AccountId: 011433970860
ContactId: 5dd4f207-5b63-4608-b4e7-3539d3a73f0e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 781609 ms
Total Talk Time (AGENT): 132123 ms
Total Talk Time (CUSTOMER): 215489 ms
Interruptions: 5
Overall Sentiment: AGENT=1.2, CUSTOMER=-1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/5dd4f207-5b63-4608-b4e7-3539d3a73f0e_20250116T19:33_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you today?
[AGENT][POSITIVE] I'm good and yourself?
[CUSTOMER][NEUTRAL] Doing all right thank you. I've got an insured on the line um calling regarding a couple of claims for two dependents, um, stating that we're missing uh primary EOB and diagnosis codes. She believes she sent that information in with it and just kind of wants to review what was submitted and what else she needs.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] Policy number is 01653654.
[CUSTOMER][NEUTRAL] And these claims are for uh parts 2 and 3.
[AGENT][NEUTRAL] And who's the member on the phone?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What claim is she calling about?
[CUSTOMER][NEUTRAL] So for part two, the claim is 355-0524.
[CUSTOMER][NEUTRAL] And then for part three it is uh 355-0569.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] You can send her over and I'll be able to tell her while we've been make the payment on the client. You're welcome. Have a good one.
[CUSTOMER][POSITIVE] All right, thank you. Sounds good thank you. You too.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] Hi, how are you doing?
[CUSTOMER][POSITIVE] Good how are you?
[AGENT][POSITIVE] I'm great, thanks for asking. You're calling in regards to the claims.
[AGENT][NEUTRAL] 355-0524
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] For inpatient?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I think so. Oh, let me see here. Um.
[CUSTOMER][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] 355. I'm so sorry. Can you repeat that?
[AGENT][NEUTRAL] 0524 for inpatient services.
[CUSTOMER][NEUTRAL] Yes, I think so. Oh.
[AGENT][NEUTRAL] From [PII]?
[CUSTOMER][NEUTRAL] Um, yeah, I was calling about a lot of them. I have multiple claims open.
[AGENT][NEUTRAL] Mhm, they're not open. They've been processed and we requested additional information which we have not received for [PII], [PII].
[CUSTOMER][NEUTRAL] So that
[CUSTOMER][NEUTRAL] Yeah, so
[CUSTOMER][NEUTRAL] Yes, so that's why I'm calling is because I have sent um.
[CUSTOMER][NEUTRAL] Well this one in particular.
[CUSTOMER][NEUTRAL] That one I
[CUSTOMER][NEUTRAL] That one I'm waiting on, I uh ICD 10 codes from there they have to mail it to me unfortunately and then I'm also waiting for my primary to send EOBs for that one, but I'm mostly talking about the date of service of [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then I think there was another date of service of [PII] around that time frame, um.
[AGENT][NEUTRAL] And so [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] So my son had an emergency room visit both of those times. One was an ER I think [PII]. We just went to the ER but I still had like um
[CUSTOMER][NEUTRAL] A bill from that and then.
[CUSTOMER][NEUTRAL] I think it was around [PII] date.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Which both of these I uploaded EOBs today for it.
[AGENT][NEGATIVE] Today, well they won't be processed today with this claim was processed.
[AGENT][NEUTRAL] This claim was processed.
[CUSTOMER][NEUTRAL] So I guess my question to you is I know it's not gonna be processed today, but I, I have so many claims open. I'm like what do I need still for what stuff? So I have, I submitted last week UB 40s for them for those two claims, the EOBs I submitted today, so I know you guys aren't gonna see that, but the UB 40s because I still received a thing in the mail where it's like I don't have the diagnosis codes for that.
[CUSTOMER][NEUTRAL] I thought the UB 40s for those two visits covered those codes, so I guess that's what I'm trying to confirm it.
[AGENT][NEUTRAL] OK. Could I place you on a, if, if you don't mind, I can only look at one claim at a time. Could I place you on a brief hold while I research the claims that you're in you're inquiring about?
[CUSTOMER][NEUTRAL] Is if I have
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[AGENT][NEUTRAL] Thank you. I greatly appreciate it. I'll be very bad.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello ma'am. So you currently are calling about a claim that's currently being processed. Is there any way that you can give us a call back once the claims are actually done being completed with being processed because there are several claims that's actually in the middle of being processed.
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, sounds good. I will call.
[AGENT][NEUTRAL] Like 1234 look like several dates of services which which is 4 claims altogether but several multiple dates of services and they're currently processing them.
[CUSTOMER][NEUTRAL] OK, yeah, I'll call back next week then.
[AGENT][NEUTRAL] And some remark codes have to be changed.
[CUSTOMER][POSITIVE] OK, sounds good thank you.
[AGENT][NEUTRAL] I do apologize for the inconvenience.
[CUSTOMER][NEUTRAL] Oh no you're fine thank you.
[AGENT][NEUTRAL] Let me check on part 3 for you to see if they're processing those claims as well.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Yeah, I guess I'm just getting discombobulated of like what I need EOBs for still and what I need.
[AGENT][NEUTRAL] 0569056 I could see you sent stuff in but I'm not sure how it's gonna because they are processing it now, so I don't know what we still need an EOB or not and then for date of service of [PII] was a duplicate.
[CUSTOMER][NEUTRAL] I think um.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, sounds good thank you.
[AGENT][POSITIVE] Alright, I do apologize. Thanks for calling APL and have a good day.
[CUSTOMER][POSITIVE] Thanks you too bye.