AccountId: 011433970860
ContactId: 3f24db4e-c7ea-4d0f-b96f-20be0f3f6a62
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 744619 ms
Total Talk Time (AGENT): 192797 ms
Total Talk Time (CUSTOMER): 266075 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=-1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/3f24db4e-c7ea-4d0f-b96f-20be0f3f6a62_20250402T20:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Ameribank Group Benefits, or American Bank of Oklahoma broker's office on behalf of one of um our groups, specifically a client claim.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just tell me where best to start.
[AGENT][NEUTRAL] Um, do we have the claim number or the policy number for the client? OK.
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] I have a claim number 358-025-5.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Members's number or member's name [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And then for, if you could just verify her date of birth on here.
[CUSTOMER][NEUTRAL] Yes, um, [PII].
[AGENT][NEUTRAL] OK. Right.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEGATIVE] I see the claim. It looks like it was denied stating no diagnosis code provided.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Looks like we got the claim, but in order to provide further consideration.
[AGENT][NEUTRAL] Um, we need supporting documentation to the evidence of the accident or sickness. Supporting documentation can include but not limited to an itemized bill with the diagnosis codes, super bills, or um hospital admission or discharge summaries.
[CUSTOMER][NEUTRAL] So I put the diagnos diagnostic codes that she gave me up at the top.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Of the
[CUSTOMER][NEUTRAL] Because she asked for a rebill, so two things happened.
[CUSTOMER][NEUTRAL] Um, Saint [PII]'s build insurance twice.
[CUSTOMER][NEUTRAL] Um, it was like a double bill.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it was.
[CUSTOMER][NEGATIVE] It was really weird and they were only off by like $100 and insurance denied one because it was a double bill.
[CUSTOMER][NEUTRAL] And so she had she called [PII]'s and asked for like a correct second bill to be sent to her like the one that insurance paid that matched the EOB so the one that I uploaded because that's why it looks weirder because it does, it just doesn't look like your normal.
[AGENT][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] Like statement but it says mail payments to Ascension [PII] and um that's what they mailed to her anyway I just typed out the diagnostic codes at the top that she those are what they gave her.
[AGENT][NEUTRAL] Oh OK
[AGENT][NEUTRAL] Let me see who processed this claim.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I see the 3 diagnostic codes up there at the top that you typed up.
[AGENT][NEUTRAL] Um, let me reach out to claims and see if um I need to send this back to the examiner themselves or if they can just put it in for resubmission. Do you mind holding the line?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and that's why I always, no, no, I don't mind and this is why I follow up just to make sure that who I mean we just go with what the the employee gives us and I just make sure that you guys get everything that you need from them so whether it's the right information.
[AGENT][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, yeah, no, absolutely. Let me double check on this one. OK, great. One moment. Uh-huh.
[CUSTOMER][NEUTRAL] Yep
[CUSTOMER][NEUTRAL] Yeah, I'll hold.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] I don't understand
[AGENT][NEUTRAL] Diagnostic and diagnosis, I guess are different.
[AGENT][NEUTRAL] Oh Lord have [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much for waiting on that. I appreciate your patience. Um, so when I reached out to them, they said that those are actually procedure codes.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So for like things done and they're saying not diagnosis codes.
[CUSTOMER][NEUTRAL] OK, mhm.
[CUSTOMER][NEUTRAL] And see when yeah and see I was wondering because so when we tell them to ask they don't always get what.
[CUSTOMER][NEUTRAL] When they ask if you know an office or something I don't think they always understand what they're.
[AGENT][NEUTRAL] Sending
[CUSTOMER][NEUTRAL] They're to get yes and and then even when they ask for them, the people giving them to them.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Don't always provide them with exactly what they're supposed to get.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Yeah and it's really frustrating that they won't take so many providers won't take the card I think that they're just lazy.
[AGENT][NEUTRAL] Oh, yeah, I mean, if they would.
[CUSTOMER][NEGATIVE] Oh, so so many, so many just are like, no, we, I, it's ridiculous no we don't file that.
[AGENT][POSITIVE] Oh my gosh.
[AGENT][POSITIVE] Oh my, cause see, I tell people all the time, I'm like, honestly, the easiest thing is if your provider will do it for you, you know.
[CUSTOMER][POSITIVE] Oh, wouldn't that be nice? But no. And so again, I, after I file, I like, yes, because I'm like, I'm gonna see if this, everything is good because it's always, yeah.
[AGENT][NEUTRAL] I know, right? Oh my.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, so, yeah, not diagnos diagnostic codes.
[AGENT][NEUTRAL] Man.
[AGENT][NEUTRAL] Yeah. So they just need the diagnosis code and not, um, so what, yeah, what she was being seen for, not the procedures done. Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The Percy.
[CUSTOMER][NEUTRAL] Yeah, and I asked her, right, yep. OK, thank you. That's and I will. So what's the best way just on another piece of paper like upload and just say these are the procedure or the diagnosis codes, correct diagnosis codes, and will that show up?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, and yeah, and then just if you want, you can reference the claim number. Do you have the claim number or I can give it to you?
[CUSTOMER][NEUTRAL] It's, it's, it's on the in the portal when I, when I look in the portal, it pulls up that's where I got it and gave it to you with your confirmation number and it shows processed, but I've, I've learned that that doesn't mean that it's processed in a checks. It just means it's been viewed so yeah but.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] They, yeah, and they did say that I guess, you know, there's this UB 04 form that if you can get that from them, that's generally the easiest.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] It's, it's called a what?
[AGENT][NEUTRAL] Uh UB
[AGENT][NEUTRAL] 04.
[CUSTOMER][NEUTRAL] UB 04 form? OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] OK, well, we'll see. I mean again some of these offices, yeah, and this girl, she called me this morning and told me that [PII]'s already they sent her another bill for 50,000 like 50,000, where are they getting these numbers? They already like I like just call them back and go, look, you already double billed my insurance with the wrong amount and I had to ask you for the right bill so no.
[AGENT][NEUTRAL] All right, girl, yeah.
[AGENT][NEUTRAL] That's when I just tell him in this economy, get in line, buddy.
[CUSTOMER][NEUTRAL] So, OK.
[CUSTOMER][NEGATIVE] Right? Just, just no.
[CUSTOMER][NEUTRAL] Like, yeah.
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] I max I owe you is 2500. That's yeah, so end of, end of story, fools. So OK, we'll get this, we'll get the right thing uploaded. Thank you for your help. I appreciate it. Have a good rest of your day bye bye.
[AGENT][NEUTRAL] Right, right.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] You're welcome. Yeah, no worries. You too. Bye.