AccountId: 011433970860
ContactId: 27fe2fe3-eaf4-45d8-9fde-4b680f5e1294
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 647849 ms
Total Talk Time (AGENT): 203882 ms
Total Talk Time (CUSTOMER): 201209 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/27fe2fe3-eaf4-45d8-9fde-4b680f5e1294_20250401T15:38_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm sorry. Is it [PII]?
[AGENT][NEUTRAL] Certainly.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hey, [PII], um, we submitted a claim and I have that claim number if you need it to um look up the claim. Um, it is 358.
[CUSTOMER][NEUTRAL] 2985
[AGENT][NEUTRAL] And are you calling with the provider's office?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Are you calling with the provider's office?
[CUSTOMER][NEUTRAL] No, ma'am, I'm the patient, the claimant.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I'm sorry, um, this was the 2nd claim submitted for the same procedure because the first claim that I submitted had the wrong documentation with it, so I had to wait and get the correct bill with the correct codes on it to resubmit the claim.
[CUSTOMER][NEUTRAL] And the, so the this claim with the number that I just gave you, it's, it looks like it was just denied because they thought it was a duplicate.
[CUSTOMER][NEUTRAL] When in fact it's not really a duplicate because the first one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] was denied because they didn't have the right information.
[AGENT][NEUTRAL] OK. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yes ma'am, it is 024.
[CUSTOMER][NEUTRAL] 94,500
[AGENT][NEUTRAL] And what was your name and date of birth?
[CUSTOMER][NEUTRAL] My name is [PII], and my date of birth is [PII].
[AGENT][NEUTRAL] And the claim.
[CUSTOMER][NEUTRAL] The claimant is my son.
[AGENT][NEUTRAL] OK, and that was for?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is your address on the policy?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you so much. And do you have a callback number?
[CUSTOMER][NEUTRAL] Yes ma'am, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, let's see what's going on with this claim.
[AGENT][NEUTRAL] OK, let me pull up what we received.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, give me just a moment running a little bit slow.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so yes, I see the first one that we had denied needing more information.
[AGENT][NEUTRAL] And then let me see what we've got to make sure it wasn't um.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, let's
[AGENT][NEUTRAL] OK. Do you mind if I place you on a brief hold?
[CUSTOMER][NEUTRAL] Uh, sure, that's OK.
[AGENT][NEUTRAL] OK, hold on one moment. Thank you.
[CUSTOMER][NEUTRAL] Thank you. You are on hold.
[AGENT][NEUTRAL] OK, so what do we do here?
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you so much for holding. OK, so I do show we did receive that itemized bill, but what what we need is actually the diagnosis.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Um, that indicates it's an accident or illness. I, I mean, I understand it's a large bill and obviously it would be from that, but, um, so typically we can see that on the actual claim from the hospital. They always have a diagnosis on it, um, or just there's something I, I'm not sure, do you have access to like a portal for this, um, provider?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Like, OK, so again what we're looking for is an actual diagnosis code.
[AGENT][NEUTRAL] So that tells us exactly why he was in the hospital.
[AGENT][NEUTRAL] And then once we
[CUSTOMER][NEUTRAL] I thought that's what the C P T H C PCS codes were.
[AGENT][NEUTRAL] So CPT codes are procedure codes that says what was done, but it doesn't tell us what the diagnosis was.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] You can ask for a UBO4. That's the actual claim from the hospital, which they should be able to provide.
[AGENT][NEUTRAL] Um, or look through if you have access to that portal, it's called an ICD 10.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The diagnosis code would be an.
[CUSTOMER][NEUTRAL] I'm sorry, it's called the IC.
[AGENT][NEUTRAL] ICD 10.
[AGENT][NEUTRAL] That's gonna be your diagnosis code.
[CUSTOMER][NEUTRAL] Am I, I'm so sorry. I am I looking for a document labeled ICD 10 or is it just a document with a code on it that says ICD 10?
[AGENT][NEUTRAL] It's with a code on it that says ICD 10 or like I said, you could call the hospital and ask if they can provide you the actual claim, uh, that would work as well. That's gonna have what we need on it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, because
[CUSTOMER][POSITIVE] I've I went through this once already and when I called them and told them I needed the diagnostic codes, which is what I was told I needed, they sent me what I uploaded.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] And I had to wait 3 weeks for that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You might have
[CUSTOMER][NEUTRAL] Um, I'm not, I'm not complaining. I'm just trying to work this out in my head if I, if because it's through my chart, it's through the.
[CUSTOMER][NEUTRAL] The portal. I mean, I should be able to figure this out.
[AGENT][NEUTRAL] Yeah, I, so I use my chart myself, um, for my doctor they use that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there should be a place on there if you go on to his records, look for that ICD 10.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] I think you should be able to find it because I know I can see mine um for when I go to the doctor, so it should be on there.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And just look out for that specific.
[CUSTOMER][NEUTRAL] Would it be under
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Would it is that like would it be under billing or visit summary?
[AGENT][NEUTRAL] Probably more than likely the visit summary, yeah, it's not gonna be under billing they typically don't list it there um check under the visit summary and see if you can see it's usually like a code that's like D83.42 or that's just an example but um so it'll say ICD 103842 or something to that effect just trying to give you kind of an idea of what it'll look like.
[CUSTOMER][NEUTRAL] Do you know?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][POSITIVE] OK perfect and then I'll just reupload. OK, all right, [PII], thank you. I appreciate your help.
[AGENT][NEUTRAL] OK, anything else I can help with today, [PII]?
[CUSTOMER][POSITIVE] No, ma'am. I appreciate it.
[AGENT][POSITIVE] OK, well, thank you for calling APL and I hope you have a good day.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you. Bye.
[CUSTOMER][NEUTRAL] Bye-bye.