AccountId: 011433970860
ContactId: 5728d690-82ec-47f1-b060-46dd36ded56a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 637090 ms
Total Talk Time (AGENT): 279321 ms
Total Talk Time (CUSTOMER): 170379 ms
Interruptions: 5
Overall Sentiment: AGENT=1.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/5728d690-82ec-47f1-b060-46dd36ded56a_20250110T15:53_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I was calling to see, it looks like my client has a 0 payout, and I'm trying to understand why.
[AGENT][NEUTRAL] OK, yeah, I'd like to help you look at that, [PII]. Um, do you mind if I get a policy number from you?
[CUSTOMER][NEUTRAL] Uh, can I give you my social security number cause I don't have my policy number in front of me.
[AGENT][POSITIVE] Yeah, no worries, I can look it up with that whenever you're ready.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Perfect and [PII], do you mind if I also get a really quick call back number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Wonderful, thank you, thank you. And let me start searching for you now, my friend.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Would you be able to verify for me, please, your last name and your date of birth, sir?
[CUSTOMER][NEUTRAL] My name is [PII] [PII].
[AGENT][POSITIVE] Wonderful. And I do just need to verify some additional information with you, um, if you don't mind uh verifying your mailing address.
[CUSTOMER][POSITIVE] Wonderful.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Beautiful. And then if you could verify for me, sir, just the email address.
[CUSTOMER][NEUTRAL] Uh, I don't know which one I use, uh, [PII] or [PII].
[AGENT][NEUTRAL] Alright, it was that 2nd 1 and I've got that here. And I do see we had a recent claim that processed for you, um, it
[CUSTOMER][NEUTRAL] I, um, can you say that again?
[AGENT][NEUTRAL] I do see that recent claim we just processed for you and I can talk you through um where where it was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so it looks like there was a couple um fees that were denied um saying that just the office visits, those administrative charges aren't covered by the policy.
[CUSTOMER][NEUTRAL] No, OK, so that's the wrong one.
[AGENT][NEUTRAL] And then the next, oh, OK.
[CUSTOMER][NEUTRAL] I'm talking about the the the hospital adminis uh the hospital uh claim.
[CUSTOMER][NEUTRAL] Unless that's not completed yet. I'm looking at it wrong.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] I guess I'm not sure I'm seeing any of them from a hospital. They were under.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] You said what?
[AGENT][NEUTRAL] It looks like the one I'm looking at is a claim. It looks like that this the provider was [PII].
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] From the [PII]?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This was the [PII] or [PII], 1 of those.
[AGENT][NEUTRAL] [PII] you're saying?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] So the charge I see from the [PII], it looks like, oh my, I'm sorry, I just had it and I lost the screen I was looking at.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] A Zara Central Campus.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, perfect. That one has a, let me read the denial code. I
[AGENT][NEUTRAL] C182. It says please provide a diagnosis code for the state of service. This information may be obtained from your provider of service, um, so that one, it seems like if we can get a diagnosis code on hand, they would be able to maybe reconsider that charge, um, but we would just need some additional information.
[CUSTOMER][NEGATIVE] I'm confused. I see this is what I'm confused about this damn company about. I sent everything. I sent the EOB. I sent the doggone, uh, um, my, uh, discharge papers that has everything on it. I shouldn't have to work for an insurance company when I pay a premium and I submitted everything that I was supposed to submit and then there's something else. So this company means it's a little janky.
[AGENT][NEUTRAL] I'm really sorry. We do need the diagnosis code to process all the claims, um, and it looks like they just didn't have a diagnosis code for that date of service. Um, I highly recommend like when you're in a facility like giving them your your card and having them submit the work for you because I agree like it's a lot to to try to track down and get all of the information needed to submit the claim and like typically the facilities pay somebody to do that work and so I agree like it's a lot like it's a lot to do.
[CUSTOMER][NEUTRAL] And
[AGENT][POSITIVE] Um, so I'd really say like in any situation you're in if you can, you know, try to put that on the facility for them to submit the claim to us they have access to all their paperwork and so it's a lot easier for them to get it together and to get it sent over and I definitely understand that frustration.
[CUSTOMER][NEGATIVE] Well, they, they really can't do it. They really can't do it because they don't have, they're not gonna send you the EOB for me. I'm gonna have to send the EOB. So what I don't understand is that I'm giving you my discount.
[AGENT][NEUTRAL] Well, your major medical actually sends them a copy of the EOB so they should have that EOB on hand too.
[CUSTOMER][NEUTRAL] Who? The hospital?
[AGENT][NEUTRAL] Yeah, so when your major medical, cause they charge your major medical first, and then the major medical sends them the EOB and then typically the provider would send us the EOB their claim and their documents, and then we would process from there. But your major me like your, your major medical does send them the EOB.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][POSITIVE] But what I'm saying is I sent everything. I've even sent my discharge paper that has everything on there. What more? Like you all have like.
[AGENT][NEUTRAL] But your discharge paper might not have your diagnosis code, and we do have to have that diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So what I need to do is get, so how do I, so what do I need to do, just write it down on the sheet to pay for it or like what would I do?
[AGENT][NEUTRAL] And so,
[AGENT][NEUTRAL] Um, yeah, you would want to, you, I would, I would reach out to the provider and I would ask them for your itemized bill with your diagnosis code on it.
[CUSTOMER][NEUTRAL] I have it. I sent it in.
[CUSTOMER][NEUTRAL] It's because you at the hospital give itemized bills anymore. You have to, they have to mail it to you. So they mailed it to me and when they mailed it to me, I sent it to you all.
[CUSTOMER][NEUTRAL] So everything that that that.
[AGENT][NEUTRAL] I'm really sorry. It just doesn't have the diagnosis code on it. Like I don't.
[CUSTOMER][NEUTRAL] You is what I'm asking you is how do I send the diagnosis code cause I will call the hospital today and I'll get it. How do I, how, how do I
[CUSTOMER][NEUTRAL] And I call.
[AGENT][NEUTRAL] Oh, let me see if there's like a particular form or something you can ask for or what they need. Is that OK? I'm gonna put you just on a quick hold and I'm gonna see if I can get any further information to make getting that document easier for you, OK?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] My pleasure.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] And then I
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey there, are you still with me?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Perfect. Um, alright, so I was able to find out, so the form that you want to ask for that will have your diagnosis code for your claim, it's a UB04.
[CUSTOMER][NEUTRAL] Hold on, give me one second for me.
[AGENT][POSITIVE] Yeah, no, absolutely.
[CUSTOMER][NEUTRAL] Give me let me.
[CUSTOMER][NEUTRAL] OK, what's the name of the client, the form?
[AGENT][NEUTRAL] The form, it's UB 04.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So just ask for the UV 04 paper.
[AGENT][NEUTRAL] Yep, and that will have your diagnosis code on it and send that in and then we'll be able to um to reprocess that charge, OK?
[CUSTOMER][NEUTRAL] OK, I'll do that now.
[AGENT][POSITIVE] Hey, [PII], I, again, I just wanna say I really understand that it's frustrating and I'm really sorry, and I wish you the best of luck.
[CUSTOMER][POSITIVE] Thank you so much. [PII].
[AGENT][POSITIVE] You too. You take care. Thank you so much.