AccountId: 011433970860
ContactId: 5aa66d68-8d99-48b6-b602-c2fef61eb380
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 487779 ms
Total Talk Time (AGENT): 212793 ms
Total Talk Time (CUSTOMER): 281526 ms
Interruptions: 8
Overall Sentiment: AGENT=1.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/5aa66d68-8d99-48b6-b602-c2fef61eb380_20250303T15:19_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Well hi Miss [PII] how are you doing today?
[AGENT][POSITIVE] I'm doing good. How are you doing?
[CUSTOMER][NEUTRAL] I'm doing OK. I'm calling in reference to uh understanding a claim I put in, well, a couple of claims I put in, and I was looking at the explanation of benefit page.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I, I just kinda need to understand what I'm doing here.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Uh, it's the group hospital entity. What do I need to give you so you can look at this with me?
[AGENT][NEUTRAL] Um, may I have your name and then a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Oh, OK. It's [PII]. I don't know if y'all have it as [PII], but uh [PII] It might be [PII] or just [PII]. It look like it's just [PII]. I don't think y'all changed it to my marina.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And then on that I'm sorry.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] No, you're fine. And then on the explanation of benefits, um, does it say, it should say policy number and claim number. Um, I would need the policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's one I'm sorry 01807691.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] I think we're changing companies for [PII], but this is previous.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, here we go. And um Miss [PII], I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Uh, what else, my mailing address is [PII].
[CUSTOMER][NEUTRAL] And I don't know if you have my work email or my personal email. Uh, [PII].
[AGENT][NEUTRAL] This one, let me see.
[CUSTOMER][NEUTRAL] If it's [PII], it's not personal. If it's [PII], it's personal.
[AGENT][NEUTRAL] Personal.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And so, um, so would this be, well, we received a few claims on
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, that's why I, I think I'm a little confused. I see on the remote, I'm looking at the one that uh let's see.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Claim number 3567898. I just went to that one.
[AGENT][NEUTRAL] 898.
[CUSTOMER][NEUTRAL] That was the last one on there, uh-huh, 356-7898.
[AGENT][NEUTRAL] So these are all outside, so it'll probably be easier to do it like this outside of all the ones that were received on [PII], except for the one that ends in 7980.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] I'm sorry, 7908.
[AGENT][NEUTRAL] You see that one?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, I'm looking at the what am I looking at? Which number? OK.
[AGENT][NEUTRAL] The claim number, um, all the, so are you online or you're looking at the like the paper?
[CUSTOMER][NEUTRAL] Climb
[CUSTOMER][NEUTRAL] I'm online. I'm online and, OK, I have both. I got the paper and online. OK. All right, let me go to the one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You got it. OK, so all of
[AGENT][NEUTRAL] All of them except the one that ends in 7908 were denied asking for the diagnosis code.
[CUSTOMER][NEUTRAL] That's what I was gonna ask cause I sent the whole thing and I didn't know which one on there. I sent the whole file cause you know, it just ran uh all together the date, so I wasn't sure what they were asking for because I sent the whole, uh, what I'm trying to say?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You sent out everything you had.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yeah, the bill, the bill, and it had all the codes on it, so I wasn't quite sure.
[AGENT][NEUTRAL] So let me do this
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull up the documents so I can see what came in so to know what's needed.
[CUSTOMER][NEUTRAL] OK. OK, that's fine, that's good. OK.
[AGENT][NEUTRAL] It's pulling up now. Hold on one second.
[AGENT][NEUTRAL] Uh let me see. OK, here it is.
[AGENT][NEUTRAL] OK, OK, I see. So, this is your patient bill. This
[AGENT][NEUTRAL] Your bill was generated from the bill we're needing. So this shows you basically all the treatment and what was charged for it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, and it should have a code on it too.
[AGENT][NEUTRAL] Sorry, I was sneezing, sorry.
[CUSTOMER][NEUTRAL] Oh, that's OK baby. Uh-huh, that's alright.
[AGENT][NEUTRAL] Excuse me. So, um, it does have a code on it, but these are not diagnosis codes. These are procedure codes. So these, this tells us the treatment. We need to know the medical necessity.
[CUSTOMER][NEUTRAL] Oh, so how do I get a
[CUSTOMER][NEUTRAL] OK, so how do I get those those that's all, that's all I've ever sent in. Well, I don't know if I send it in to you all, but to the other vendor that we had. So how would I go about getting diagnosis codes because that's what they generated when I told them what I needed.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so you would reach out to the, is this a doctor's office or hospital? I'm trying to.
[CUSTOMER][NEUTRAL] Yes, it's a doctor's, it's a doctor's office, yeah. This, well this was the actual, no, this was the actual insurance, I mean, how should I say the provider that like it it uh it's a whole corporation that do all this. So I called them so they could give me several years into one, and that's what she gave me.
[AGENT][NEUTRAL] OK, so just
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And that's what usually what the doctor give you, so that's why I went through them because it's the same, uh, if I could have went online, it would have been the same document. So how do you go about getting a diagnosis code?
[AGENT][POSITIVE] Right, you're right.
[AGENT][NEUTRAL] So you would reach out to the doctor's office and let them know that you need a copy of the item, now they may call it an itemized bill or a universal bill. Different places call it different things, but it's the same document. Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Different things.
[CUSTOMER][NEUTRAL] OK, OK, OK.
[AGENT][NEUTRAL] So that that um itemized bill or universal bill will have the diagnosis codes, the procedure codes, and all the charges. It's what they generate your bill from, but for your bill, it just shows the treatment. So you know what you got and what you're paying for. We need the medical part to prove why you got that.
[CUSTOMER][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] Oh, OK, OK, so I need let me write that down. I need the itemized deal is what I'm really needing.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, I see, I got that from the MD [PII].
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I, I, I knew that. OK, OK, I see what, see what you're saying now, even with the doctor's office, you have to ask for an autoized bill. OK, now I'm understanding.
[AGENT][POSITIVE] Yes, ma'am, because they're gonna give you your part, but we need their part. Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, OK, OK, well, I'll call that, uh, call that insurance coming back. I mean, I call them the insurance company, but the doctor's office, the main office, and see if they can generate that.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And then once they send it to you.
[CUSTOMER][POSITIVE] OK, now I'm on the right page.
[AGENT][NEUTRAL] Yes, and they'll usually email it to you and then you can upload it on the online service center there and you'll get a confirmation number, you know, we got it and um we'll continue processing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, sounds good.
[CUSTOMER][POSITIVE] OK, sounds great. That's what I need to do though. I appreciate that. Thank you so much.
[AGENT][POSITIVE] Well, you're very welcome. Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, ma'am, that was it. I just didn't understand what was needed. I thought I had what you needed, but now I understand there's a different uh cause.
[AGENT][POSITIVE] Well, I'm glad you got it now. Yes.
[CUSTOMER][POSITIVE] Yes ma'am, yes ma'am. Thank you. I appreciate that.
[AGENT][POSITIVE] You're welcome. Well, thank you for calling APL. I hope you have a wonderful week.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You have one too now. All right. Mm, bye-bye. OK, bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.