AccountId: 011433970860
ContactId: 6dc8e87c-3f29-4918-844e-08ceedcb53fc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 988059 ms
Total Talk Time (AGENT): 470823 ms
Total Talk Time (CUSTOMER): 506261 ms
Interruptions: 12
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/6dc8e87c-3f29-4918-844e-08ceedcb53fc_20250625T14:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I too.
[CUSTOMER][NEUTRAL] I'm calling about some claims that I put in.
[AGENT][NEUTRAL] OK, so you're the insured in these claims or for yourself that you're wanting to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry, [PII], what was the last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] The policy is 2456796.
[AGENT][NEUTRAL] OK, thank you. Give me a moment please to get your policy information pulled up and then the show I will have to verify several things with you first for security and also any information that I provide for you will be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, also your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that is on file for you is the same as the one that you provided for me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][POSITIVE] Thank you and lastly your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you very much for verifying all of your information. OK, so I do see that we have several documents that were uploaded to your portal that have been reviewed, um, and you should be able to also, Ms. [PII], in case you're not aware of this, but you should also be able to log in to your portal to see the explanation of benefits along with the remarks on here. Now,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Alright, yeah, well, unfortunately your system isn't that great.
[CUSTOMER][NEGATIVE] It took me 3 more than 3 hours just to put those claims in.
[AGENT][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEGATIVE] We can't fill out the claim form, uh, it's terrible.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] I'm very sorry about that. So on your claim that I see for data service, this is for 42825, is that correct?
[CUSTOMER][NEUTRAL] No, it was 485.
[AGENT][NEUTRAL] OK, what's your
[AGENT][NEUTRAL] What is the data service?
[CUSTOMER][NEUTRAL] The claim was 48428.
[AGENT][NEUTRAL] The data services for?
[CUSTOMER][NEUTRAL] There were more than one claim.
[CUSTOMER][NEUTRAL] 428 25.
[AGENT][NEUTRAL] OK. Yes, ma'am. So that's the date that I just said.
[CUSTOMER][NEUTRAL] The bill was for $485 or actually $48,450 something like that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] OK, so on the claim that has been reviewed for you for data service 4 28 25, Ms. [PII], I can see that this claim was denied.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the reason for the denial on here states receipt of your claim is acknowledged. However, in order to provide further consideration of this loss under this policy, we will need supporting documentation to evidence the accident or sickness, supporting the.
[CUSTOMER][NEUTRAL] Why?
[CUSTOMER][NEUTRAL] Like what?
[CUSTOMER][NEUTRAL] What uh it it wasn't an accident.
[AGENT][NEUTRAL] Yeah, ma'am. I did say accident.
[CUSTOMER][NEUTRAL] What are you talking about?
[AGENT][NEUTRAL] Would you like for me to continue reading you the remark?
[CUSTOMER][NEUTRAL] Well, what is, what do you mean accident?
[CUSTOMER][NEUTRAL] It was for an anesthesiologist.
[AGENT][NEUTRAL] I said accident or sickness?
[AGENT][NEUTRAL] It says or sickness.
[CUSTOMER][NEUTRAL] Oh I'm not really.
[AGENT][NEUTRAL] Yes, ma'am, or sickness, supporting documentation may include.
[CUSTOMER][NEUTRAL] I went into surgery.
[AGENT][NEUTRAL] Yes, ma'am. On this policy, we're needing a diagnosis code. So it says that the sporting document.
[CUSTOMER][NEUTRAL] I gave it to you.
[CUSTOMER][NEUTRAL] I gave it to you. I gave you the bill.
[CUSTOMER][NEUTRAL] This OK this is what you asked me for.
[CUSTOMER][NEUTRAL] They asked me for um all the medical numbers, the medical ID numbers to pay the bill.
[CUSTOMER][NEUTRAL] That was on the bill.
[CUSTOMER][NEUTRAL] That's all on the bill.
[CUSTOMER][NEUTRAL] And everything is not listed on that bill. It was an anesthesiologist for surgery, and it the numbers are listed on there.
[AGENT][NEUTRAL] OK, so this indicates that there was.
[CUSTOMER][NEUTRAL] So I gave you the pay bill. I
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I gave you the paid bill.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And so I'm not really sure what you're trying to get out of here. I can't possibly give you anything else.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK. According to the note, the documents were missing the diagnosis code.
[CUSTOMER][NEUTRAL] The diagnosis is on there. The code is right on the bill.
[AGENT][NEUTRAL] OK, now,
[CUSTOMER][POSITIVE] It was right on the bill that I sent you.
[AGENT][NEUTRAL] OK, so I will be happy to send a request to have someone to review this information and to call you back if you would like for me to do that, Ms. [PII].
[CUSTOMER][NEUTRAL] Yeah, because uh all everything was on the bill, every diagnosis code, in fact, hold on a second.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I'll look it up right now. I have all those bills on my phone.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You asked me for the explanation from, from the, the insurance company that was sent to you too.
[AGENT][NEUTRAL] That is, yes, and that is not something right, but that's not what we're missing. It doesn't indicate that we were missing that. It was the diagnosis code.
[CUSTOMER][NEUTRAL] Explanation of benefits.
[CUSTOMER][NEUTRAL] Well,
[AGENT][NEUTRAL] For that data service.
[CUSTOMER][NEUTRAL] Where do I, yeah, alright, so and where is that on?
[AGENT][NEUTRAL] That would be obtained from the provider or the facility.
[CUSTOMER][NEUTRAL] OK, so this is what you asked me for. You asked me for an itemized bill with diagnosis, and it was on there.
[CUSTOMER][NEUTRAL] And then you ask me explanation of benefits which I sent to you, so on the bill that I sent you.
[CUSTOMER][NEUTRAL] The itemized bill which I did send you and then I paid you on top of that I also send you the paid bill, OK?
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It was all listed on there.
[CUSTOMER][NEUTRAL] The diagnosis are on there. You want the diagnosis number. Am I correct?
[AGENT][NEUTRAL] Yes, ma'am. That is what it is stating.
[CUSTOMER][NEUTRAL] Because all that this is what you have and it's and it's on the bill.
[AGENT][NEUTRAL] Yes, ma'am, that
[AGENT][NEUTRAL] Now
[CUSTOMER][NEUTRAL] It's on the bill.
[AGENT][NEUTRAL] Uh, yes, ma'am. I heard you say that. I'm looking, I can, again, I can only read to you what the remark code is on this claim.
[CUSTOMER][NEUTRAL] All right, well, who did that come from? Because it's on the bill. I don't know. Do I have to get an attorney for this? Do I have to get an attorney for this?
[AGENT][NEUTRAL] But I would be
[AGENT][NEUTRAL] That would
[CUSTOMER][NEGATIVE] Please tell me, because that's what I'll do, because you guys owe me out about $2400 and I got the bills.
[AGENT][NEUTRAL] Now,
[CUSTOMER][NEUTRAL] And all the diagnosis codes are on there and it's also on the explanation of benefits from the insurance company. Everything is on there.
[AGENT][NEUTRAL] Now, your diagnosis, OK, so I will be happy to send the
[CUSTOMER][NEUTRAL] I'm gonna tell you the diagnosis. I'm, I'm looking at the diagnosis code right now, OK? Code 00940.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] CPT code 00940.
[AGENT][NEUTRAL] OK, that's
[AGENT][NEUTRAL] Yes, ma'am. And a CPT code is not a diagnosis code, that is a procedure code.
[AGENT][NEUTRAL] That's different than a diagnosis code.
[CUSTOMER][NEUTRAL] OK, but it's not a anesthesia, anesthesia is not a diagnosis. That's the problem. That's the anesthetic pill.
[AGENT][NEUTRAL] But yes, that's correct. That's what, yes, ma'am. That's what we're needing. We have to have also the diagnosis code in addition to the procedure codes.
[CUSTOMER][NEUTRAL] OK, well, wouldn't that be on the item, wouldn't that be on the explained explanation copy of benefits?
[AGENT][NEGATIVE] No, ma'am, it would not.
[CUSTOMER][NEUTRAL] Why wouldn't it be on there?
[AGENT][NEUTRAL] Due to HIPA, the diagnosis as to why you had to have your procedure would not be on your explanation of benefits.
[CUSTOMER][NEUTRAL] So what do you mean? What do you need?
[AGENT][NEUTRAL] They died? No.
[CUSTOMER][NEUTRAL] What code do you need exactly?
[AGENT][NEUTRAL] Diagnosis code.
[CUSTOMER][NEGATIVE] So you need to know why I had the procedure, not the code for the anesthesiologist. That doesn't make any sense.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Right, we had a
[CUSTOMER][NEUTRAL] Cause I can't give you that on paperwork from the anesthesiologist. That's from the doctor. You'll get that bill separately from the doctor.
[AGENT][POSITIVE] That is correct.
[AGENT][POSITIVE] Yes, ma'am, you would obtain.
[CUSTOMER][NEUTRAL] Well, you're gonna get that bill separately from the doctor.
[AGENT][NEUTRAL] Now, on this claim, if you would like, you may file an appeal on it. I can only provide you, Ms. [PII].
[CUSTOMER][NEUTRAL] I'm not gonna file appeal and do this all over. I will get you that number today.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am, and you can just.
[CUSTOMER][NEGATIVE] I'm not gonna file an appeal on it. That's ridiculous.
[CUSTOMER][NEGATIVE] And an email and stop laughing. An email could have been sent to me.
[AGENT][NEUTRAL] I'm not
[CUSTOMER][NEUTRAL] Well, yeah, I hear what you say, everything that's going on back there.
[AGENT][NEUTRAL] What, uh, you can't, there's no possible way, Ms. [PII], I'm sorry that you can hear anything. I'm just trying to read you the remark on this. OK.
[CUSTOMER][NEUTRAL] I hear it.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] Well, I will call back with the code.
[AGENT][NEUTRAL] OK, we cannot accept it. Yes, ma'am, but we can accept it over the phone.
[CUSTOMER][NEUTRAL] I'll call back with the code.
[AGENT][NEUTRAL] So you would need to obtain that information from?
[CUSTOMER][NEUTRAL] Well, what do you need exactly then?
[AGENT][NEUTRAL] The diagnosis code for this.
[CUSTOMER][NEUTRAL] The payment, the payment, yeah, but she's, the anesthesiologist is not gonna have a diagnosis code. The doctor will, but the doctor didn't administer that pill.
[AGENT][POSITIVE] Yes, ma'am, that was correct.
[AGENT][NEUTRAL] Yes, ma'am, but the doctor is the one who ordered and scheduled your procedure that you had done. So they would be able to provide the diagnosis code as to, you know,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So you're expecting me to put this whole thing in again, all over again, that took hours to do because your system is terrible.
[AGENT][NEUTRAL] The race
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] And just for, to get you a diagnosis code from the doctor, I have to do this thing all over again.
[AGENT][NEUTRAL] No, ma'am, you only need to obtain the information.
[CUSTOMER][NEGATIVE] And nobody even sent me an email on it. Nobody sent me an email or anything on it.
[AGENT][NEUTRAL] No, ma'am, we don't send emails.
[CUSTOMER][NEGATIVE] I got no response from it.
[AGENT][NEUTRAL] Yes ma'am, the explanation of benefits with the remark that I was attempting to read to you fully is in your portal under your claim number.
[AGENT][NEUTRAL] That you can see the exact remark on.
[CUSTOMER][NEUTRAL] Alright, well, hold on a second because I'll tell you right now on the explanation of benefits, it's on it from UMR from the insurance company.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, OK, so now you have a separate explanation of benefits from [PII], with the remark on it that I was attempting to read to you.
[CUSTOMER][NEUTRAL] I, this is what I sent you.
[AGENT][NEUTRAL] Yes, ma'am. I'm not referring to what you sent me. I'm referring what we sent to you.
[CUSTOMER][NEUTRAL] What from the insurance company?
[CUSTOMER][NEUTRAL] What do you mean?
[CUSTOMER][NEUTRAL] I'm telling you that you also got something from UMR.
[CUSTOMER][NEUTRAL] Reading you the explanation of benefits.
[AGENT][NEUTRAL] But you, what, OK, we're talking about two different explanation of benefits, [PII]. You're referring to your
[CUSTOMER][NEUTRAL] No, it's the same thing.
[AGENT][NEUTRAL] OK, you're referring to your primary insurance explanation of benefits, because you would also have an explanation of benefits that we sent once we reviewed this information from APL.
[CUSTOMER][NEUTRAL] I, I don't know.
[AGENT][NEUTRAL] And that the explanation of benefits from my APL from our review.
[CUSTOMER][NEGATIVE] That's ridiculous.
[AGENT][NEUTRAL] Again, a copy was mailed to you in the mail.
[AGENT][NEUTRAL] And then also it's available to you in.
[CUSTOMER][NEGATIVE] I don't go. Listen, I can't, I can't get, I can't get my mail. I'm a truck driver. We're over the road. We don't come home for months. I explained this a while back.
[CUSTOMER][NEUTRAL] And you should know that since your insurance, you're insuring people from a trucking company. You know people don't go home for months.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And again, this
[CUSTOMER][NEUTRAL] So why would you send me anything at home?
[AGENT][NEUTRAL] Because that's that's standard procedure.
[CUSTOMER][NEGATIVE] All right, well, so what do I have to do now? What do I have to, well, I can't go by what's mailed. I can't because I'm not gonna be home for 4 months. So I can't go by what's mailed.
[AGENT][NEUTRAL] That a copy is mailed and it is also available.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So when you log in to your portal and click on your claim number, you will have access to that explanation of benefits that was also mailed to you and it has that entire remark again that I was attempting to read to you about what is it we are in need of to further review your claim.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I know what you're in need of, but that's, that's totally different than what you even asked me for. Because originally all they asked me for, all they asked me for was an itemized bill. Yes it is, because I wrote down exactly what this woman said to me.
[AGENT][NEUTRAL] No, ma'am, it's not.
[CUSTOMER][NEGATIVE] When I asked her what she needed for a claim, and the claim form needed to be filled out, but you can't fill out the claim form on your site. It doesn't allow you to do it. So that was a horror in the half, OK? Secondly, you got the itemized bill with diagnosis, and that's what I gave you. And it says you need an explanation of benefits from the insurance company, which I sent.
[AGENT][POSITIVE] Correct. That's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And according to what you gave me a while ago, [PII], you said that what you submitted had CPT codes. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] That is not a diagnosis code. Those are procedure codes.
[CUSTOMER][NEUTRAL] Well, the diagnosis is gonna be on UMRs.
[AGENT][NEUTRAL] The diagnosis code is not on the primary insurance's explanation of benefits.
[CUSTOMER][NEUTRAL] It will be on UMR.
[AGENT][NEUTRAL] That does not
[CUSTOMER][NEUTRAL] Reason code explanations.
[AGENT][NEUTRAL] Again, those are your procedure codes, not the diagnosis code.
[CUSTOMER][NEUTRAL] All right. So now, how do I go about doing this? Getting this to you?
[AGENT][NEUTRAL] So you would be wanting.
[AGENT][NEUTRAL] Excuse me, once you obtain the information, you can upload it.
[CUSTOMER][NEUTRAL] What information exactly do you want? You want the diagnosis code from the doctor, not from the anesthesiologist, OK? Right? Is that correct?
[AGENT][NEUTRAL] The
[AGENT][POSITIVE] Yes, ma'am. Correct.
[AGENT][NEUTRAL] And you, correct. And once you get that, you will upload it to your portal like you did your other information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's all you're gonna need.
[AGENT][NEUTRAL] And that's
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] That's it? I don't have to fill out another claim form or anything else.
[AGENT][NEUTRAL] That's what this
[AGENT][NEUTRAL] You do not, no, ma'am. You would just upload the missing information.
[CUSTOMER][NEUTRAL] OK, well, we'll find out about that.
[CUSTOMER][NEUTRAL] OK, and what is your name?
[AGENT][NEUTRAL] Yeah. My name again is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So would you like for me to read you the complete remark or do you want to just log into your portal so that you can see the full.
[CUSTOMER][NEUTRAL] I'll try to log in and do it, but I'll try to log in and do it. All right. All right, bye.
[AGENT][NEUTRAL] OK. If you.
[AGENT][NEUTRAL] OK. All right. Well, can I help you with anything else today?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK, Miss [PII], well thank you for