AccountId: 011433970860
ContactId: 6aa46506-506d-4368-9468-4aebdea15f04
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 476640 ms
Total Talk Time (AGENT): 181880 ms
Total Talk Time (CUSTOMER): 258503 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/6aa46506-506d-4368-9468-4aebdea15f04_20250304T22:36_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Uh yes, I had just called in and I was talking to somebody and explaining the situation and all of a sudden we were cut off, so I guess I need to start over.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um,
[AGENT][POSITIVE] Mm I'm sorry for that.
[CUSTOMER][NEUTRAL] I had filed a claim for an accident. My, my wife fell and dislocated her shoulder last October.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And she got treated for it and I, I turned in a claim for the hospital cost for the hospital bill and an MRI bill that was done shortly after that.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] I got a check but it only covered.
[CUSTOMER][NEUTRAL] Amounts for the hospital and not for that follow up MRI.
[CUSTOMER][NEUTRAL] And when I called yesterday to ask about it they said it.
[CUSTOMER][NEUTRAL] The the substantiating documentation I sent in didn't show a diagnostic diagnostic code.
[CUSTOMER][NEUTRAL] You with me so far?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes, I'm here. Mhm.
[CUSTOMER][NEUTRAL] OK, um, so I called them today and got a different, uh.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] A out of my statement.
[CUSTOMER][NEUTRAL] And it's they added.
[CUSTOMER][NEUTRAL] Two columns that say one says DX1 and one says DX2 and it has some letters and numbers in it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And and they said that's a diagnostic code.
[CUSTOMER][NEUTRAL] It doesn't have the words diagnostic code, but I'm just wondering if if you know if that would suffice to get the proper documentation.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Forgetting whatever kind of coverage that is allowed for the MRI.
[AGENT][NEUTRAL] OK, um, let me have, um, your name and a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the number is [PII].
[AGENT][NEUTRAL] OK. Thank you, Mr. [PII]. We have bad weather, so that's probably why you got hang up the first time. Um, and do you have the policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yes, it's uh.
[CUSTOMER][NEUTRAL] 1289078
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK. And may I have um your date of birth and mailing address for verification?
[CUSTOMER][NEUTRAL] And [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and I do see an email here. Can you verify that email?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. And what are those um letters and numbers that you see under the DX?
[CUSTOMER][NEUTRAL] Uh, on the DX one it's M 25.311.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And under DX2 it's M25.511.
[AGENT][NEUTRAL] OK. Do you see.
[CUSTOMER][NEUTRAL] And there's a description column.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It says MRI.
[CUSTOMER][NEUTRAL] N E J T.
[CUSTOMER][NEUTRAL] U X T R
[CUSTOMER][NEUTRAL] C dash M A T R L.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And I'm I'm guessing the problem was that there just wasn't enough information on the first thing to tie that to a.
[CUSTOMER][NEUTRAL] Any way to tie that to her shoulder.
[CUSTOMER][MIXED] Problem, but hopefully this adds enough information to do that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then.
[AGENT][NEUTRAL] Yeah, yeah, that is a code for a shoulder, um.
[AGENT][NEUTRAL] So yeah, just go ahead and send that information they gave you and yeah, that is a diagnosis code.
[CUSTOMER][POSITIVE] OK great um.
[CUSTOMER][NEUTRAL] Can I email this?
[CUSTOMER][NEUTRAL] I am no longer a a I mean a policyholder.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Because we changed this year.
[CUSTOMER][NEUTRAL] Uh, so this is from last year and so I had to mail in the original.
[CUSTOMER][NEUTRAL] Uh, claim form.
[AGENT][NEUTRAL] Yeah, um, the only options we have because, um, email is not a secure way of sending medical information, like medical records or documents that are for medical. So, um, the only two options you have right now because the policy is terminated will be fax or mail only.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, well I'm gonna try to fax it. I, I had a problem trying to fax from my home computer, uh, but we may have got that worked out now. Should I send this with the original claim form?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] You can or you can just send it in um as long as um you put the policy number somewhere there so we know what where to apply it to. You can do that. Mhm.
[CUSTOMER][NEUTRAL] Alright, I'll I'll, I'll add the policy number to it and, and my name and some stuff like that.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yeah, that will be great.
[CUSTOMER][NEUTRAL] And then just fax that in and then.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then follow up with y'all like next week or something.
[AGENT][NEUTRAL] Yeah, it takes about 24 hours for a fax to get here and be imaged into your account. So once you send it, you can wait 24 hours and if you want to check back to see if we got it, you can um check back during that time and it takes 7 to 10 business days for the claim to be processed.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Alright, and that's [PII]?
[AGENT][NEUTRAL] Yes, make sure to put that one in in front of it, because sometimes if you don't put the one, it will not go through.
[CUSTOMER][NEUTRAL] Oh really?
[AGENT][NEUTRAL] So it's 1877. It's [PII].
[CUSTOMER][NEUTRAL] OK, I didn't know we had to use ones anymore, but.
[AGENT][NEUTRAL] Yeah, for faxes, yeah, for faxes is um best there's some machines that are like smart machines that will put the one because it recognizes [PII], but um sometimes it doesn't. So to be sure it's best to put that one in front of it.
[CUSTOMER][NEUTRAL] Maybe that's the normal calling.
[CUSTOMER][NEUTRAL] OK, and I'll send this.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] When I when I send a fax, I actually create an email.
[CUSTOMER][NEUTRAL] And, and it gets sent as a fax through my email.
[CUSTOMER][NEUTRAL] Program
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Uh, and I, I think I, I, I make an attachment out of it.
[CUSTOMER][NEUTRAL] I think that's what I was told I have to do.
[AGENT][NEUTRAL] OK. Yeah, if you're gonna send it electronically, that is, yeah, it sounds like that's the way that you do it, um, if you have one of those um set up where you can use your email and send it as a fax. Um, but yeah, it, it will require for you to put that one, OK?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Yeah, OK, um, alright, well that's what I'll do because I, I don't have a landline so I can't actually fax from my my printer like I was thinking I could, but, uh, OK, well I appreciate your help and I'll get this to you and, and I'm gonna follow up sometime soon with the follow up.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] You
[CUSTOMER][NEUTRAL] Receipts for her physical therapy and stuff like that. I think I get up to 8 of those covered at $25 or something like that.
[AGENT][NEUTRAL] Mm. Correct, Mr.
[CUSTOMER][NEUTRAL] And I'll just do sep separate claim for that.
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][POSITIVE] OK, thanks a lot for your help.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. You have a good afternoon, Mr. [PII].
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] You're welcome. Thank