AccountId: 011433970860
ContactId: 46cc6913-78bd-4088-be01-5627e0096cfb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1167160 ms
Total Talk Time (AGENT): 274361 ms
Total Talk Time (CUSTOMER): 247779 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/46cc6913-78bd-4088-be01-5627e0096cfb_20250521T17:43_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good afternoon. Um, this is [PII], and I recently filed a claim.
[CUSTOMER][NEGATIVE] And so, for the life of me, I can't understand this explanation of benefits.
[CUSTOMER][NEUTRAL] I don't know if I'm gonna be reimbursed or not.
[AGENT][NEUTRAL] OK. I can go over it with you if you like. Um, Ms. [PII], may I have a good contact number in case we're disconnected and your policy number?
[CUSTOMER][NEUTRAL] Sure, 305 510.
[CUSTOMER][NEUTRAL] 9247.
[AGENT][NEUTRAL] Thank you for that. And your policy number?
[CUSTOMER][NEUTRAL] It's 02502437.
[AGENT][NEUTRAL] I'm sorry, can you repeat that for me? 0250, I missed a number somewhere.
[CUSTOMER][NEUTRAL] Oh, OK, no problem, 02502437.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Alright, and I have you here, Ms. [PII], can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] Oh wow. [PII].
[CUSTOMER][NEUTRAL] And what else you needed?
[AGENT][NEUTRAL] Your email address?
[CUSTOMER][NEUTRAL] Oh, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the claim number?
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. 3 3601696.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And all the information provided is a verification of benefits, not a guarantee of payment. So this, let me see if this is the same as what just finished. Hold on one second, let me look at these dates.
[AGENT][NEUTRAL] So that [PII].
[AGENT][NEUTRAL] OK, that's different.
[AGENT][NEUTRAL] OK, these are different. OK, so this claim was denied, but it's denied asking for additional information. So basically, we just need to know what the diagnosis was. Um, so if you have like a, um, you can ask the provider for an itemized bill, um, if you have office notes.
[AGENT][NEUTRAL] Um, you know, from
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I, I did, I'm sorry, I did that already and I sent it to you guys. I uploaded that on the website.
[CUSTOMER][NEUTRAL] And also the proof of payment.
[AGENT][NEUTRAL] When you submitted the claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Or after, OK.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, do you mind if I place you on just a brief hold? I'm just gonna go through the documents and see what was received.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] We received this on [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, thank you for holding. So yes, what you submitted is itemized billing, but this is, so it's showing what you received and how much you paid. Diagnosis is why so that we can prove medical necessity. So these are all your copies. What we're requesting is the itemized bill from the doctor's office or the hospital that has the diagnosis codes, the procedure codes, and then all the charges.
[AGENT][NEUTRAL] It
[CUSTOMER][NEUTRAL] Oh, but I thought that's what they, that's what they sent me from the doctor.
[CUSTOMER][NEUTRAL] I asked for an itemized bill and, and that's what they sent me.
[AGENT][NEGATIVE] Did you ask them for their copy of the itemized bill, because this is an itemized bill, but it's the patient version and it only shows treatment. We're we're needing to know why you got this treatment.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Oh [PII].
[AGENT][NEUTRAL] So you can either
[CUSTOMER][NEUTRAL] You know, the
[CUSTOMER][NEGATIVE] Yeah, call them again. It, it took me 3 weeks to get a hold of them.
[CUSTOMER][NEUTRAL] And this has been going on since March.
[AGENT][NEUTRAL] OK, would you like for me to reach out to them and see if I can assist because this
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] That's once we receive what we're asking for, we can continue processing it's just.
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] If there's an audit or something and we pay out on the claim that didn't give a reason why it was needed that.
[CUSTOMER][POSITIVE] Yeah, yeah, I, no, I understand that. I understand that. Um, if you could, I really appreciate it.
[CUSTOMER][NEUTRAL] And I, I have another question. This, this also here from um [PII]. Quest Diagnostics. Why is this lump up lump up together with the, with the doctor's visit?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Cause I only filed a claim for the doctor.
[AGENT][NEUTRAL] Um, on your explanation of benefits that was submitted, it has [PII] and Quest Diagnostic on here.
[CUSTOMER][NEUTRAL] Yeah, no, no, it was supposed to be just for the doctor, [PII].
[AGENT][NEUTRAL] Right, but your question was why, so I was letting you know it was because what was submitted has both of them on, like it's one after the other, so we process both. So you're only wanting the doctors.
[CUSTOMER][NEUTRAL] I don't know if you can say it, uh-huh.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, what, um, so this is a doctor, what's the name of the doctor's office because it's not, it's not on this paperwork.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Or do you have a phone number?
[CUSTOMER][NEUTRAL] It's a bunch of them together.
[CUSTOMER][NEUTRAL] I, I do, I don't know if I can pull it out. He's a, he's a hand specialist, um.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEGATIVE] It'll be terrible if I can't.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Oh dear.
[CUSTOMER][NEUTRAL] Over.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I got the number it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, do you mind if I place you on just a brief hold?
[CUSTOMER][NEGATIVE] No, no, not at all.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII] OK.
[CUSTOMER][NEUTRAL] You've reached the office of Doctors [PII], [PII], [PII], [PII], and [PII]. For English, press one, [PII].
[AGENT][NEUTRAL] Um the name.
[CUSTOMER][NEUTRAL] For appointment scheduling, press 1. For MRI scheduling, press 2. For injections, press 3. For surgery scheduling, press 4. For workers' comp, press 5. For medical records, press 6. For all other inquiries, please press 0.
[CUSTOMER][NEUTRAL] Please hold while we connect you to a representative.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm here, um, yes.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] I'm here.
[CUSTOMER][NEUTRAL] I'm here.
[AGENT][NEGATIVE] OK, I don't know what just happened. It just went blank. Hold on one second, I think they hung up on me. Hold on one moment.
[CUSTOMER][NEUTRAL] They probably don't know.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] You've reached the office of Doctors [PII], [PII], [PII], [PII], [PII], and [PII]. For English, press one, [PII].
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Please hold while we connect you to a representative.
[AGENT][NEUTRAL] Oh my God.
[CUSTOMER][POSITIVE] Good afternoon, thank you so much for holding how may I help you?
[AGENT][NEUTRAL] Hi, my name is [PII]. I'm calling from American Public Life. We have a mutual patient. She's on the line as well. I'm just trying to obtain an itemized y'all's copy of the itemized bill like a UBO 4 or 1500, um, so that we can continue processing her claim.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, the, the person who do that, she's not here today, she's coming tomorrow.
[AGENT][POSITIVE] OK, we'll give a call back tomorrow. Thank you.
[CUSTOMER][NEUTRAL] What is her name?
[CUSTOMER][NEUTRAL] She hung up.
[AGENT][NEUTRAL] They already hung up. Um, so if you'd like.
[CUSTOMER][NEUTRAL] I know, I know.
[AGENT][NEUTRAL] If you'd like to give us a call tomorrow, I'm the only [PII] here. We can try again. Um, I'm here from, well, are you central or what time zone are you?
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], Easter.
[AGENT][POSITIVE] Eastern, OK, so I'm here from [PII] our time, um, Eastern time, and um I'll be more than happy whenever you get ready to call, we can try to call them again and um get the documentation.
[CUSTOMER][NEUTRAL] OK, OK. Yeah, I'll call you around the same time because after [PII], they don't answer any calls. So, uh, I'll call you around the same time. Yeah, yeah. I, I'm telling you, it's been 3 weeks.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, well, I will
[AGENT][NEUTRAL] Well, I'm sorry that you have to go through this and I will um put notes on the policy. So just in case, I mean, I'm the only [PII] here, but just in case you can't reach me or something, uh, whoever answers the phone will know what's going on and they'll be able to help you as well.
[CUSTOMER][POSITIVE] OK. OK. Excellent. Thank, thank you so much.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] No, no, you've been wonderful. Thank you so much.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too, you too, bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] I'm.