AccountId: 011433970860
ContactId: 4bb63b07-504c-4ae4-8e0a-339139d023d8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 281220 ms
Total Talk Time (AGENT): 144428 ms
Total Talk Time (CUSTOMER): 121530 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/4bb63b07-504c-4ae4-8e0a-339139d023d8_20250327T13:03_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is. How may I help you today?
[CUSTOMER][NEUTRAL] Good morning. I was calling regarding, um, I, I got a notification about a claim that was that was the that was denied. I'm sorry, and I'm trying to get clarification. I did see the notes, um.
[CUSTOMER][NEUTRAL] Referencing why the claim wasn't and I, I guess I needed additional information, so I'm trying to get clarification as to what I need to submit because I basically submitted everything the EOB and the bill from previous um claims. So not sure what's different about this one, that, and what more is requested.
[AGENT][NEUTRAL] OK, go ahead and give me your name and your policy number.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] [PII] 2054422
[AGENT][NEUTRAL] So say that one more time, a little bit slower for me, [PII].
[CUSTOMER][NEUTRAL] OK, my name, um, oh, the policy number I'm sorry, 2054422.
[AGENT][NEUTRAL] All right, [PII], I think I got it that time. Let me get it pulled up. Now, [PII], while I'm pulling this up, go ahead, or maybe I didn't, it's not coming up. Give me that policy number one more time.
[CUSTOMER][NEUTRAL] Uh, 2054422.
[AGENT][NEUTRAL] OK, maybe I keyed it in wrong. Let's see.
[AGENT][NEUTRAL] Alright, [PII], I got that time, [PII], give me a good return telephone call number please, ma'am.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right, now go ahead and verify your date of birth and address.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Alrighty, [PII], thank you for all the information. OK, let's see, so you're calling about a claim. What dates of service are you calling about?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um, well, from the explanation, it's like they took and did three different things for office visits, but um, it was referenced in an MRI that I did on 226.
[AGENT][NEUTRAL] OK, 226, let me see about that. Let's see.
[AGENT][NEUTRAL] OK, I think I see that that claim, yeah, 22634. I do see that. OK, what we're needing is, um, yeah, it looks like you submitted everything, but what we actually have to have is a documentation uh for the diagnosis in writing from the provider's office.
[AGENT][NEUTRAL] We have to have something in writing from them.
[CUSTOMER][NEUTRAL] So
[AGENT][NEGATIVE] It can't be written anywhere. It has to be documentation from the office.
[CUSTOMER][NEUTRAL] Uh, OK, um, when you say of the results, like what, what I, what I went for the MRI for, is that what you wanting?
[AGENT][NEUTRAL] Yeah, a diagnosis.
[AGENT][NEUTRAL] Yes, we have to have a diagnosis from that provider.
[AGENT][NEUTRAL] It has to be in writing from the provider somewhere.
[AGENT][NEUTRAL] The best way to get that?
[CUSTOMER][NEUTRAL] OK, have, are you familiar with?
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, the best way to get that is call them and tell them and yeah that you need a copy of your bill that way it's gonna have that diagnosis code number on it and it's from them because that is what we require.
[CUSTOMER][NEUTRAL] Because I have a MyChart. Yes, ma'am.
[CUSTOMER][NEUTRAL] So, the bill that I submitted, it wasn't on there?
[AGENT][NEUTRAL] Uh, no, ma'am.
[CUSTOMER][NEUTRAL] So I need a, a copy of my bill with the diagnostic, diagnosis code. I'm sorry.
[AGENT][NEUTRAL] Diagnosis, right, diagnosis code, yes, ma'am. That's what we're needing.
[CUSTOMER][NEUTRAL] OK, so it's a specific code that you're looking for.
[AGENT][NEUTRAL] Yes, the diagnosis code number. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK, so what, once I get that, do I, would that be considered a new claim? Would I just log in and someone will automatically know what that is for?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, well, uh, go ahead.
[CUSTOMER][NEUTRAL] Once I just log that one?
[AGENT][NEUTRAL] Well, I would go ahead and and resubmit what you send in so we would know exactly what it goes for because it has to connect to that data service as well so you could just uh upload it on the OSC website just like you did the first time but submit the additional information with that diagnosis.
[CUSTOMER][NEUTRAL] OK, so the EOB and this new piece of information.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, and that's all you need.
[CUSTOMER][NEUTRAL] OK, I'll do that. All right, thank you so much cause I was gonna call but I really didn't know exactly what I was calling the doctor's office for.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, yes, ma'am. Well, that's fine. You call us anytime you need us, Ms. [PII], and is that all I can help you with?
[CUSTOMER][NEUTRAL] That was it.
[AGENT][POSITIVE] OK, well, thank you so much and [PII] for calling APO and you have a great rest of your day, OK?
[CUSTOMER][POSITIVE] You do the same. Thank you very much.
[AGENT][POSITIVE] Thank you. You as well. Bye-bye.