AccountId: 011433970860
ContactId: 254307ad-3271-462f-8b5f-18a4b64ff40f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1093739 ms
Total Talk Time (AGENT): 200940 ms
Total Talk Time (CUSTOMER): 179797 ms
Interruptions: 4
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/254307ad-3271-462f-8b5f-18a4b64ff40f_20250131T13:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APR. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, how you doing? Um, I'm calling because uh I filed a claim for my spouse.
[CUSTOMER][NEGATIVE] And um it got denied because we didn't have the diagnosis code and I keep asking the hospital to send it to me and it's been like 2 months already. They just keep sending me an itemized bill so I submitted it with uh with a discharge paper to see if it works.
[AGENT][NEUTRAL] Yes, sir. I can assist you with claim status. First, could I get your name and a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] and the number is [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. Now I need your policy number, please.
[CUSTOMER][NEUTRAL] Um, can I give you my social?
[AGENT][NEUTRAL] Um, yes, one moment.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I'm sorry. Could you please, could you please start over?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And please verify your first and last name and your date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, and please verify your mailing address and your email address.
[CUSTOMER][NEUTRAL] [PII] and my email is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And one moment.
[AGENT][NEUTRAL] OK, I'm showing the claim that you submitted on yesterday is actually still pending and we just ask that you give us 5 to 7 business days for it to be processed, but we did receive the new claim.
[CUSTOMER][NEUTRAL] No, that's the same claim as I did before, but the hospital is not sending me the diagnosis code.
[CUSTOMER][NEUTRAL] So they told me to upload the, the discharge paper one.
[CUSTOMER][NEGATIVE] With, with the itemized and my EOB because they still haven't, they, they don't send us the code no matter how many times we ask. They say the UBO4 and we say yes and then when we say yes, they send us the itemized bill.
[CUSTOMER][NEGATIVE] So I my claim keeps getting denied.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, probably because you're also asking for the diagnostic code and you need to ask for the diagnosis code.
[CUSTOMER][NEUTRAL] No, I'm sorry. I, that's what I asked for. The UBO4 is what shows everything, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] Yeah, they're not sending me the UBO4. They're sending me an itemized every time.
[AGENT][NEUTRAL] Well, actually, they can, do you know what the diagnosis code is? Cause actually, all you'll need to do is write it on the documentation and send that to us. It doesn't have to be um
[CUSTOMER][NEUTRAL] They
[AGENT][NEUTRAL] Pre-printed on the form, they could actually give you that information over the phone or either give it to your wife.
[CUSTOMER][NEGATIVE] They told me they can't. Yeah, they told me that they can't give it to us over the phone, that we had to had to send the UBO4 which takes 15 to 30 days, and we waited 15 to 30 days and they send the item on.
[CUSTOMER][NEUTRAL] They sent 2 of them
[CUSTOMER][NEUTRAL] Already.
[AGENT][NEUTRAL] OK. One moment. Let me take a look at the documentation. One moment.
[CUSTOMER][NEUTRAL] Yeah, the
[CUSTOMER][NEUTRAL] Please, I
[CUSTOMER][NEUTRAL] My stomach
[CUSTOMER][NEUTRAL] So.
[AGENT][POSITIVE] Thanks for your patience, sir. I'm still um reviewing the documentation.
[CUSTOMER][POSITIVE] No, no, no, I'm, I'm letting, I'm letting you do your thing. I'm letting you do your thing. Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Mhm, no problem.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and who's your primary insurance company?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK. I'm showing that we still need the explanation of benefits from them for this date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I, I, I uploaded that one.
[AGENT][NEUTRAL] OK. I'm, that's what I'm doing. I'm reviewing all the documentation that you've uploaded and I don't see the EOB from the primary insurance company. So we still need that. I do see, now, what did, what did your wife go to the ER for? What?
[CUSTOMER][NEUTRAL] Really.
[CUSTOMER][NEUTRAL] She had a Q-tip stuck in her ear.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, sir, and I do
[CUSTOMER][NEUTRAL] Yeah, I sent, I, I, it doesn't say admin on no paper there because I could, I have it right here on my phone.
[AGENT][NEUTRAL] No, sir. I don't show the EOB from AMed and that's the information we need. We have, we have the diagnosis foreign body and right ear. We have that. Now we need the EOB, the explanation of benefits from AMed. Send us that and we can get this process.
[CUSTOMER][NEUTRAL] And my.
[CUSTOMER][NEUTRAL] Where can I upload it to because I have it right here on my phone.
[AGENT][NEUTRAL] Um, the same place you uploaded the other documentation. It looks like you filed the claim online. You uploaded the documentation. Do it, um, upload the EOB the same way you uploaded the previous documentation.
[CUSTOMER][NEUTRAL] And I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm doing that right now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] Will you be able to see it if I do it right now?
[AGENT][NEUTRAL] Um, I'll try to pull it up.
[AGENT][NEUTRAL] Go ahead and send it.
[CUSTOMER][NEUTRAL] OK, one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me sign in here.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Mm, couple of files.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, we don't know one second.
[CUSTOMER][NEUTRAL] I'm putting it on there [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] And I'm uploading it right now select files.
[CUSTOMER][NEUTRAL] For the library.
[CUSTOMER][NEUTRAL] I'm submitting
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Zip line
[CUSTOMER][NEUTRAL] remind me, I, I submitted the POB.
[AGENT][NEUTRAL] OK, I'll give it a few seconds. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, [PII], thanks for your patience.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, no problem. I do show that we've received the explanation of benefits. Um, we've received it and I also see the diagnosis code which is basically all the information we'll need to get the claim filed and processed. Um, I just ask that you allow 5 to 7 business days for it to be processed.
[CUSTOMER][POSITIVE] Well, thank you for taking the time to really look into that because everybody else just tells me to go call the hospital and I had to wait like 2 months or something like that, so thank you very much.
[AGENT][NEUTRAL] OK. It's no problem. And like I said, just uh give us time to get it processed. And I also see where you've uploaded diagnosis codes before. Um try not to upload that that diagnosis code anymore because it's showing that it's for nicotine dependence, which is not covered under the policy. I'm not sure where you got that information from. Yeah, so please don't send that.
[CUSTOMER][NEUTRAL] Whoa.
[CUSTOMER][NEUTRAL] The, the hospital gave me that information.
[AGENT][NEUTRAL] Are you sure? Is it?
[CUSTOMER][NEUTRAL] Yeah, they, they gave me that code.
[AGENT][NEGATIVE] OK, that's not correct. Don't send it. Yeah. Leave that alone.
[CUSTOMER][NEGATIVE] I know. I'm never doing that again.
[AGENT][POSITIVE] OK. All right. Well, if there, OK, if there isn't anything else I can assist you with, you have a great weekend. Thank you for calling APL. Mhm. Bye.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] You too. I'm gonna get her. Take care. Bye bye.
[AGENT][NEUTRAL] Bye.