AccountId: 011433970860
ContactId: 737ac43c-e808-4d97-9849-d48a5bc6f450
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 694869 ms
Total Talk Time (AGENT): 431981 ms
Total Talk Time (CUSTOMER): 237309 ms
Interruptions: 5
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/737ac43c-e808-4d97-9849-d48a5bc6f450_20250310T14:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], it's [PII]. I've got um hey I've got Miss [PII] on the phone. She's called already a couple of times this morning. That's why I'm calling you instead of sending it through the hub. She's trying to get her information together. Her policy number is 244-73993.
[AGENT][NEUTRAL] Hey, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And she has a claim that she's that um she's going to resubmit.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And she did call this morning and she was told that she needed to get um an ICD 9 code.
[CUSTOMER][NEUTRAL] She went to the emergency room that she visited. She's got the itemized statement she's got the EOB from the primary, but the emergency room told her that they that it came through the emergency room and they can't give her a diagnosis code because she just failed and came to the ER. She's not able to get that and she's wondering if the itemized statement and the EOB along with the claim form would be enough to send in for her claim to reprocess.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, let's see, well, nobody uses ICD 9 anymore, so I don't.
[CUSTOMER][NEUTRAL] That's what she was told.
[AGENT][NEUTRAL] Yeah, nobody, nobody would be able to provide that. Um, it's ICD1N now. Um, it has been for years, so I don't really know why she was told that. Um, but, so that, sorry about that miscommunication, but, um, as far as I'm trying to see what we have because the, let's see, the remark says an EOB and a diagnosis for which treatment was provided.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So if my own base would load this document, I could see what we have going on here um because it looks like where we see that she had like an X-ray I'm assuming and then on one day and then she went to the ER on a different day so it looks like we have two different dates going on here.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm trying to see what we have. Oh my goodness, is your own pace this slow this morning?
[CUSTOMER][NEUTRAL] My on base is always slow. It always gives me fit.
[AGENT][NEUTRAL] It is just spinning today.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Oh goodness. OK. Um.
[AGENT][NEUTRAL] Oh, here it goes, finally. OK. All right, so she had an MRI. OK. So an MRI back in [PII].
[AGENT][NEUTRAL] And then,
[AGENT][NEUTRAL] With no diagnosis codes. OK, so that it is the need for diagnosis code there. It looks like we have.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Kind of, I mean, the EOB is appreciated. It looks like we, if she can provide that, that would be great. If not, we may be able to do that, but we do need a diagnosis code for that, ICD 10.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] ICD 10
[AGENT][NEUTRAL] Not 9 ICD 10. Um, I will say that sometimes you can obtain like your medical records, um, and
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If she has access to like.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] I don't know what it's called with them, but it could be like a my chart or something like that. Sometimes you can get like an aftercare summary or an after visit summary or something like that and it will provide what your final diagnosis or what you were seeing for um to indicate if you're unable to obtain your actual the actual code from the facility that you've received services at whether that be.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] An outpatient MRI facility or imaging facility or whether that be an ER sometimes you can do that, um, yeah, because and.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you want me just to, you want me to just go ahead and go back to her and let her know this information and then if she has further questions transfer her.
[AGENT][NEUTRAL] Yeah you can do that like let her know that um that it is actually ICD 10, but if they were unable to provide a diagnosis code at all, if she could obtain any type of after visit summary that indicates why she was saying that we, we usually can use that too and if she still has more questions if you wanna just put me on hold so I'm available, um, yeah, I'll I'll stick around just in case.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I'll do that. I'll be right back, hopefully, hopefully not, but if I do this, let me hopefully to tell you that she's OK now.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] Perfect. OK, I'll hang on for a sec.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Well, she hung up.
[AGENT][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] On me, I told her the information and she said, I'm just gonna go to my doctor and have them tell me why and I'm gonna tell you why. I said well you need to have the document to come with your claim.
[AGENT][NEUTRAL] Yeah, because if she just calls and says.
[AGENT][NEUTRAL] Hey, I was seeing, you know, for this we still can't accept that we still have to have a document, so hopefully she obtains an actual document.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Goodness, I mean I understand the frustration, but at the same time like.
[CUSTOMER][NEUTRAL] Oh, yeah.
[AGENT][NEUTRAL] We're just doing our job, you know what I mean? we're just doing our job.
[CUSTOMER][NEUTRAL] Yeah, we're just doing our job, right?
[CUSTOMER][NEUTRAL] And she said this has got me upset because um I'm trying to get a house and I've got this has gone against my credit and I said I am so sorry to hear that I hope you can get it quickly and and get it turned into us.
[AGENT][NEUTRAL] I mean
[AGENT][NEUTRAL] Here's the thing, and this is just a personal opinion obviously this doesn't have anything to do with APL but you shouldn't be waiting on us to pay your bills.
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] I mean, because what if, what if it's not payable at all? I mean, not, um, this is a gap plan, so it's, it's far less likely when you have a gap plan for us to not pay unless you've just maxed out, you know, but I mean, I know, I know some of this money isn't, I personally, I, I have 3 kids, you know, and a husband, so you know, I get it. Money, money just ain't sitting around waiting.
[CUSTOMER][NEUTRAL] And, and if
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] But to be yeah, but I mean, set up a payment plan until you know for sure or something because.
[AGENT][NEUTRAL] I don't know.
[CUSTOMER][POSITIVE] Yeah, I agree, I agree. Plus if you've gone to collections, you've had a few notices before it took you to collections, so you should have already.
[AGENT][NEUTRAL] That's just personal, so.
[AGENT][NEUTRAL] Um, Rock.
[AGENT][NEGATIVE] Right, and we're just, I mean you were saying in October and we're just now getting your bills in March so and for outpatient she only gets $500 per day so if she was seen in the hospital on that $1000.01 it's still, still not gonna pay for all of it.
[CUSTOMER][NEUTRAL] That's what I thought.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So I don't, OK, well, I can't do anything about that, so.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Oh we can't, we're, I think we've helped her as much as we can help her. I think the rest is just her footwork getting what she needs to send in.
[AGENT][NEUTRAL] You're up.
[AGENT][NEUTRAL] Yeah hopefully she doesn't just call with a diagnosis code because whoever answers is just gonna have to turn around and tell her, you know, we appreciate that and we'll make a note, but we need a physical document we can't accept it over the phone.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, and I went ahead and put that in my notes that she needs to send a document to so that we have that.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, and, OK, well.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Maybe she'll be able to get what she needs and just send it in and maybe her call will be like hey I'm sending this in and not and it looks like we have two new documents so.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Hopefully.
[AGENT][NEUTRAL] I don't know if that's.
[AGENT][NEUTRAL] Going to be
[AGENT][NEUTRAL] In relation to this or if it's going to be.
[CUSTOMER][NEUTRAL] She said that um she had to get the EOB and the itemized statement. So she sent that in already.
[AGENT][NEUTRAL] OK, so let me, I'm going to look at that and see because I haven't looked at that.
[CUSTOMER][NEUTRAL] So that's probably what that is.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] One of them hasn't been transferred over to or from indexing so I just see one but.
[AGENT][NEUTRAL] I'd EOBs rarely have and out of my statement truly rarely have everything we need. Sometimes they do, but oftentimes they don't, yeah, like this is from her ER visit in October.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And it has, you know, the same thing that her thing has the balance that she owes, payments that were made, um, basically stating that, you know, her co-pay is this, and so, but it still doesn't say why. I mean we can make assumptions because they were taking images of her leg, but.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We, we don't actually have a diagnosis code, so yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Well, I'm hoping that she gets it together and gets it put it sent in so that she can get a little bit of help and if she doesn't then.
[AGENT][NEUTRAL] Yup.
[AGENT][NEUTRAL] I.
[CUSTOMER][POSITIVE] You know, don't be upset with us because you're having to rush at the last minute to get it all done.
[AGENT][NEUTRAL] I know, I know. Exactly. I mean, like I said, both of these bills are from that October visit, it looks like. So she's had 6 months, well, not quite 6 months, but.
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Like 5 months so and then they usually file pretty quick because those, you know, they can't be waiting around for payment either so she at least would have had something by December I would say.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] I would think so, yeah.
[AGENT][NEUTRAL] So yeah, I mean that's at least 3 months that this could have already been submitted and handled at least partially so I don't, I don't really know what to do from there. There's not anything we can do so hopefully she gets it and we can turn that around and get it out to her, but you know.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I don't either. I think, I think we've
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][POSITIVE] Right. And I think we've done what we can to help her, um, the rest is up to her, you know.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Absolutely, absolutely.
[AGENT][NEUTRAL] All right.
[CUSTOMER][POSITIVE] OK, well, I hope you have a good um rest of your day. Hopefully I won't have to bother you again and I'm sorry to normally I would have sent a hug, but she was a little spicy and she's already called this morning so I thought, you know what, I need to go ahead and help her now.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That's OK.
[AGENT][POSITIVE] Yeah, no, that's fine. I don't mind at all. Just when, if you need anything, give us a call.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right, you take care. Bye bye.
[AGENT][POSITIVE] All right. Have a good day.
[AGENT][POSITIVE] Thanks. Bye.