AccountId: 011433970860
ContactId: 70486eb3-448e-4123-91f7-fd1b86fc8931
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 278739 ms
Total Talk Time (AGENT): 103843 ms
Total Talk Time (CUSTOMER): 116200 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/70486eb3-448e-4123-91f7-fd1b86fc8931_20250110T18:27_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I recently submitted a claim, and I just wanted to talk about new remarks and what further is actually needed, um, to move forward in the process.
[AGENT][NEUTRAL] I could barely hear you.
[CUSTOMER][NEUTRAL] Oh, hold on one second. Give me one second, I'll switch my headset.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] All right, can you hear me better now?
[AGENT][POSITIVE] Yes, I can. Thank you, [PII].
[CUSTOMER][POSITIVE] No problem, no problem. um I recently submitted a claim and I just wanted to get further information to see what else is needed, um, to move forward with the process.
[AGENT][NEUTRAL] Can I have a policy number?
[CUSTOMER][NEUTRAL] It is 02551253.
[AGENT][NEUTRAL] And just could you verify your full name, mailing address, and your date of birth?
[CUSTOMER][NEUTRAL] Uh [PII], um, address [PII], and my date of birth is [PII].
[AGENT][NEUTRAL] Thank you and just what is the email address that we have on file for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] The callback number is [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Is this claim for yourself?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Do you have a claim number?
[CUSTOMER][NEUTRAL] 354-633-3
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it looks like we may be requesting the explanation of benefits from your primary insurance company and the diagnosis codes for their date of service.
[CUSTOMER][NEUTRAL] All right. So I provided the EOB already. I uploaded it um right away. I believe it was like the day after I got the notice that it was needed, which has the like there's no specific diagnosis. They thought my appendix was bursting.
[CUSTOMER][NEUTRAL] So they they made my, I went to my primary care doctor and she, she made me go to the emergency room to get a CT scan and do all the blood work and sit there and cause she thought my, my appendix was bursting. So I don't know if that's how to get that in writing since it was not bursting.
[AGENT][NEUTRAL] So you need, but you went, the diagnosis is the reason that you went. So your reason was because of your appendix. So you need an itemized bill.
[CUSTOMER][NEUTRAL] So that's.
[CUSTOMER][NEUTRAL] OK. So, and I can just get that from the doctor?
[AGENT][NEUTRAL] Yes, you can contact them and ask them and request the itemized bill with the diagnosis on there and you also need your EOB, your explanation of benefits from your insurance company.
[CUSTOMER][NEUTRAL] Cause I submit
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I, I already uploaded those last week to the website.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I know for that claim, this looks like some.
[AGENT][NEUTRAL] Doctor's notes or something.
[AGENT][NEUTRAL] So you're calling about the other claim.
[CUSTOMER][NEUTRAL] Oh, there's another, they have two different numbers. Sorry, I didn't know that. I apologize.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's fine.
[AGENT][NEUTRAL] And for that one.
[AGENT][NEUTRAL] So for the date of service of [PII], we still need to diagnosis codes for the [PII] and the [PII].
[AGENT][NEUTRAL] For your ER visit and your facility on the ER visit on the [PII] and the facility visit on the [PII].
[CUSTOMER][NEUTRAL] OK. So diagnosis codes for the [PII] and the [PII], and I can just call my doctor and get those that information?
[AGENT][NEUTRAL] Mhm you can get that request for an itemized bill for those data services with your diagnosis codes listed.
[CUSTOMER][NEUTRAL] OK, alright, and then I can just upload it again to the site?
[AGENT][NEUTRAL] Yeah, you can upload it and then they will look at it and review it and then check the history and if it's a lot if it's the diagnosis for the data services that we requested, they'll process the claim we process it.
[CUSTOMER][POSITIVE] All right. Thank you so much. I appreciate your help.
[AGENT][POSITIVE] You're welcome, [PII]. Is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] No, thank you. Have a nice day.
[AGENT][POSITIVE] Thanks for calling APL. Have a great day.