AccountId: 011433970860
ContactId: 55f5612c-df0c-42b8-8c12-2fb85ac4b0e8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 573349 ms
Total Talk Time (AGENT): 248270 ms
Total Talk Time (CUSTOMER): 275189 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/55f5612c-df0c-42b8-8c12-2fb85ac4b0e8_20250123T18:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling in regards to my last, uh, claim. Uh, I have received a message that I have to provide the, the CPT codes, but, uh, in one of the files I, I uploaded with the claim, I see the CPT code, so I would like to clarify.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What does the remark code say on the EOB?
[CUSTOMER][NEUTRAL] Alright, what's the EOB?
[AGENT][NEUTRAL] You would have, you said you received notification from American Public Life that additional information is required. What did you receive? Was it the explanation of benefits?
[CUSTOMER][NEUTRAL] Yes, yes, OK.
[CUSTOMER][NEUTRAL] So it says, it says, please provide a diagnosis code for this date of service. This information may be obtained from your physician.
[AGENT][NEUTRAL] OK, uh, spell your name for me and provide the policy number for me.
[CUSTOMER][NEUTRAL] I'm [PII]. If I want [PII] is my last name. I actually have two. It's [PII]. Do you need me to spell them?
[AGENT][NEUTRAL] Spell your spell your first name.
[CUSTOMER][NEUTRAL] [PII] is [PII]
[AGENT][NEUTRAL] OK. And what's the policy number?
[CUSTOMER][NEUTRAL] 01426664.
[AGENT][NEUTRAL] And what's a good phone number, [PII] in case we're disconnected I can call you back.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull up your file, verify you, and then we can proceed, OK?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And, um, what's your date of birth and your complete mailing address?
[CUSTOMER][NEUTRAL] [PII] and my address is [PII], ZIP code [PII].
[AGENT][NEUTRAL] OK. And what's your email address?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you for verifying, [PII].
[AGENT][NEUTRAL] OK, and the claim is for yourself?
[AGENT][NEUTRAL] For you
[CUSTOMER][NEUTRAL] No, it's for my daughter [PII], [PII].
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] My daughter [PII], yeah.
[AGENT][NEUTRAL] OK, let me look at [PII]'s file.
[AGENT][NEUTRAL] And what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] She was born in [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So actually this happened the day of her birthday.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Is it the, the emergency room, uh, the emergency room service?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. So, um, on the explanation, you said it's asking for the diagnosis code, which is different than the procedure code. Two different codes.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So they, they
[CUSTOMER][NEUTRAL] OK, so they say here emergency room general classification and they say code is 99283.
[AGENT][NEUTRAL] That's a procedure code.
[CUSTOMER][NEUTRAL] That is what? That's the treatment? OK.
[AGENT][NEUTRAL] No, that's just the procedure. That's what they did while she was there. Now we need to know why they did what they did, which would be the diagnosis.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Alright, OK. Last time that I have this request I used Advanc Health to.
[CUSTOMER][NEGATIVE] And they were not helpful at all. This is Orlando Health. I'm gonna try to reach them.
[CUSTOMER][NEUTRAL] And see if they can get me this, but
[AGENT][NEUTRAL] And so, uh, what you can do is contact.
[CUSTOMER][NEGATIVE] Uh, it, it's frustrating.
[AGENT][NEUTRAL] Yeah, contact the emergency room department or the billing department and I'm gonna give you a form to request this form does house or it has the diagnosis code listed on it.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So let me know when you're ready to write down this information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, go ahead.
[AGENT][NEUTRAL] OK, so it's an acronym. It's U as in university.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] B as in Bobby.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Number 04.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So as for the UBO4 form, that's an itemized hos hospital bill.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I will do that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, then that will be all.
[AGENT][NEUTRAL] And OK, and then you can just upload it online like you, you've done the others.
[CUSTOMER][POSITIVE] Sounds good. All right, I'll do that.
[AGENT][NEUTRAL] And, OK, and you have some other outstanding charges like for 22?
[CUSTOMER][NEGATIVE] Yeah, those are the those, those are the ones that I contact uh AdventHealth, which is the, the health and, and I spent, I spent hours waiting, then I talked to a person, she passed me with another person. They, they sent me some emails, the emails were incomplete, they didn't have what I was looking for, and I, I, I gave up because it was like taking so long and so it was so hard that I just gave up.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Urgent care?
[AGENT][NEUTRAL] Oh do you
[AGENT][NEUTRAL] Are you close to that location where you can go in person?
[CUSTOMER][NEGATIVE] So the, the, the issue is what if I go to, this is a company that has several locations, and I did went to one of them, but they said, oh, you need to talk to [PII] in the department, that's not here, we're here, we just, we just listen to the, we just take care of the patients. So then they gave me the they call the phone and that's where and I talked to 3 different persons, and they end up sending that something that was, it didn't, still didn't have the codes.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have the phone number?
[CUSTOMER][NEUTRAL] Now that I know this form.
[CUSTOMER][NEUTRAL] Uh, yeah, I mean, I can, I can look for it, yeah.
[AGENT][NEUTRAL] And that form name that I, the, what I just gave you is for a hospital charge. But if it's, if it's, uh, is that Be Health Centercare, is that urgent care?
[CUSTOMER][NEUTRAL] What up?
[CUSTOMER][NEUTRAL] So they have uh they have a small clinics where they do um emergency. It's an emergency room, but it's a simple one. If it is something serious, you, you can just go there. It's like, you know, like you have a, a cold or a, or, or maybe a broken finger, or maybe you have, but, but nothing serious, nothing major, it's small places. And one that.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK. So.
[AGENT][NEUTRAL] So for an urgent care visit, the form is gonna be different because it's not a hospital. So I have that form name as well. Maybe it'll help if you give them the form that you need.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] You're ready?
[CUSTOMER][POSITIVE] Yes, go ahead please.
[AGENT][NEUTRAL] OK, it's an acronym as well. It's C as in Charlie.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] M as in Mary.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] S as in Sam.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then number 1500. So that's the CMS 1500 form.
[CUSTOMER][NEUTRAL] CMS 15,000, yeah, and this is for urgent care.
[AGENT][NEUTRAL] 1500.
[AGENT][NEUTRAL] This is for any service other than a hospital. You would request that form.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So doctor's office visit, urgent care visit, you would request the CMS 1500 form. If it's done in a hospital, then you would request the UVO4 form.
[CUSTOMER][NEUTRAL] Not a hospital.
[CUSTOMER][NEUTRAL] One question, can I ask for these documents when, when I'm leaving the facility, when I'm checking out?
[CUSTOMER][NEUTRAL] Or they will say, oh no, you need to contact in a few days or something like that.
[AGENT][NEUTRAL] So the the specific itemized bill that they use to send to insurance companies is usually not generated the same day it could take them a week or so to prepare it, but you can ask for an after visit summary. I get those the same day. um, it's an after visit summary and you may wanna ask them if it can include.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] After recent summary.
[AGENT][NEUTRAL] Uh, the diagnosis code and procedure codes on there.
[AGENT][NEUTRAL] And of course, it, it depends on the provider's office, but um I know I received one of those each time I go to the doctor.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Ger codes, OK.
[CUSTOMER][NEUTRAL] We'll start doing that.
[AGENT][POSITIVE] OK. And it might be easier. I have an, you know, to set up an account with whatever, you know, the hospital or your doctor, and mine are always uploaded in my account and I can just go online.
[CUSTOMER][NEUTRAL] Yeah, for example,
[CUSTOMER][MIXED] Yeah, with Advan with AdventHealth, I don't have it, but for example, for the visit I was calling today, we do, I do have an app where I see everything. The issue, it does, it shows my stuff, it doesn't show my daughter, so I don't know if I can create something in my daughter's name and and look for it, but I, I'll just call them and, and hopefully with the code form, they, they'll be able to provide it to me.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. All righty. Well then, anything else [PII], I can help out with today?
[CUSTOMER][NEUTRAL] No, that, that will be all.
[AGENT][POSITIVE] All [PII]. Well, thank you for calling APL and have a good day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.