AccountId: 011433970860
ContactId: 3e59a435-2316-40fc-a085-4c292d2dbd3d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 481750 ms
Total Talk Time (AGENT): 175049 ms
Total Talk Time (CUSTOMER): 228646 ms
Interruptions: 11
Overall Sentiment: AGENT=1.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/3e59a435-2316-40fc-a085-4c292d2dbd3d_20250530T17:01_UTC.wav
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[CUSTOMER][NEUTRAL] the low on her nose.
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I was calling because I was trying to pull up. I got a notification that my, um, a claim that I submitted was complete, but I'm unable to pull it up to see the reason why it wasn't paid out 678382-2298.
[AGENT][NEUTRAL] OK, um, I can take a look at the claim for you. And Mr. [PII], may I have a good contact number in case we're disconnected?
[AGENT][POSITIVE] Thank you for that. And the policy number?
[CUSTOMER][NEUTRAL] Uh, one second, let me try to, I got you on the phone.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] [PII], talk about how.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um, the policy number is, hold on.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 206 no.
[CUSTOMER][NEUTRAL] 205.
[CUSTOMER][NEUTRAL] 4422. I'm trying to look at it and still talk on my cell phone. I don't have my earpiece. I'm sorry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] Take a toll.
[AGENT][NEUTRAL] And can you verify your date of birth and the mailing address on file?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you, and your email address?
[AGENT][NEUTRAL] Thank you, and all the information provided is a verification of benefits, not a guarantee of payment. And hold on one moment, let me take a look at the claim here.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so we just need to, so it was denied, but it was denied needing additional information. So we need the diagnosis. Um, so,
[CUSTOMER][NEUTRAL] on
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It could either be from an itemized bill with the diagnosis code, it could be an office note. Um, did you go, like, was this a doctor's office or like did you go to the hospital?
[CUSTOMER][NEUTRAL] Hi there.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Man
[CUSTOMER][NEUTRAL] I did. They didn't, but the diagnostic code was on the EOB portion that I sent.
[AGENT][NEUTRAL] OK, hold on one second.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold so I can pull up the documents?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] There's no diagnosis code on here.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh, there's no diagnosis code on here.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, thank you so much for holding. I apologize for that wait. So, so we received two documents. We received an a bill, your patient bill, and then we received this could be a portion of the explanation of benefits, but either way, there's no diagnosis code on here. There's, there's really no coding on here except for a reason code, um, but that just tells like an explanation of
[CUSTOMER][NEUTRAL] I found it.
[CUSTOMER][NEUTRAL] Mhm. I don't.
[CUSTOMER][NEUTRAL] A certain
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] I'm going to the houses.
[AGENT][NEUTRAL] What they're saying is being paid.
[AGENT][NEUTRAL] So, we would need either an itemized bill from the doctor's office or wherever you went. Um, it could be office notes if you were um discharged or, you know, at the hospital, the discharge or the admission papers, just something showing why you were there.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I have, um, actually because I had to get it for another insurance company. I have my entire medical record, uh, in a PDF. Would that be sufficient?
[CUSTOMER][NEUTRAL] From the entire process or you're needing that would be too much? I don't.
[AGENT][NEUTRAL] Yeah, that's too much. We just need for [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Because it shows that you got anesthesia, but why did you get the anesthesia? We have to prove medical necessity.
[CUSTOMER][NEUTRAL] Uh, so, uh, uh, OK, so it could be run it down to me again. I'm gonna try to, um, hold on one second, let me try to take notes while I got you hold on.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, hello?
[AGENT][NEUTRAL] Yes, ma'am, I'm here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, so I'm able to type now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you're gonna need of a discharge.
[CUSTOMER][NEUTRAL] Summary or OK, go ahead.
[AGENT][NEUTRAL] Yeah, like was this, um, so this was like a, a surgery in a hospital or was it like a
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so your um discharge papers?
[CUSTOMER][NEUTRAL] A surgery center, so we got a hospital.
[AGENT][NEUTRAL] Um, should show like, you know, when you, that will probably show the admission date, time, all of that, um, and when you discharged and went home.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I don't want to.
[CUSTOMER][NEUTRAL] I think I pay on I I can call somebody talk about me for one.
[AGENT][NEUTRAL] Um, it could be office notes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] I'm going.
[AGENT][NEUTRAL] And um it could be the itemized, hold on.
[CUSTOMER][POSITIVE] I'm probably that I won.
[AGENT][NEUTRAL] Like a super bill if you um have them from your major insurance.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and, and, but the main thing you're looking for off of this is the, the reasoning, the code.
[AGENT][NEUTRAL] Right, they're looking for the diagnosis code.
[CUSTOMER][NEUTRAL] OK, alright, I will work on that, um, and try to, and I will upload it the same back in the portal, correct?
[AGENT][NEUTRAL] Mhm. You can upload it on the portal and as soon as you upload it, um, you'll get the confirmation number and then it will um come to us for processing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, alright, thank you so very much.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] So it's like
[CUSTOMER][NEUTRAL] That was it.
[AGENT][POSITIVE] Alright, well, thanks for calling APL. Have a great weekend.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Thank you. You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Mm OK bye bye.
[CUSTOMER][NEUTRAL] Yeah