AccountId: 011433970860
ContactId: 3808346d-1c7a-4bbd-a57a-87b55489bdb3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 237570 ms
Total Talk Time (AGENT): 87637 ms
Total Talk Time (CUSTOMER): 123675 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/3808346d-1c7a-4bbd-a57a-87b55489bdb3_20250228T13:37_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh, hello, [PII], it's [PII]. Good morning.
[AGENT][POSITIVE] Good morning.
[CUSTOMER][POSITIVE] Happy Friday.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Well, I have an insured on the line and I've gone over her claim. I've told her about the appeals process, but.
[CUSTOMER][NEUTRAL] OK, first off, the policy number, [PII], I get ahead of myself, it's 021-844-73.
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it's on the most recent claim that was processed on yesterday, 356-927-4.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Went over the remarks. She says that what she has was an upper GI series. Now all I can see is, you know, is a diagnostic. I read her the full description.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On the remark
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] But I can't see what that is. I did tell, OK, and I did tell her about the appeals process, and I just wanna clarify one thing, [PII], since I have you on the line, appeals can be faxed and uploaded as well as long as they're clearly marked to attention appeals department.
[AGENT][NEUTRAL] What we got here.
[AGENT][POSITIVE] Yeah, they can. Yeah.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So I've given her that information but I could see her diagnosis, OK, but as far as the procedure, so she's just wanting.
[AGENT][NEUTRAL] So it looks like she had a colonoscopy. Let's see if it's the same. This is.
[CUSTOMER][NEUTRAL] That was, she said that. Mhm. She said she did have that as well, but she said she had 2, so she said.
[AGENT][NEUTRAL] Colonoscopy.
[AGENT][NEUTRAL] Let me see what else we got here.
[AGENT][NEUTRAL] It's a little blur, but let me see where.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] My eyesight so bad if it was blurred, I wouldn't be able to read it. I can barely read it when it's super crisp.
[AGENT][NEUTRAL] And on this other page this other one is just talking about, OK, she has.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, she, let's see here. OK, I do see the upper GL let me.
[AGENT][NEUTRAL] Take a look here.
[CUSTOMER][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEUTRAL] And she is fully verified too, so.
[AGENT][NEUTRAL] So the, under the diagnostic, it does cover for uh upper GI so we'll have to send a request to have this. I wonder where, let me see where she got the CPT codes from. Let me take a look.
[AGENT][NEUTRAL] To make sure where where this was listed on the document.
[AGENT][NEUTRAL] Cause right now I'm not seeing them.
[AGENT][NEGATIVE] Oh wait, hold on. I'm looking at something else, wrong screen.
[AGENT][NEUTRAL] I clicked off clicked on the wrong screen. Can you give me that? Oh, that my, I got the policy number. I clicked on clicked on my other screen.
[CUSTOMER][NEUTRAL] You wanna get it, OK.
[AGENT][NEUTRAL] Here we go.
[AGENT][NEUTRAL] Yeah, there is a benefit for an upper GI. So we'll just have to send a request on this claim to get it reprocessed, but I do see that she did also have an upper GI.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEUTRAL] She had a colonoscopy in the upper GI was performed.
[CUSTOMER][NEUTRAL] Right, and uh she understands that the colonoscopy, like I said, I read through all that. So are you gonna send that then? I mean, I can just tell her that. Are you gonna send the request or do you want to speak to her and let her know?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I can get with the examiner to reprocess the claim.
[CUSTOMER][NEUTRAL] It doesn't
[CUSTOMER][NEUTRAL] OK, well I'll just let her know that that's what we're gonna do.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yup.
[CUSTOMER][POSITIVE] OK. All right. Well, you are the best. Thank you so much. I will be happy to relay that information instead of transferring it to you, OK?
[AGENT][NEUTRAL] I can do that. Mhm.
[AGENT][POSITIVE] All right, that works.
[CUSTOMER][POSITIVE] OK. Thanks, [PII].
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK, bye bye.
[AGENT][NEUTRAL] Right.