AccountId: 011433970860
ContactId: 25da251b-59e2-4f9f-9f04-dfdefeb4a9c3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 443720 ms
Total Talk Time (AGENT): 177291 ms
Total Talk Time (CUSTOMER): 118565 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/25da251b-59e2-4f9f-9f04-dfdefeb4a9c3_20250527T18:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Doctor [PII] and his office. We have a patient that put in a claim. He's asking for us to send medical records, but he couldn't provide a fax number or an email address.
[AGENT][NEUTRAL] OK, um, can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII]. My [PII] is [PII].
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] I have a 02552774.
[AGENT][NEUTRAL] OK, give me one moment, let me look that up.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, give me one second, I just closed this chart.
[CUSTOMER][NEUTRAL] Just had a birthday.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And he was needing information on how to submit the claim or he wanted you all to file it on his behalf?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] He wanted us to send medical records, I guess he needs uh data like supplemental data for his claim.
[AGENT][NEUTRAL] OK, and you wanted to send that through fax, email, or I'm sorry, not email, fax or uh.
[CUSTOMER][NEUTRAL] she's waiting to wait like maybe we can do we can do fax.
[AGENT][POSITIVE] That's probably the quickest way or you can send it through mail.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We could do 5 whichever you guys prefer.
[AGENT][NEUTRAL] OK, um, fax should be the quickest. Our fax number here is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, attention to anyone in particular?
[AGENT][NEUTRAL] And this
[AGENT][NEUTRAL] Um, it'll go to attention claims department.
[AGENT][NEUTRAL] And if he's
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] If he's asking you to send a bill, we will need an itemized bill or receipt showing procedure codes if that's what he was asking for.
[CUSTOMER][NEUTRAL] OK, no, he was asking us for records, like his surgical procedure records.
[AGENT][NEUTRAL] Oh, OK, yeah, anything with procedure codes on it, um, so we know what benefit he's trying to submit the claim for.
[CUSTOMER][NEUTRAL] OK, and then he, he uh gave us um.
[CUSTOMER][NEUTRAL] Kind of like uh a claim number we can we put that on the cover sheet?
[AGENT][NEUTRAL] Did he tell you when he submitted it?
[CUSTOMER][NEUTRAL] He submitted them in April.
[AGENT][NEUTRAL] OK, well, he submitted. I see he submitted 3 in April. So what was the date of service so I can look it up.
[CUSTOMER][NEUTRAL] Uh, one was.
[CUSTOMER][NEUTRAL] For [PII], the second was for [PII], the third was for [PII].
[AGENT][NEUTRAL] Oh, OK. All three of them? OK.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see what else is being needed um and who are you calling from? What provider?
[CUSTOMER][NEUTRAL] We're his PCP.
[CUSTOMER][NEUTRAL] We requested the records from the surgical.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Uh, orthopedic doctor.
[AGENT][NEUTRAL] Yeah it looks like what we're needing for some of these is a receipt of the claims that have supporting documentation, um.
[AGENT][NEUTRAL] That shows evidence to an accident or sickness, um, that could be an itemized bill with diagnosis codes, uh, super bills, office notes, hospital admission and discharge summaries.
[AGENT][NEUTRAL] And it looks like we're also needing.
[AGENT][NEUTRAL] Uh, a copy of the explanation of benefits from the primary insurance carrier.
[AGENT][NEUTRAL] And you said he sent 3 in correct?
[CUSTOMER][NEUTRAL] OK, I'll let him know.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Oh, there's actually 4 he submitted in April.
[AGENT][NEUTRAL] But it's all for the same reasons.
[CUSTOMER][NEUTRAL] Right, he had a knee surgery, and they needed to do like MRIs, X-rays.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, because those are the only claims that I'm seeing on file is all for those all the ones that he submitted, um, and they all have the same code saying that they need.
[AGENT][NEUTRAL] The primary EOB.
[AGENT][NEUTRAL] And then itemized bills for each one, you shouldn't need to put the claim number on there um because it is spread out into 4 different claims, um.
[AGENT][NEUTRAL] If you would like to, I can try and look up each one for you to see which one, but our claims department should be able to do that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because it is 4 separate ones, all with the same code.
[CUSTOMER][NEUTRAL] Um, no, it's OK because I don't have, he would have to contact his insurance for the EOBs, but I'll let him know that he, he needs some.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, he will need those um because this is a secondary gap policy.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So we need, yeah we need to show that that the primary paid first for some benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, OK, I'll let him know thank you for the fax number.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Oh, anytime, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No that was all thank you.
[AGENT][POSITIVE] Alright, thank you for calling APL and have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Mm