AccountId: 011433970860
ContactId: 6a012137-e34a-476d-9f76-60f7ea245a52
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 846440 ms
Total Talk Time (AGENT): 269946 ms
Total Talk Time (CUSTOMER): 142960 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=-1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/6a012137-e34a-476d-9f76-60f7ea245a52_20250113T15:20_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. My name is [PII], and I am calling to um get some clarification on a claim that I filed.
[AGENT][NEUTRAL] OK, sure, I can assist you with claims, Miss [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, ma'am. It's [PII].
[AGENT][NEUTRAL] Thank you. And may I have the policy numbers?
[CUSTOMER][NEUTRAL] Yes, ma'am. It is 244-2603.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. And for security, may I have your date of birth, mailing address and email address on file?
[CUSTOMER][NEUTRAL] Uh, mailing address is [PII]. My email address is [PII]. And what was the last one?
[AGENT][NEUTRAL] Um, the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Mm thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Check the claims.
[AGENT][NEUTRAL] OK, let me go over this and see what you're needing. Um, do you mind holding for me?
[CUSTOMER][NEUTRAL] No, that's fine.
[AGENT][POSITIVE] Thank you.
[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][POSITIVE] Thank you for holding and being patient for me, Miss [PII]. OK, so I went ahead and pull up the documents and um check the notes and everything and it looks like um uh the the
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The examiner is requesting um for a complete itemized bill with the diagnosis code.
[CUSTOMER][NEUTRAL] Yes ma'am and I uploaded that.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Last week.
[AGENT][NEUTRAL] OK, this, this information was um put in the system on the [PII]. So it was after that you have uploaded the information.
[CUSTOMER][NEUTRAL] Yes, it was after I uploaded the information correct.
[AGENT][NEGATIVE] Um, yeah, meaning that it's still missing that information.
[CUSTOMER][NEUTRAL] Um, well, I mean, I guess can you tell me the documents that I uploaded, how they're not the, it's an itemized bill with the medical codes I uploaded 4 documents, um, and I was on the phone with a woman last week when I did it, and she checked them and said yes she can read them, and she said that I should be good to go.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because I have to take pictures of them on my phone and upload them. I don't have a a scanner.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I just wanted to make sure it was.
[CUSTOMER][NEUTRAL] It wasn't blurry or anything she said it's fine.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let me check it to see if it has the diagnosis code because, um, that may be the problem. Um, let me go ahead and just check, make sure that it has the diagnosis code because it can have some codes, but it probably not the diagnosis code. So let me, let me pull this image really quick. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm waiting on the image to upload one moment.
[CUSTOMER][POSITIVE] No problem.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Japanese.
[AGENT][NEUTRAL] Mhm. OK. Based on the first one I just seen, those are the procedure codes. Let me check the rest, OK?
[AGENT][NEUTRAL] Um, I want this procedure code.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, here's the 2nd 1.
[AGENT][NEUTRAL] OK, these are procedure codes as well. Yeah, it looks like it's just missing the diagnosis codes. The diagnosis codes are not on the regular bill. Um, it's an itemized bill that you can request from the hospital. The um bill that you get like in the
[AGENT][NEUTRAL] Mail usually has only procedure codes. It doesn't have any diagnosis codes. Um, let me check the, the third page just to make sure that it's not in that one.
[CUSTOMER][NEUTRAL] This is the
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, cause this is the one I've requested from them cause I've
[CUSTOMER][NEGATIVE] I've done this twice now. I've called you guys asked what I needed, gone back to the hospital, told them what you guys told me they sent me this, so I, I don't know what to do anymore. Do you guys communicate directly with the hospitals when.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, we don't. Um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The only other thing that I can think of is if you can get it, um, if you can call the hospital and get that diagnosis code over the phone, I'm not sure if they're gonna be able to give it to you or not, or have them to like whenever you call, ask them, I need an itemized bill, but it has to have the diagnosis code because the one that they're sending has no diagnosis codes. This is just general um procedure codes.
[AGENT][NEUTRAL] Um, and I'm just looking at the last page. I'm sorry. And you didn't have any other pages besides the 4, the 4 was the last page?
[CUSTOMER][NEUTRAL] No, this is it.
[AGENT][NEUTRAL] Yeah, yeah, and it's not there, OK, um.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Yeah, um, or you can ask them to see if they can give it to you over the phone. If they can give it over, over the phone, you can just write it down on this in one of the documents, maybe the page number 4, page number 1, and uh send it again. We just need to have it in writing o[PII] you can just send us like a letter with the diagnosis code. Um, we just need to have it in writing.
[CUSTOMER][NEUTRAL] So when you say diagnosis code, I mean, I have a lot of things done. So what, what does this code link to? Is it just the hospital stay that I need the code for?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, uh uh. OK. The, the diagnosis code is the reason why they had to do everything, all the procedures they did. So basically, I'm just gonna put you in a sample. The diagnosis code could be like a chest pain and that's why they had to do an EKG, an X-ray, and that's the procedure codes. Mhm. Yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So it's not numbers and letters, it's an actual diagnosis like appendicitis.
[AGENT][NEUTRAL] Yeah, it's a diagnosis. Uh, yeah, and it's like, uh it has letters and numbers because it is coded like that, but it is not, it's a diagnosis code that's when you call, you need to be like a specific, sometimes they just don't put in the paperwork. I don't, I'm not sure why, but um yeah, it needs to be a specific to the diagnosis code and it's gonna be like an example um.
[CUSTOMER][NEUTRAL] Is what you
[CUSTOMER][NEUTRAL] That's to be difficult.
[AGENT][NEUTRAL] I will say, uh, L 5395, um, S 9526, something like that. It's gonna have probably one letter or two letters and then numbers.
[CUSTOMER][NEUTRAL] OK, I will call them and ask for that and then uh.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I guess I'll call you guys back if I have any other questions.
[AGENT][NEUTRAL] Yeah, I'm so sorry, but yeah, we're just missing why they had to do it.
[CUSTOMER][NEUTRAL] Oh, it's OK. It's not your fault.
[CUSTOMER][POSITIVE] I understand, I understand. OK, I will call them and I'll call you guys back if I need help. Thanks so. I appreciate your help.
[AGENT][NEUTRAL] Uh
[AGENT][POSITIVE] You, you're welcome, Miss [PII], and thank you for calling ATL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.