AccountId: 011433970860
ContactId: 3a8c2e0f-79bf-4a85-bae6-c92d8a941588
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 676429 ms
Total Talk Time (AGENT): 168760 ms
Total Talk Time (CUSTOMER): 249262 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/3a8c2e0f-79bf-4a85-bae6-c92d8a941588_20250411T17:00_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, yes, good morning. Um, I wanted, or afternoon, I'm sorry, I wanted to know if you can help me and just know the status on the claim I submitted.
[AGENT][POSITIVE] Sure, I can assist you with that.
[AGENT][NEUTRAL] Can I have a good callback number for you and that policy number?
[CUSTOMER][NEUTRAL] [PII] policy number 2173202.
[AGENT][NEUTRAL] Are you the provider or the insurer?
[CUSTOMER][NEUTRAL] Insured.
[AGENT][NEUTRAL] Can I have your name, mailing address, and your date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] And what else did you ask me I'm sorry.
[AGENT][NEUTRAL] What was your um date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and give me that mailing address one more time because I didn't get the full address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the email address that we have on file and I'll be able, we don't, we don't have one, so you don't have to verify that. Would you like for us to add one on file for you?
[CUSTOMER][NEUTRAL] Yeah, that'll be fine.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] What's the email address?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you're calling about a claim. What, when did you submit that claim? or do you have the date of service?
[CUSTOMER][NEUTRAL] Uh, yeah, um, I have the confirmation number, but it was submitted on the, I think it was on the [PII].
[AGENT][POSITIVE] Do you have a data service or what would the claim for? Yes please, that'd be very helpful.
[CUSTOMER][NEUTRAL] Do you need the claim number?
[CUSTOMER][NEUTRAL] OK, the claim number I think it's 358-818-1.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] For your doable medical equipment.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] So it looks like
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The doable, so what was the equipment that you were you that you have that you submitted a claim for?
[CUSTOMER][NEUTRAL] It wasn't, it was, I'm sorry?
[AGENT][NEUTRAL] What was the equipment like? Was it something that you can use and throw away?
[CUSTOMER][NEUTRAL] Yes, it's a no, it's a pump, uh, insulin pump.
[AGENT][NEUTRAL] Because we don't cover disposable equipment.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEGATIVE] It's not a disposable. It's an insulin pump.
[AGENT][NEUTRAL] And you use it once or multiple times?
[CUSTOMER][NEUTRAL] It's something that you put
[CUSTOMER][NEUTRAL] No, no, multiple times. No, you put it multiple times. I mean, you have to be using it and you have to be um injecting the insulin there. And what it is, it's a monitor that it, it, instead of me injecting all the time, that one is, is telling when my body and it's connected to my phone and, or the monitor, and it's letting me, my body know when the, when my insulin is low or when it's high, and it's dropping the insulin into my body immediately when I need it.
[CUSTOMER][NEGATIVE] So it's something that needs to be there, but no, it's not something that it's um disposable, no, no, not at all.
[CUSTOMER][NEGATIVE] And as a matter of fact, I need to be ordering new, um, just materials, it's just like an insulin. I have to be ordering insulin to be putting it in there every month, just like it is, instead of injecting, it's in your stomach.
[AGENT][NEUTRAL] OK, give me your policy number one more time because I deleted it went out of it.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] 335881881
[AGENT][NEUTRAL] That's your policy number or the claim number?
[CUSTOMER][NEUTRAL] Oh, that's the claim number, the policy number, I'm sorry, it will be 2173202.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I place you on a brief hold?
[CUSTOMER][NEUTRAL] Yes, ma'am, please.
[AGENT][POSITIVE] Thank you. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding. So hello, thank you for holding. I apologize for the inconvenience. So it looks like we're requesting the itemized bill in your.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] We're requesting an itemized bill.
[AGENT][NEUTRAL] And your diagnosis codes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Are you able to reach out to the to the facility to retrieve that?
[CUSTOMER][NEUTRAL] Yeah, I mean.
[CUSTOMER][NEGATIVE] I did. I mean, I, I, I mean, if you, all I, I've been getting, what I got from them and that what they sent to me was, I don't know if you can see in my file, was what they told me that they billed to the insurance and it's that claim and I sent it on that claim that I sent and I don't know if that is the procedure code or the service, I mean, that they even sent me in the email that it stated that that's what they got.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] I don't know if you can see it there.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] I, I, I sent two things that that's what they, they sent me. And they even sent me what they billed the insurance. That was the claim they sent to them.
[AGENT][NEUTRAL] Mhm, but we still need the diagnosis codes, like we need.
[AGENT][NEUTRAL] The diagnosis codes for the reason that you have, you need this.
[AGENT][NEUTRAL] This um medical equipment. The diagnosis code is the ICD 10 code.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Cause that's not listed on your paperwork that you sent us. I ICD 10 and the diagnosis code.
[CUSTOMER][NEUTRAL] I C D T
[CUSTOMER][NEUTRAL] And I keep telling them that, but I guess that, and then they even send me the certificate of medical necessity, that that's what the doctor submitted.
[CUSTOMER][NEUTRAL] The reason why I needed it.
[AGENT][NEUTRAL] And so,
[AGENT][NEUTRAL] So the doctor, so I don't see anything with your diagnosis codes and that's what they're requesting from you in order for us to process the claim.
[CUSTOMER][NEUTRAL] I see the, how, what number does it start with? or, so I can let them know, I mean, cause they've been like.
[AGENT][NEUTRAL] We start with letters and then end with numbers. Start with, it starts with letters like your diagnosis code, just ask them for a diagnosis code.
[CUSTOMER][NEUTRAL] Diagnosis called.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So this is the 2nd time.
[CUSTOMER][NEUTRAL] It starts with the letters cause, yeah, I don't see anything. The letters I see there are only in A 4224. I don't think, is that not it?
[AGENT][NEUTRAL] Those are the procedure codes. No, those are the procedure codes.
[CUSTOMER][POSITIVE] Oh, OK, yeah, that's what the procedure code, you're right.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] So we need something with the diagnosis codes.
[CUSTOMER][NEUTRAL] OK, let me try to reach out to them and see if they can give me something with diagnosis code.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And let me just ask you, um.
[AGENT][NEUTRAL] You call them on a conference call if you would like and I can tell them that we need the diagnosis codes. What do you need documentation with your diagnosis codes listed on there.
[CUSTOMER][NEGATIVE] Yeah, oh, but they're gonna take long for you, trust me, they keep me like at 30, 40 minutes, wait. I don't wanna keep you on that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, cause they do that to me.
[CUSTOMER][NEUTRAL] Let me just try one more time. If not, I will try to.
[AGENT][NEUTRAL] Oh, once
[AGENT][NEUTRAL] Go ahead, what were you about to say?
[CUSTOMER][NEUTRAL] Um, let me
[CUSTOMER][NEUTRAL] Oh, and when I say resubmit the claim, I have to resubmit with everything again, right?
[AGENT][NEUTRAL] No, ma'am. No, just the information with the diagnosis code, yes.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, OK, I will do that. And then I, I just upload it, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let me try and call back then. Diagnosis code you said right?
[AGENT][POSITIVE] Is there anything else that I can assist you with today? Yes.
[CUSTOMER][NEUTRAL] No, ma'am, let me go ahead and do that.
[AGENT][POSITIVE] Thanks for calling ACL and have a great day.
[CUSTOMER][POSITIVE] Thank you very much.
[AGENT][POSITIVE] You're welcome. Goodbye.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] Bye-bye.