AccountId: 011433970860
ContactId: 3c0aa54c-93b1-47f1-9335-7a9582f8fa7b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 490920 ms
Total Talk Time (AGENT): 232929 ms
Total Talk Time (CUSTOMER): 153527 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/3c0aa54c-93b1-47f1-9335-7a9582f8fa7b_20250519T22:11_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yeah, I submitted a claim not that long ago that I'm trying to figure out.
[CUSTOMER][NEUTRAL] Um, what I need to do, because I'm not sure that.
[CUSTOMER][NEUTRAL] Either I understand exactly what is needed or what, but I had an emergency room visit that I was transported by ambulance.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 2,
[CUSTOMER][NEGATIVE] And I got something back saying that it needed more of something and I'm confused.
[AGENT][NEUTRAL] Oh, I see. OK, so the client did complete processing and we just needed additional information, is that right?
[CUSTOMER][NEUTRAL] Yeah, but I, I'm not clear on what information.
[AGENT][POSITIVE] Sure, OK, yeah we can definitely get that pulled up and take a look um what was your name? I'm sorry.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Then [PII], can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then do you have your policy number?
[CUSTOMER][NEUTRAL] Um, yeah, it's 244-0123.
[AGENT][NEUTRAL] OK, one moment please.
[AGENT][NEUTRAL] OK, I'm just gonna verify some information really quick. Uh, [PII], can I get your date of birth please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then do you uh can I get your mailing address please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Perfect. Last thing I need is the email address that we've got on file for you uh it looks like it might be through your employer.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][POSITIVE] OK, thank you so much for verifying all of that. All right, do you have that uh claim number, [PII], that we're looking at?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, uh yes.
[CUSTOMER][NEUTRAL] So I don't know why it has 2.
[CUSTOMER][NEUTRAL] From that date
[CUSTOMER][NEUTRAL] I'll give you, I think the one. And every time I put, I don't know why this happened when I put one in previously, but always does one under the cancer one also, and I don't know why it does that, but of course that one is getting.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] Denied because that's not what I'm actually trying to clean.
[AGENT][POSITIVE] That is odd yeah no worries.
[CUSTOMER][NEUTRAL] Um, I think it's 359.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 4725
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] I said there's 2 for that date.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Sure, OK.
[CUSTOMER][NEUTRAL] Not sure why.
[AGENT][NEUTRAL] Alright, one moment.
[AGENT][NEUTRAL] OK, so it does look like we are needing first off uh we're needing um an itemized statement that shows uh diagnosis codes so you can simply if this was an ER visit you said?
[CUSTOMER][NEUTRAL] Yeah, and I thought that's what I uploaded. Is that not what I sent?
[AGENT][NEUTRAL] No, so sometimes um this is the information you have to specifically ask for um it depends on the provider uh but most of the time that's not information they would just give you without asking for it they would just kind of give you just the actual bill itself um they also have.
[CUSTOMER][NEUTRAL] Yeah, I asked for an item like still.
[AGENT][NEUTRAL] Yeah, the itemized statement that shows those diagnosis codes specifically though, um, for this kind of policy that's something that we would definitely need um along with uh hospital admission and discharge uh summaries or if there were any diagnostic testing results, things like that um and if the provider has any questions they're more than welcome to give us a call as well and we can kind of explain.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Um, what you need and if you tell them that it's for an insurance claim, uh, they would know what to give you.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] You need the diag the itemized with the diagnosis codes.
[CUSTOMER][NEUTRAL] Um, either or that with the discharging summary?
[AGENT][NEUTRAL] I would say that
[CUSTOMER][NEUTRAL] Do you need both?
[AGENT][NEUTRAL] I would say both um well this is stating specifically it does say that we just need further uh supporting documentation to evidence the accident or what happened and treatment received. So it states documents may include but not limited to.
[AGENT][NEUTRAL] Then my statement with the diagnosis codes, um, hospital admission and discharge summaries and or diagnostic testing results most of the time again it really all the providers are different, but it could all be on, you know, one form that they give you, um, especially the.
[CUSTOMER][NEUTRAL] Yeah, can you, can you see the document I uploaded?
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Um, I cannot, but if you would like, I can transfer you to a claims specialist so they can go over what was submitted.
[CUSTOMER][NEUTRAL] Cause I did send something, it does have the codes.
[AGENT][NEUTRAL] OK, yeah, if you don't mind.
[CUSTOMER][NEUTRAL] Like at the individual codes for.
[AGENT][NEUTRAL] Sure, if you don't because I kind of just see surface level, um, but if you don't mind I can put you on a brief hold and reach out to our claim specialist regarding this.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Um, that'd be great, thanks.
[AGENT][NEUTRAL] OK sure alright give me just a moment I'm just gonna put you on a hold. I'll get right back with you OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Alright thanks one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] I know agent staff. Goodbye.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] No.
[AGENT][POSITIVE] Alright, well, Ms. [PII], I'm so sorry about that. Are you still with me?
[CUSTOMER][NEUTRAL] I am.
[AGENT][NEUTRAL] It looks like they might have all left for the day so we have um a couple different options um you can call back tomorrow or I can try to arrange uh a call back for you regarding this so that we can because that's not a bad idea just to double check what was submitted.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Yeah, can you, um, real quick, can you tell me what it's because I requested an itemized statement.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And it says it it's an itemization of services and it has like the REV code and the HCPCS codes.
[CUSTOMER][NEUTRAL] Is there something else I need to call it?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It I would diagnosis code's probably going to be the easiest thing to say um but I I would go ahead and in the meantime um because we wouldn't be able to obviously there's nobody here at the moment so in the meantime if you're able to go ahead and request that information from your provider and then again you can either call back tomorrow or I can try to arrange a call back for you so that we can review what was submitted.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, I can try and call back tomorrow. I'm not sure what my schedule is tomorrow.
[AGENT][POSITIVE] OK, no worries. All right, yeah, that's usually that's how I am too, or I'm like I will when I can.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, well I'm sorry there wasn't more I could do for you at the moment. Do you have any other questions for me right now?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, nope, that's all, thank you.
[AGENT][POSITIVE] Oh of course thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you bye bye.