AccountId: 011433970860
ContactId: 3f4cb061-b0a4-4a61-9c71-dbc50969bacc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 643989 ms
Total Talk Time (AGENT): 242095 ms
Total Talk Time (CUSTOMER): 125120 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/3f4cb061-b0a4-4a61-9c71-dbc50969bacc_20250210T20:01_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], I'm calling to check on a claim. They said it was complete, but I can't get into the, to see what went on with it.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what's your name, ma'am? I can help you.
[CUSTOMER][NEUTRAL] And I
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK, do you have your policy number, [PII]?
[CUSTOMER][NEUTRAL] No, I don't.
[AGENT][NEUTRAL] OK, what state do you live in?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I can search it by your name. Let's see.
[AGENT][NEUTRAL] [PII] [PII] and then [PII] [PII] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] What I it? [PII]
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK. [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Oh, SIA OK, so is it [PII] or [PII]?
[CUSTOMER][NEUTRAL] Either one, I say both.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] But how do you pronounce it?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, [PII], thank you. I wanna pronounce it the right way.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] They, they murder it so sometimes uh.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] I just said OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I know, and what type of policy do you have?
[CUSTOMER][NEUTRAL] I claimed the policy from my incident, uh, accident that happened, uh.
[AGENT][NEUTRAL] Accident, OK.
[CUSTOMER][NEUTRAL] Last year.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Were you trying to go online to check the status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What happened when you went online?
[CUSTOMER][NEGATIVE] It wouldn't download the file. The date I couldn't get into it it has the [PII] and it wouldn't bring up anything.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me one moment to pull up your information.
[AGENT][NEUTRAL] And what is your date of birth and your mailing address?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mailing address is [PII].
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And are you, were you the policy holder on this policy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And is it an accident policy or a meddling policy?
[CUSTOMER][NEUTRAL] It was an accident that I was in.
[AGENT][NEUTRAL] OK, but you do not have an accident policy. I'm trying to figure out which policy it's under.
[CUSTOMER][NEUTRAL] I think some pops up mid link or something.
[AGENT][NEUTRAL] OK, that's the name, OK.
[AGENT][NEUTRAL] And do you have a claim number?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] If not, if you, if you have the data service I can search it by that as well.
[CUSTOMER][NEUTRAL] Hold on, let me see.
[CUSTOMER][NEUTRAL] It was 5524.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected I can call you back?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] So so what's your email address on file?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you. So we have.
[AGENT][NEUTRAL] So this one is from [PII].
[AGENT][NEUTRAL] This was processed on [PII].
[AGENT][NEUTRAL] And it says.
[AGENT][NEUTRAL] Please provide a diagnosis code for this state of service. This information may be obtained from your physician.
[AGENT][NEUTRAL] So we're needing additional information to complete the processing of this claim.
[CUSTOMER][NEUTRAL] I said, I'll check that in.
[AGENT][NEUTRAL] You send it in with the original information?
[CUSTOMER][NEUTRAL] No, I'll send that in later.
[CUSTOMER][NEUTRAL] I took a photo of it and send it in.
[AGENT][NEUTRAL] When did you send it?
[AGENT][NEUTRAL] In January.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Sometime in January.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me look.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Could have been January, uh, probably was January, yeah.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, I see the claim detail, but I don't see a diagnosis code on this document.
[CUSTOMER][NEUTRAL] OK, so.
[AGENT][NEUTRAL] You know, it has like processing codes, but that's not the diagnosis code, um.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Is this from a Doctor [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, um, I can give you the form name to request.
[AGENT][NEUTRAL] Um, from this doctor.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now this looks like your primary EOB that I'm looking at. It's an acronym. Let me know when you're ready.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK, so it's U as in university.
[AGENT][NEUTRAL] B as in boy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 04, so you're gonna request the.
[AGENT][NEUTRAL] I'm sorry, I gave you the wrong form. This looks like the, is this the emergency room physician's fee?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Let me give you the form. I gave you the wrong one. That's for the hospital. For the physician, it's C as in Charlie.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Elm [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] S Sam
[AGENT][NEUTRAL] One
[AGENT][NEUTRAL] 500.
[AGENT][NEUTRAL] So you're gonna request the CMS 1500 form and that's an itemized bill.
[AGENT][NEUTRAL] Um, for the ER physician's office. Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] And what you uploaded is, is it looks a little fudgy.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Let me try to enlarge it.
[AGENT][NEGATIVE] Uh, the date of service is very fudgy.
[AGENT][NEUTRAL] Can't make out what the
[CUSTOMER][NEGATIVE] It's sad that.
[AGENT][NEUTRAL] Yeah, you can't make out what it is though on the document that may be an issue when they go to review it.
[AGENT][NEUTRAL] Uh, I can, I can't see the total charges, but we may have received that before because they, they didn't request it. They just request the diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look and see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 54
[AGENT][NEUTRAL] Yeah, so we need a copy of the itemized bill. We do need this [PII]B um, can you take a, a clearer picture of it again with your phone, um, because I can't, um.
[AGENT][NEGATIVE] I can't it's fudgy. It's smear looking the date of services.
[CUSTOMER][NEUTRAL] OK, then. I will.
[AGENT][NEUTRAL] And let's see.
[CUSTOMER][NEGATIVE] I'll get my son and she can't even send a clear picture cause I done that, so.
[AGENT][POSITIVE] OK. OK. All [PII]. Anything else we can help out with today?
[CUSTOMER][NEUTRAL] So that's all I need is the CMS 1500.
[CUSTOMER][NEUTRAL] ER, uh, physician phone.
[AGENT][NEUTRAL] Which is
[AGENT][NEUTRAL] Which is the itemized bill and then a clear picture of the.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, explanation of benefits from your primary.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Which you've already said it just needs to be a better picture of it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] All right. Any other questions I can help out with [PII]?
[CUSTOMER][POSITIVE] No, that'll be all. Thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.