covered under the plan.
[CUSTOMER][NEUTRAL] So, the first time around, I sent all the receipts of everything that was paid and invoiced and paid. Um, and then they asked for EOBs and the doctor's notes. So that was the second time around. I sent all the EOBs and then uh for the doctor's notes, I kind of screenshotted where the doctor says that I have, you know, obstructive sleep apnea and I need
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I need a, that I need a machine. Um.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] So, I, I, I, I see there where they responded with
[CUSTOMER][NEUTRAL] Um, let me see if I can pull it up again, um.
[AGENT][NEUTRAL] Looks like it says diagnosis code is needed.
[CUSTOMER][NEUTRAL] that should, that should have all been on, I mean, that, that would be on.
[CUSTOMER][NEUTRAL] The initial
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, on the, the receipts, right? On the initial invoices I sent.
[AGENT][NEUTRAL] Um, I'm gonna take a look and see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Um let's.
[CUSTOMER][NEUTRAL] And then it, I mean, they put something like, you know, the service is not covered when it's in a doctor's office or clinic, but, you know, hospitals don't, like, when you do like sleep studies, it's never in a hospital, it's always in a specific.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Sleep study clinic or, you know, like uh one of those uh outpatient places where they have the, the whole, the bed set up and all that where you have to spend the night.
[CUSTOMER][NEUTRAL] I'm not sure why they put that there.
[AGENT][NEUTRAL] Yeah, I mean, it's how it's being billed from
[AGENT][NEUTRAL] It looks like them.
[AGENT][NEUTRAL] On the procedure codes and stuff like that.
[AGENT][NEUTRAL] would have to do.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] On that one, Jude. So,
[AGENT][NEUTRAL] I'm gonna have to reach out to claims and have somebody research this and then give you a call back because the upload that you did was 111 pages it's a lot to go through so.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] If there was an error, then, um, you know, I can let them know kind of why you're calling and, and what the concerns are regarding.
[AGENT][NEUTRAL] A claim and that you have stated that you had already submitted the diagnosis codes on it. Um
[CUSTOMER][NEUTRAL] I mean, yeah, the diagnostic codes that I have are just the ones from the vendor from um Carecentric. They, there's something called an HCPC code. I don't know if that's what they're looking for, which is
[CUSTOMER][NEGATIVE] I mean, I, it's, they, they're not, it's a little frustrating, I gotta be honest, cause I wasn't expecting to, cause this is like a lot that was out of pocket, which I thought my insurance was gonna cover and they obviously didn't. So, you know, I, I'm, I'm trying to get this reimbursed now with you guys, but you guys are really putting me through some hoops, um.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I, I.
[AGENT][NEUTRAL] Yeah, um,
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Let's see, give me just a second here, [PII].
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah, because what I initially see are procedure codes so like procedure codes would be what the provider is giving to us and then that's letting us know.
[AGENT][NEUTRAL] The services that were provided to you based off of that code.
[AGENT][NEUTRAL] What they're looking for is the.
[AGENT][NEUTRAL] Diagnosis that you need you have sleep apnea and need the CPAP machine.
[CUSTOMER][NEUTRAL] So that would be from the doctor's office, some kind of uh
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Something showing that.
[AGENT][NEUTRAL] You know, you've medically been tested for this and this is a medically necessary device.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Um, OK, so I, I did provide an EOB from
[CUSTOMER][NEUTRAL] The sleep study.
[AGENT][NEUTRAL] Primary.
[AGENT][NEUTRAL] Yeah, I see that.
[CUSTOMER][NEUTRAL] Well, yeah, so, so that should be fine, right? So that, that proves that I went to a sleep study and, and did the, the testing.
[CUSTOMER][NEUTRAL] Um, I, I have all the EOBs, of course, for the machine, right? So, even though, you know, you would think that.
[CUSTOMER][NEGATIVE] You guys would, you know, they wouldn't give me this machine and all this, and I wouldn't do a sleep study if I, if it wasn't something that was needed. So, um, I would assume that you guys would, would, would kinda
[CUSTOMER][NEUTRAL] figure that, but, um, so I need to contact my doctor's office and get, I guess, the diagnostic codes.
[CUSTOMER][NEUTRAL] Uh, I mean, wouldn't there be something internal to them that you guys wouldn't really understand? I, I don't know.
[AGENT][NEUTRAL] Let them know that you need documentation.
[AGENT][NEUTRAL] And it can be an itemized bill showing the diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For the sleep apnea and let them know that you're attempting to file a claim with your secondary insurance, and the secondary insurance needs a diagnosis code.
[AGENT][NEUTRAL] For the sleep apnea, showing that that was the diagnosis from the provider.
[CUSTOMER][NEUTRAL] OK. I'm sorry, I'm right, um, can you, can you say that again? I'm, I'm writing it down.
[AGENT][NEUTRAL] No, that's OK.
[CUSTOMER][NEUTRAL] Um, I need to, yeah.
[AGENT][NEUTRAL] So let them know that you need documentation.
[AGENT][NEUTRAL] And it can be an itemized bill.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] With a diagnosis code.
[AGENT][NEUTRAL] Show, showing the diagnosis of the sleep apnea that you need the CPAP machine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let them know that the reason that you need this is for your secondary insurance to submit the claim. So when you let them know that you need it for insurance reasons, they should know exactly what you're talking about.
[CUSTOMER][NEUTRAL] OK. And uh from what you see, once I get that, that should be the only thing left, right?
[AGENT][NEUTRAL] That's the only thing that I see um that is asking, that it's asking for, yes, correct.
[AGENT][NEUTRAL] Um, I don't see any other denial reasons on there, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, dude.
[CUSTOMER][NEUTRAL] I will, I'll, I'll send that out to them. I'm, I'm actually I have to go see them on Monday anyway, so I'll, I'll get on them and I'll get that information and then I'll, I'll submit, I'll submit it on the website.
[AGENT][POSITIVE] OK, sounds good, dude.
[CUSTOMER][POSITIVE] Thank you for your help.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.