AccountId: 011433970860
ContactId: 4357a077-b6c2-4828-8ff9-b00512811ca6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 571830 ms
Total Talk Time (AGENT): 197264 ms
Total Talk Time (CUSTOMER): 176729 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/4357a077-b6c2-4828-8ff9-b00512811ca6_20250514T20:14_UTC.wav
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[AGENT][POSITIVE] Good afternoon.
[AGENT][NEUTRAL] can I help you?
[CUSTOMER][NEUTRAL] Yes, hello?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes, I'm calling um because I submitted a claim.
[CUSTOMER][NEUTRAL] Um, but I know that when you submit a claim, you, you're supposed to have like, what, what are the two things? The itemized bill.
[AGENT][NEUTRAL] Um, itemized bill that has the diagnosis code and procedure codes on it along with the explanation of benefits from the primary insurance provider. What is your policy number, please?
[CUSTOMER][NEUTRAL] My policy number is gonna be.
[CUSTOMER][NEUTRAL] One second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 255
[CUSTOMER][NEUTRAL] 2440
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] May I have your name and date of birth?
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Low date of birth is [PII].
[AGENT][NEUTRAL] Thank you, Mr. [PII]. What is your callback number please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you very much, one moment please.
[AGENT][NEUTRAL] OK, and if you would also verify both your mailing and email addresses.
[CUSTOMER][NEUTRAL] My mailing address is [PII].
[CUSTOMER][NEUTRAL] And my, you said date of birth?
[AGENT][NEUTRAL] No, your email address.
[CUSTOMER][NEUTRAL] Oh, email is [PII].
[AGENT][NEUTRAL] OK, thank you very much for the verification process, and I do show that we received two claims or two separate documents on [PII], and they are both in line to be reviewed and processed. But yes, sir, to answer your question, we would need the itemized bill that has the procedure codes and diagnosis codes along with the explanation of benefits from your primary insurance provider.
[CUSTOMER][NEUTRAL] Yeah, it was a, it was an accident. It was a um.
[CUSTOMER][NEUTRAL] It not it was an accident, but it was a um
[CUSTOMER][NEUTRAL] It was a motor vehicle insurance and they saying that like they don't.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Like they just paid it.
[AGENT][NEUTRAL] I'm
[AGENT][NEUTRAL] OK, so you're saying that
[AGENT][NEUTRAL] In regards to your claims that I'm sorry, what, what are you asking, Mr. [PII] I just wanna make, just wanna make sure.
[CUSTOMER][NEUTRAL] My motor, my motor vehicle um insurance, like when you have an accident, or this is what they told me, when you have an accident, they um make you put the, your, your insurance policy, like your, your car insurance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I gave them my car insurance, but my car insurance, they um they didn't pay it. Like it was like 961 or something.
[AGENT][NEUTRAL] OK, so you want
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Once we receive the claim, of course, because right now it's in line to be reviewed and processed, we will review the claim.
[AGENT][NEUTRAL] Um, do you have the, did you submit the diagnosis codes as well, or diagnosis code?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so once you, OK, now your claim or your claims or documents are in line to be reviewed and processed, and once we review them and process and then we'll render that decision if it will be paid or not.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah, I, I understand that part, but how would it like, it's not.
[CUSTOMER][NEGATIVE] I, I hate when my kids.
[CUSTOMER][NEGATIVE] OK, so the insurance, they didn't, my primary insurance just so happens to be the car insurance. They didn't, I don't think they're, they're gonna pay it or what not. They said they denied it. It was like for 961. So how does it work?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] If I'm trying to get an explanation of benefits when no benefits was dispersed like.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] From, from, uh, the, the motor vehicle.
[AGENT][NEUTRAL] OK, if your major medical did not pay or.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Apply any charges towards your deductible, your co-pay or co-insurance, then we will not pay.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And you guys won't pay?
[AGENT][NEUTRAL] Correct. And as a supplemental, what we do is is help with your major medical deductible, co-pay, and our co-insurance. So if they do not apply any charges towards that, then we will not pay.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Um, OK, uh.
[CUSTOMER][NEUTRAL] So, do you think I, I'm able to give them
[CUSTOMER][NEUTRAL] Um, I have met or something, like my.
[CUSTOMER][NEUTRAL] Because that, I never heard of nothing like that. Like when you, I, I didn't know that when you go to the hospital that you, well that was my like first accident, but I didn't know that you had to give them.
[CUSTOMER][NEUTRAL] Your car insurance insurance.
[AGENT][NEUTRAL] Um, well, I'm not certain as to what that procedure is, but if you received or seek any medical attention,
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] I would think possibly that you would provide them your medical insurance. So did you give them your, who is your major medical, did you say AvMed?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Did you give that to them when you went to the hospital?
[CUSTOMER][NEUTRAL] I tried to give it to them. They told me that I, I, they needed my insurance policy number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well maybe if you can call the provider Memorial Hospital West and provide them with your.
[AGENT][NEUTRAL] Major medical insurance because again, we will not pay anything unless your major medical admed.
[AGENT][NEUTRAL] Applies charges towards your deductible, co-pay or co-insurance.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] That's what we'll need.
[AGENT][NEUTRAL] Mr. [PII], are you there? OK.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Oh yeah, I'm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So we'll need your explanation benefits from your major medical insurance provider. And if your claim that you submitted does not have the diagnosis code or codes on it, then we'll also need the diagnosis code from the provider or the hospital.
[AGENT][NEUTRAL] Or if you can't get the diagnosis because we need some, we need something that um medical notes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, from the provider.
[CUSTOMER][NEUTRAL] Yeah, I submitted the diagnostic codes. It's on the itemized bill.
[AGENT][NEUTRAL] There are revenue codes on the bill that was sent in but not the diagnosis. The diagnosis would be the reason why you have to see, be seen at Memorial Hospital West. I don't see that on what was submitted.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh that's another
[CUSTOMER][NEUTRAL] It says DBX code on there.
[CUSTOMER][POSITIVE] I guess that's not bad.
[AGENT][NEUTRAL] There are revenue codes on here, but not diagnostic codes or diagnosis codes.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Oh, that's PX code.
[AGENT][NEUTRAL] We need the um diagnosis or D like David, DX codes.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You know those just submit them.
[AGENT][NEUTRAL] I'm sorry, sir, your voice cut out. Say that one more time.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] When I, when I get those just submit, just submit them on like the same way like with the.
[CUSTOMER][NEUTRAL] Submitted as a claim.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] And also along with that, you'll need that exploration of benefits also.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Anything else I can help you with, Mr. [PII]?
[CUSTOMER][NEUTRAL] Um, no, not today.
[AGENT][POSITIVE] OK, well thank you so much for calling AP I'll take care.