AccountId: 011433970860
ContactId: 778db310-7c31-4424-ae07-d826b8e48eef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 375089 ms
Total Talk Time (AGENT): 155262 ms
Total Talk Time (CUSTOMER): 101531 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/778db310-7c31-4424-ae07-d826b8e48eef_20250423T18:04_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, I'm just calling to get the status of my claim, please.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with.
[CUSTOMER][NEUTRAL] I have a
[CUSTOMER][NEUTRAL] The policy number 7368888.
[AGENT][NEUTRAL] May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And can you, I um have the policy here. I just need you to verify your date of birth, your mailing and email address on file if you have one.
[CUSTOMER][NEUTRAL] 5156 D. [PII].
[AGENT][NEUTRAL] And the mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment.
[AGENT][NEUTRAL] And would this be, let me see, it looks like the claim that came in on [PII]?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This is the most, I'm just trying to make sure this is the claim you're looking for, the most recent claim. OK.
[CUSTOMER][POSITIVE] Yes, yes. Yes, I think so. Yes, it is, yes.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] There's a one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, one of your codes was denied because um office visits are not covered by this policy?
[AGENT][NEUTRAL] But then for your [PII] data service looks like this is radiation at Northside. We just need a copy of the itemized bill from the hospital. So you would just call Northside.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I, I thought, I thought I sent it to you.
[CUSTOMER][NEUTRAL] You didn't get it?
[AGENT][NEUTRAL] Uh, let me look at the documents. Hold on one moment.
[CUSTOMER][NEUTRAL] The itemize.
[AGENT][NEUTRAL] I'm gonna pull the documents and see if it's here. Do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Mhm, mhm, mhm.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello Ms. [PII].
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So, yes, we received an itemized bill, but this bill here is, is like your patient copy. So it lists codes, but it's the procedure codes, where, so basically this is telling us what you received and how much you paid, but we need to know why, which is the diagnosis, and that's on the itemized bill from the hospital.
[CUSTOMER][NEUTRAL] Oh gosh, I think they sent it to me, but.
[CUSTOMER][NEUTRAL] All right. And uh the one that you said, mhm.
[AGENT][NEUTRAL] So basically, um.
[AGENT][NEUTRAL] Um, you would just call Northside and let them know, um, or request a universal bill for dates of service, uh, [PII] and just stress to them that it needs to be their copy of the bill, not the patient version, and it needs to have diagnosis codes.
[AGENT][NEUTRAL] Or they may say ICD 10.
[CUSTOMER][NEUTRAL] OK, another thing.
[CUSTOMER][NEUTRAL] Yes. Another thing, um, for the, for the uh patient visit, that was to the doctor, you said that you're not covering?
[AGENT][NEUTRAL] Yes, office visits are not.
[CUSTOMER][NEUTRAL] There's another
[CUSTOMER][NEUTRAL] OK, I, that was.
[CUSTOMER][NEUTRAL] That was the amount to the doctor.
[CUSTOMER][NEUTRAL] When I went for radiation, so.
[CUSTOMER][NEUTRAL] Yeah, they have it on the visit, huh?
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] All right. I thought that they paid her for doing the radiation, but that wouldn't be, OK.
[CUSTOMER][NEUTRAL] I'll question that also with them, OK?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] To find out if that was a visit or if that was any treatment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, and if it is, if they did mean to send it for the treatment, then they would and she could, uh, they can send the correct the claim anytime, so there's no like deadline or anything. But then they would just, it's the coding on there, the coding is for uh like a place of service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[CUSTOMER][POSITIVE] All right then, thank you. I'll check into it. Thank you.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] No, that's it. Thank you.
[AGENT][POSITIVE] Alright, thanks for calling API. You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] OK. Bye-bye.