AccountId: 011433970860
ContactId: 5d1c29a9-5243-4b2b-8594-cfa6487b59f6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 312690 ms
Total Talk Time (AGENT): 138536 ms
Total Talk Time (CUSTOMER): 140807 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/5d1c29a9-5243-4b2b-8594-cfa6487b59f6_20250219T15:49_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I'm calling again about claim number 3564.
[AGENT][NEUTRAL] I could barely hear you, ma'am. I could barely hear you.
[CUSTOMER][NEUTRAL] Good morning. My name is [PII]. I'm calling about claim number 35.
[AGENT][NEUTRAL] Can I have a policy number first, [PII], if you don't mind? I don't mean to cut you off, but I need a policy number to pull up the policy. Are you the insured or are you the provider?
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] The insurer. 024.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 66661.
[AGENT][NEUTRAL] OK, give me, that's not enough numbers. Could you verify your policy number for me please?
[CUSTOMER][NEUTRAL] It's on here I'm looking at the EOB it says 0241234466666661.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] You, I'm not sure if you adding numbers to when you putting out the numbers or so could you just give me the policy numbers that you see.
[CUSTOMER][NEUTRAL] 02466661
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you. And what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], could you verify your mailing address and your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what was your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEGATIVE] I'm having a hard time hearing you. I'm not sure if the volume on your phone is low.
[CUSTOMER][NEUTRAL] No, because I'm hearing you well.
[AGENT][NEUTRAL] Yes, I can hear you. I mean, you could probably can hear me because my volume is up, but I could barely hear you. So.
[CUSTOMER][NEUTRAL] The volume of me.
[CUSTOMER][NEUTRAL] I, I turned, you're hearing me now because I turn up my volume.
[AGENT][NEUTRAL] Yes, thank you. The mailing address, could you provide me that again because I couldn't hear you when you was providing it.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and [PII], the policy, the mailing address that you provided us is not on file. That's not the address that we have.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] So you have the 3, OK, so [PII].
[AGENT][POSITIVE] Thank you. And what is your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And a callback number just in case the call is disconnected is the [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And you're calling in regards to the claim that we just recently processed of 356-489-3?
[CUSTOMER][NEUTRAL] 50
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] There was no payment made on this claim, and the reason why there was no payment is.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] And the reason why there was no payment is because the, the procedure where the diagnosis code is considered as a preventative service.
[CUSTOMER][NEUTRAL] Mm, um, no. You know what though, it's, it's an ultrasound I get off the breast. I wasn't getting the, the mammogram. So I don't know what code you have or if I put the wrong um procedure code, but on
[CUSTOMER][NEUTRAL] 49 2024 last year that same test I did because you know when you get a mammo um mammogram, you have to do an ultrasound which is a diagnostic testing. That's the reason why I had to pay that co-pay of the ultrasound and they reimbursed me that $80 and I did that same procedure just now again.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, you gave us proof, so this is a self-insured claim that you submitted with this ICDT code of Z12.31 meaning in counter screening of a mammogram.
[AGENT][NEUTRAL] And the screening is considered as preventative.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, so it's not the mammogram. I need the diagnostic codes for the ultrasound. So after we submit it.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, you might wanna reach out to the provider to verify.
[AGENT][NEUTRAL] The actual ICD code and just resubmit that it'll be the same information that you sent us but write the diagnosis on there.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, alrighty, will do.
[AGENT][NEUTRAL] OK, is there anything else that I can assist you with? Would you like for me to transfer you to customer service to change your mailing address?
[CUSTOMER][POSITIVE] No, no, no, that's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] Thanks for calling APL, Nadine, and have a great day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thanks. Goodbye.