AccountId: 011433970860
ContactId: 54919f7f-c6cf-41fa-9880-8ed195966ac1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 684890 ms
Total Talk Time (AGENT): 214090 ms
Total Talk Time (CUSTOMER): 278658 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/54919f7f-c6cf-41fa-9880-8ed195966ac1_20250507T18:53_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], how are you? This is [PII].
[AGENT][POSITIVE] I'm doing good how about you?
[CUSTOMER][NEUTRAL] I'm good, thank you. Um, I have a member on the line that she said that she sent in the diagnosis code that they're listed. I, I went ahead and look at the paperwork, but I only found one, but she said that they're all supposed to be there. I'm not sure, but I went ahead and marked the one that I did find. Um, so can you help this member to see what else she needs to do to send this information because she said she already sent 4 times and we're not seeing what she's seeing for some reason.
[AGENT][NEUTRAL] OK. May I have the name and the callback number?
[CUSTOMER][NEUTRAL] Uh yes. Her name is [PII].
[CUSTOMER][NEUTRAL] And the callback number is [PII].
[AGENT][NEUTRAL] And the policy number?
[CUSTOMER][NEUTRAL] 216-65702.
[AGENT][NEUTRAL] OK, and is there a specific claim number or date of service?
[CUSTOMER][NEUTRAL] Um, we're, yeah, we're looking at claim number 3587926.
[AGENT][NEUTRAL] OK. We're not, we're not requesting.
[AGENT][NEUTRAL] Oh, you said 7926. I'm looking at 7927.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm. All right. 26. It says uh quest diagnostic and then in the back is stating that um we need a fully itemized bill with the diagnosis code which I prouest and I didn't see the diagnosis code on their quest. Um.
[CUSTOMER][NEGATIVE] And the only thing I found on the paperwork was a diagnosis code for [PII], which that's not Quest. I went ahead and highlighted it, but um that's definitely not Quest. Um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You can go ahead and transfer.
[CUSTOMER][NEUTRAL] Yeah, I try to pull as much documents as I could, but I didn't find anything. OK, so here she comes and she just need help on how to send in what she's looking at because um she said that every time she said that we said we get something different, OK? So here she comes.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] OK. Have a good day. Yeah, thank you. Thank you for holding and being patient for me, Ms. Bro. I got Ms. [PII] on the line. She's in the claims department and she's gonna assist you from here.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Awesome thank you so much.
[CUSTOMER][POSITIVE] You're welcome. Have a good afternoon, Ms. [PII].
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Hi [PII]. Thank you for calling American Public Life. This is [PII], and how may I assist you?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEGATIVE] I'm just calling because I had uploaded 2 bills into the portal with the Medin form and the diagnosis codes and my primary insurance's explanation of benefits. I've actually sent it twice, but I got something in the mail from you guys.
[CUSTOMER][NEUTRAL] An explanation of benefits saying that you didn't, that you needed diagnosis code for it so I'm just calling to figure out, since I've already submitted those twice, how else I can get them to you.
[AGENT][NEUTRAL] OK, I'm pulling the images up.
[CUSTOMER][NEUTRAL] And like why it's not showing up on your end.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I do see on the image that was received.
[AGENT][NEUTRAL] 148 of 25.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I see that there is a page that is listed that is showing the diagnosis code. Was this typed up by you or was this submitted by the provider?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So they sent me that and I just stapled it with everything like I put it together with everything else.
[CUSTOMER][NEUTRAL] Which I've had at first, I get blood work done all the time. I, and I have to, for some reason, Quest doesn't know how to send things to y'all, so I have to send it myself and it's always been, it's always looked like exactly like this, but I'm not sure why.
[CUSTOMER][NEUTRAL] This time, it's causing a problem, I guess.
[AGENT][NEUTRAL] OK. The reason is because we no longer just accept diagnosis that has been written or typed in unless it has the provider's letterhead or something listed on it because we are not to know that this is the correct diagnosis code for those dates of service or for that provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So they have to send it to me on a different form, or is there something that they need to fill out?
[AGENT][NEUTRAL] We have to have something.
[AGENT][NEUTRAL] It, it has to have something that has that provider's name listed on there. So if they have something with a letterhead, when they send you that email or fax, it has to have that name listed. Not just saying two quest bills because see, this could have been typed up by you, and we would know if that is the correct diagnosis.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that's why when they submitted this, it's stating that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For that denial is reading that we were needing something um supporting documentation from them, yes.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] From them.
[CUSTOMER][POSITIVE] But it doesn't have to come from them like they can send it to me and I can resubmit this whole packet to you guys.
[AGENT][NEUTRAL] Yes, but it just has to show, we have to see it, yes, that it is from them.
[CUSTOMER][NEUTRAL] As long as it has their name on it, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. I can handle that. Is that for?
[CUSTOMER][NEUTRAL] Cause there's, OK, so that was for the quest bills. Now there's another bill in the same claim number that was in Oshner bill that also says it needs diagnosis codes that I don't have diagnosis like I didn't send diagnosis codes for, but whoever I was just on the phone with told me that you already have the diagnosis code, so I don't know why.
[AGENT][NEUTRAL] Let me check that.
[CUSTOMER][NEUTRAL] I'm being asked for more of them, I guess.
[AGENT][NEUTRAL] Let me check that for you.
[CUSTOMER][POSITIVE] It was for Ossner Health and yeah thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so the one that is from Auster, I do see on here that it does have the diagnosis code that is listed on there. So what I can do, I will be able to submit this back to that examiner and have them to review it and or reprocess that due to this diagnosis. It listed with something like from Achna. But if you would look at the information that you did send in.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That day, it is kind of something that says Archer Health and they do have it listed for that data. That is something that we, that's how we would know that that is the diagnosis code.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, right, right.
[AGENT][NEUTRAL] From that provider so it can be an itemized bill or something that listed listed on there.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can I have you look at one more then while I have you on the phone?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's a bill from [PII].
[AGENT][NEUTRAL] Do you have that date of service?
[CUSTOMER][NEUTRAL] I guess they
[CUSTOMER][NEUTRAL] Oh, I'm sorry. It's um [PII].
[CUSTOMER][NEUTRAL] I guess they all type up their bills differently is that why it's on some and not the other?
[AGENT][NEUTRAL] Could be, it's just based off of the provider that's submitting the claims.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's for 125.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so for Laura shopping, is that how it's pronounced?
[CUSTOMER][POSITIVE] Yes ma'am, yes ma'am.
[AGENT][NEUTRAL] OK, so I see that we did process that claim and it shows that for the procedure code 99204 due to that being an office visit, that is not covered under your plan, so that one denied.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, can I ask you one more question about the quest, the two quest bills?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Would the diagnosis codes come from Quest or would it come from the doctor that sent me there? Like, which one do you need the, the letterhead from?
[AGENT][NEUTRAL] Whoever rendered this, whoever render, whoever rendered the services, but if the provider is the person that submitted you over, sent you over there, they would have those diagnosis codes for that data service.
[CUSTOMER][NEUTRAL] Cause I got it from the doctor that sent me to Quest.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, that's what I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. OK, I'll get that and I'll resend it and is yeah OK I got it, just put it in the portal like before.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, and once we receive it, we would just review based off of the previous claim if any information is listed there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect OK awesome thank you so much for helping me with this.
[AGENT][NEUTRAL] You're welcome. Is there anything else that I can assist you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] I think that's it.
[AGENT][POSITIVE] OK, well I do wanna thank you for calling American Public Life. You have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] You're welcome. Bye.