AccountId: 011433970860
ContactId: 2d1a362d-17b2-4dcb-b005-72d1399d74fb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 455649 ms
Total Talk Time (AGENT): 139956 ms
Total Talk Time (CUSTOMER): 246301 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/2025/06/12/2d1a362d-17b2-4dcb-b005-72d1399d74fb_20250612T15:33_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, yeah, I have um a question. I submitted for some benefits, but I got an explanation of benefits back saying they needed some more information.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I'm just trying to clarify what exactly I can send that will be OK.
[CUSTOMER][NEUTRAL] Um, it says I don't know if you need my reference number or policy number.
[AGENT][NEUTRAL] Um, let's give me, uh, give me your name and policy number first so I can verify your information, please.
[CUSTOMER][NEUTRAL] OK, it's [PII]
[CUSTOMER][NEUTRAL] And the policy number is 02291134.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And Ms. [PII], verify your date of birth, mailing address and email address for me, please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And my address is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then you need you need my phone number?
[AGENT][POSITIVE] Uh, email address and a callback number would be great. Yes, ma'am.
[CUSTOMER][NEUTRAL] Or what what else oh.
[CUSTOMER][NEUTRAL] OK, OK, um, my email address, my home one is got [PII].
[CUSTOMER][NEUTRAL] And then my number, my cell phone number which I don't have at work so I'm not sure which one you.
[AGENT][NEUTRAL] Just a callback number. If our call gets disconnected, I have a number to call you back.
[CUSTOMER][NEUTRAL] You want my work number or?
[CUSTOMER][NEUTRAL] Oh, OK then OK OK then I'll give you my um desk number. It is [PII].
[CUSTOMER][NEUTRAL] [PII] and the area code is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] And what is the claim number?
[CUSTOMER][NEUTRAL] Uh, the claim number is 361.
[CUSTOMER][NEUTRAL] 0133.
[AGENT][POSITIVE] OK, thank you, give me one moment please.
[AGENT][NEUTRAL] Uh let's see.
[AGENT][NEUTRAL] It looks like they're requesting the itemized bill showing diagnosis and procedure codes. Well, uh, itemized bill showing the procedure or the diagnosis codes.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Well, that's where I was a little confused because the bill that I had sent.
[CUSTOMER][NEUTRAL] For the X-ray has the code on it.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Which was from the hospital because they do the X-rays for um.
[CUSTOMER][NEUTRAL] The orthopedic surgeon.
[CUSTOMER][NEGATIVE] And then I didn't get a bill from the doctor. All I got was all I have is the what was submitted to my insurance.
[CUSTOMER][NEUTRAL] Buy them. I haven't gotten anything back from the actual like an actual invoice and that particular piece of docu does have the codes on it as well so I was a little confused. I wasn't sure what.
[CUSTOMER][NEUTRAL] I mean I did print out my um.
[CUSTOMER][NEUTRAL] I got into my portal and printed out the visit.
[CUSTOMER][NEUTRAL] Is that something that would be helpful?
[AGENT][NEUTRAL] Um, looking at the information we received and it's a balance forward statement and it does not have the diagnosis codes on this information.
[AGENT][NEUTRAL] Uh, the diagnosis codes will show the reason, the reason for the visit. Like it would show the diagnosis has been for an accident.
[AGENT][NEGATIVE] It does not show that on this information we received that's why they're requesting itemized bill with the diagnosis codes.
[CUSTOMER][NEUTRAL] OK, so, alright, so like the bill that I sent, it just says DX X-ray 032 that's not.
[CUSTOMER][NEUTRAL] That's not like I don't know what else to get from the from the hospital that would show.
[CUSTOMER][NEUTRAL] I mean it's an X-ray so I don't know.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And then the other thing was says office outpatient visit and the code was 99203 and then the knee X-ray was 73564 which as I'm assuming is the doctor to read it.
[AGENT][NEUTRAL] Those are procedure codes. They're just stating that there was an office visit and then that there was an X-ray of, of the knee.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But there's no diagnosis codes on it. Um, you can request.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Like um
[AGENT][NEUTRAL] And this was at a doctor's office?
[CUSTOMER][NEUTRAL] I had, yes, um.
[CUSTOMER][NEUTRAL] I went to the orthopedic for them to because I didn't know what happened. I didn't, I wasn't sure if I had torn something so.
[AGENT][NEUTRAL] Mm. Mhm.
[CUSTOMER][NEUTRAL] Yeah, that I went to the doctor, the orthopedic doctor, he had an X-ray done.
[AGENT][NEUTRAL] OK, uh, you can request from their office, um.
[AGENT][NEUTRAL] Medical notes or um
[CUSTOMER][NEUTRAL] Well, I did pull up my medical notes so if I pull like obviously a lot of the stuff will have to be redacted because it's obviously a lot of like.
[CUSTOMER][NEUTRAL] You know your a lot of your history so what on this is the best thing to.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like it says chief complaint like fell and the date.
[CUSTOMER][NEUTRAL] Left knee injured, pain, da da da with ambulation, some swelling, and then the review of symptoms, yes, the date that I fell and it also has, and it also has the date of the visit.
[AGENT][NEUTRAL] And it shows the date?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, yes, yes, ma'am, you can submit that into us.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, um, and then it says diagnos diagnostic results.
[CUSTOMER][NEUTRAL] X-ray completed left knee series comparison clinical indication and assessment plan is that all?
[AGENT][NEUTRAL] You can submit that into us for review. Yes, ma'am. If it's showing the date of the injury and then the date you went to the provider and then give the diagnosis, then yes, you can submit that to us for review.
[CUSTOMER][POSITIVE] Good stuff.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and then still also try to get some kind of diagnostic codes?
[AGENT][NEUTRAL] No, ma'am. Uh, what you have, it sounds like it has a diagnosis description, at least, so we can use that. So, yes, ma'am, you can use that, submit to us.
[CUSTOMER][POSITIVE] Nope, this this should be good.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I just wasn't sure when you said about a code. I was like, I don't see any other codes, so, OK, I will go ahead and redact all this other, um, HIPA stuff that you guys don't need. So alright, I just wanted to clarify.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, Ms. [PII], is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Nope, I can just attach the explanation I can just resend the all this stuff back with this attached.
[CUSTOMER][NEUTRAL] And I should be OK, right? Is that OK?
[AGENT][NEUTRAL] Yes, that's fine.
[CUSTOMER][POSITIVE] OK all right thank you.
[AGENT][POSITIVE] Uh, yes, ma'am. Thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] All right thank you you too bye bye.
[AGENT][NEUTRAL] Bye.