AccountId: 011433970860
ContactId: 5a9d5a43-0c32-48cf-ac6b-650a82b692a0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 406910 ms
Total Talk Time (AGENT): 171530 ms
Total Talk Time (CUSTOMER): 168371 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/5a9d5a43-0c32-48cf-ac6b-650a82b692a0_20250214T17:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, [PII]. Good afternoon. How are you?
[AGENT][POSITIVE] I'm doing well. How are you doing today?
[CUSTOMER][NEUTRAL] Good, thank you. uh I am calling uh because uh one of my claims was denied because they they needed a diagnostic code, uh, so I called the provider office to get it, so I wanted to speak to someone who I can give that to.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, all right. Um, can I get your name and your callback number, please?
[CUSTOMER][NEUTRAL] Yes, uh, it's [PII].
[CUSTOMER][NEUTRAL] And my call back number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, Ms. [PII], and then what is your policy number?
[CUSTOMER][NEUTRAL] Um, one second.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] It is 245-505-9.
[AGENT][NEUTRAL] OK, let's pull that policy in.
[AGENT][NEUTRAL] OK, Ms. [PII], can you give me your date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Thank you. And then also, can you verify your address, phone number, and email address for me?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, [PII]. My email is [PII] and my phone number is [PII].
[AGENT][NEUTRAL] Thank you. I appreciate you verifying that information. OK, so you called because you, you do have the diagnosis code.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And you wanted to give, OK, we don't take them over the telephone. So you have, um,
[AGENT][NEUTRAL] Two options you can send it in, send in the paperwork through the online service center.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, upload that for us.
[AGENT][NEUTRAL] For your claim or if you want you can give our payer ID number to the facility that you went to and see if they can send it in.
[CUSTOMER][NEUTRAL] So I spoke to the hospital and they said that they don't have anything that they can send to you. They gave me the diagnostic code, they said usually um sometimes I don't know who, but she said sometimes people will have like a, a document that they can fax to them and they can fill it out, but they didn't have any documents they could give me to send to you. She just gave me the code over the phone.
[AGENT][NEUTRAL] OK, so it can be sent to and it should should be on your itemized statement your itemized statement from the facility should have the diagnosis codes and procedure codes on it.
[CUSTOMER][NEGATIVE] I don't have a statement from them yet. The statement I have from them is from last year. It doesn't show anything from this year. I just have the explanation of benefits and normally I submit that and there's no issue. I've been doing chemotherapy since last year and I've never had an issue, but this time I uploaded the same documents I always upload and they're saying you guys are saying you need to diagnostic code.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the, the note that the claim uh document said is to uh get the diagnostic code from the facility.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, let's look.
[AGENT][NEUTRAL] OK, do you have the claim number?
[CUSTOMER][NEUTRAL] Yeah, um.
[AGENT][NEUTRAL] OK, what is that?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The claim number with you.
[CUSTOMER][NEUTRAL] Or the claim number with, with what I submit with you?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, 356.
[CUSTOMER][NEUTRAL] 33333363563336.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][POSITIVE] OK, what I'm gonna do is I'm gonna go ahead and transfer you on over to the claims department so that they can talk to you about your claim, um, to see if they can give you any information and assist you better than I can, OK? It's gonna be a brief hold while I transfer you over. You're so welcome. You have a blessed [PII] and thanks for calling APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Oh you as well, thank you.
[AGENT][POSITIVE] You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] OK. Bye.
[CUSTOMER][NEUTRAL] Referring
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How may I assist you?
[AGENT][NEUTRAL] Hi [PII], it's [PII] in the care team. I have an insured on the phone. Her name is [PII]. Uh, her policy number is 2455059, and she has been verified and the number she's calling from is a good call back number. She is calling about claim number.
[AGENT][NEUTRAL] 356-3336. And I read her the remark that she needs to send in the diagnosis code. She has that, but she said that, yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On this claim?
[AGENT][NEUTRAL] But she needs further assistance.
[CUSTOMER][NEUTRAL] She provided it.
[AGENT][NEUTRAL] Yeah, she needs further assistance though because she said that the facility is not giving her any paperwork for it.
[AGENT][NEUTRAL] To send in, they just gave her the diagnosis code.
[CUSTOMER][NEUTRAL] She didn't, I'll explain to her that's all she needs. All she had to do was write it on the EOB and resubmit it, but I'll let her know.
[AGENT][POSITIVE] OK, alright, thank you so much.
[CUSTOMER][POSITIVE] Thank you, [PII]. Have a good day. Happy [PII]'s.
[AGENT][POSITIVE] All right, you too. Happy [PII]'s to you too. Thanks, [PII]. Bye-bye.
[CUSTOMER][POSITIVE] You're welcome. Goodbye.