AccountId: 011433970860
ContactId: 4d3b47e8-48aa-4482-bfa0-d18119a6d6d5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 377559 ms
Total Talk Time (AGENT): 162832 ms
Total Talk Time (CUSTOMER): 180998 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/4d3b47e8-48aa-4482-bfa0-d18119a6d6d5_20250401T15:51_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. I just um got off the phone with you guys just a minute ago, um, but I'm, I know you need all my information again um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What information do you need for me to look up our claim? I'm the patient's mom.
[AGENT][NEUTRAL] Sure, OK. Um, what was your name, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Last name is [PII]. It's [PII]
[AGENT][NEUTRAL] OK and then [PII], can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yes ma'am, [PII].
[AGENT][NEUTRAL] OK, thank you. And then did you have the policy number?
[CUSTOMER][NEUTRAL] Um, uh, yes, it's 249.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 4500
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right, and then just gonna verify some information really quick. Can I get your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Perfect. The last thing I need is the email address we've got on file. Uh, looks like it might be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. OK, thank you so much for verifying that information. Give me just a moment.
[AGENT][NEUTRAL] OK, and so we were needing to check on a claim, is that correct?
[CUSTOMER][NEGATIVE] I just got off the phone with um a customer service representative named [PII] and I have submitted a claim. I've submitted the same thing twice and both times it was denied because I'm not providing the correct documentation.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So [PII] tried to like guide me through on the phone a little bit and I was actually calling back because I think I found something, but before I submit another claim, I wanna know if it's correct.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Sure, OK. And who, who was this claim for? I'm sorry.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Got you. OK, let's take a look there.
[AGENT][NEUTRAL] Oh, that was it. Let's see.
[AGENT][NEUTRAL] Let me just, OK, yes, so we're missing the diagnosis code. All right. Um, so, unfortunately,
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So I did find a document.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, it's the physician discharge summary, and in this document, it has a note and it says admission. Now my computer's messing up, um, admission diagnosis, and it has two codes with it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um I.
[CUSTOMER][NEUTRAL] I wanted to know if if those were the correct codes if that documentation plus the billing information that I already sent you guys would be appropriate.
[AGENT][NEUTRAL] So unfortunately over the phone I could not say yes or no um of course without having seeing it myself I wouldn't be able to actually tell you that is correct. You can go ahead and send whatever it is that you have if you'd like just for good measure. um I would always recommend though reaching out to the provider or facility wherever he went for treatment.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Simply telling them that you need the itemized statement that shows diagnosis and or procedure codes and they'll have that information to be able to send it to you but that way you know you've got exactly what it is that you need.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I know, and that sounds really easy, but that's what I did after the first claim was denied. And I, I'm not kidding, no less than 6 times. I said, I need the diagnostic codes, and the guy was getting very upset with me. Yes, ma'am, I understand, like I'm not stupid. And then they sent me again, I guess, something that wasn't sufficient.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, because then they sent me that the documentation that I uploaded last week.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, and it takes, it took 20 days to get that documentation.
[AGENT][NEUTRAL] OK, um, yeah, all right, yeah.
[CUSTOMER][NEGATIVE] So it, I know it sounds super simple, but they are not with it.
[AGENT][NEUTRAL] No, I, I know, yes, unfortunately some of these providers can be a little bit difficult to work with. I'm so sorry um so just for good measure I would go ahead and upload what you have. I mean the worst thing that's going to happen is we say this isn't what we need best thing is it's what we need um right so.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Still not enough, yeah.
[AGENT][POSITIVE] I would go ahead and upload what you've got and then in the meantime I would still reach out to them and if they are willing or you know again it depends on them and I hate that for you but they are more than welcome to give us a call as well we do talk to providers all the time you can give them this phone number if there's any confusion and we can explain exactly what it is that we need so you can get this all completely processed.
[CUSTOMER][POSITIVE] OK, that sounds good. All right, I will do that. Thank you.
[AGENT][NEUTRAL] All right, sorry, I couldn't help you more. Yes, is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, I appreciate it. No, ma'am. Thank you so much.
[AGENT][POSITIVE] Of course, thanks for giving us a call. Yeah, I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.