AccountId: 011433970860
ContactId: 26bea47d-4b29-4b5b-b72e-d339f6fbb7b8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 244570 ms
Total Talk Time (AGENT): 84241 ms
Total Talk Time (CUSTOMER): 112594 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/26bea47d-4b29-4b5b-b72e-d339f6fbb7b8_20250505T18:38_UTC.wav
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[AGENT][NEUTRAL] This is [PII].
[CUSTOMER][NEUTRAL] Hi, this is [PII] over Broker Resources. I have a broker's office on the phone trying to check the status on a claim. Can you help on a gap policy?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, the policy number is 1419054.
[AGENT][NEUTRAL] OK, I see.
[AGENT][NEUTRAL] OK. And who's the patient?
[CUSTOMER][NEUTRAL] The patient is [PII]. Date of birth [PII]. I forgot to ask her for the data service. Um, that's who she's calling on, and it's, and it's, it's [PII] with the broker's office and her call call back number is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. You can send her over. Thank you.
[CUSTOMER][POSITIVE] OK, alright, thank you so much. Just one second, I'll pull her in.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Hi [PII].
[CUSTOMER][POSITIVE] Yes. I've got [PII] on the line and she's gonna help you with this that claim status, OK? Thank you so much. Thank you you have a great day thanks for calling APL bye bye. You too.
[AGENT][NEUTRAL] Hello, this is [PII] and the yes, ma'am. This is [PII] in the claims department. Um, I have the policy pulled up. Could you please verify the patient's name and date of birth on the claim?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Um, so the claim is for [PII]. Uh, her date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And can I get your name one more time, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. And what's the date of service and bill charges for the client?
[CUSTOMER][NEUTRAL] Um, I have a confirmation number or a claim number if that helps.
[AGENT][NEUTRAL] OK, yes, I'll take that.
[CUSTOMER][NEUTRAL] OK, so the claim number I have, it's 359-427-5.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's for the data service of.
[CUSTOMER][NEUTRAL] 8:29.
[CUSTOMER][NEUTRAL] Oh there's a couple. I think the one was signed.
[AGENT][NEUTRAL] Yeah, you said the claim number is 359-427-5?
[CUSTOMER][NEUTRAL] Yeah, 3 359-4275.
[AGENT][NEUTRAL] OK. Yeah, the only claim
[CUSTOMER][NEUTRAL] From what I can see online is mhm go ahead.
[AGENT][NEUTRAL] Mhm. Go ahead.
[CUSTOMER][NEUTRAL] No, no, I was just saying that we submitted online and I can see that it's processed.
[CUSTOMER][NEUTRAL] But nothing else.
[AGENT][NEUTRAL] OK. Yes, ma'am. I'm showing that that claim did process and I'm showing that it's denying because we need the diagnosis code. So the same information can be resubmitted, just make sure that um you guys include the diagnosis code um and it has to come from the provider's office.
[CUSTOMER][NEUTRAL] So the provider needs to submit it?
[AGENT][NEUTRAL] Well, the provider
[CUSTOMER][NEUTRAL] Or we can submit it the code.
[CUSTOMER][NEUTRAL] Sorry, go ahead.
[AGENT][NEUTRAL] Right. You'll reach out to the provider's office and um get documentation that has the diagnosis code on it. And once you receive that documentation with the diagnosis code, you'll um resubmit the claim again along with that documentation.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][POSITIVE] OK, I will let the member know. Thank you so much for your help.
[AGENT][NEUTRAL] OK, thank you, [PII] for calling APL. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] No, that was it.
[AGENT][POSITIVE] OK. Thank you again for calling APO. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][POSITIVE] Mm thank you.