AccountId: 011433970860
ContactId: 7a7c4ad5-389a-4c3f-b717-b391d1fba191
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 451679 ms
Total Talk Time (AGENT): 155319 ms
Total Talk Time (CUSTOMER): 146538 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/7a7c4ad5-389a-4c3f-b717-b391d1fba191_20250122T17:41_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling for my husband [PII]. His policy number is 9A as in Alpha.
[CUSTOMER][NEUTRAL] 0100242
[AGENT][NEUTRAL] I'm sorry, can you please repeat that policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] 9 A as in Alpha 0100242
[AGENT][NEUTRAL] OK, give me just a few minutes so I can get some information pulled up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And I'm sorry, what is your husband's name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And his last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Can you please verify his date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is your mailing address?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what is the city and state and zip code?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, Mrs. [PII]. Um,
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And what is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And how may I help you, Mrs. [PII]?
[CUSTOMER][NEUTRAL] The reason for my call today is that I received the explanation of benefits from American public life stating that in order for this um consideration to be given to this claim that you would need a fully itemized surgery bill that includes the procedure code and diagnosis.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I did submit what I thought was what you required um I'm looking back over it um the actual submission, um, and it states the date of service it states the diagnosis which is malignant neoplasm of the mandible and it gives the charges with the coding, the description, the quantity and the cost.
[CUSTOMER][NEUTRAL] Can you help me to understand what more you would need or what this is referring to?
[AGENT][NEUTRAL] Yes, give me one minute. I'm gonna pull up your pol the the um claim. Give me just a few minutes, please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Give me a few more minutes. I'm going through what was sent in to us.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] What type of surgery did he have?
[CUSTOMER][NEUTRAL] Um, he had, um, surgery in his mouth to remove cancer.
[AGENT][NEUTRAL] OK, because based on the information that we have on file for this state of service of [PII], it is what the facility charges and it does not have the procedure code that shows the type of surgery um was performed on these, um, on these codes. It that usually, uh, that will come from the doctor who did the surgery himself.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So you will have to contact that, that surgeon and ask for that detailed itemized bill that has the um 5 number procedure code and his charges for that data service that and those will tell us those chart that procedure code will tell us what type of surgery it is and it will um calculate the benefit that is due to him for that procedure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I understand.
[AGENT][NEUTRAL] And based on this information, there was none of those codes were for that gave us that those procedure codes. That was for that procedure. They were for the facility, you know, what was all the stuff that was done to him or he received at the at the place of service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] At the these places.
[CUSTOMER][NEUTRAL] Right, right, yeah, I was just looking back through that, and that's what I see too. I do see the coding. I see the description, um, but if there's something more that you need, then I will give, give the, um, doctor a call and see if I can get that.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] And we and
[AGENT][NEUTRAL] Yes, so we need to make sure we have the five-digit code because you can have the description, but we need that code because that is what determines the calculation of that benefit for that surgery.
[CUSTOMER][NEUTRAL] OK, and you see the page where it states admission to Oshner LSU and you see all the coding there that state, OK, OK, OK, because that's.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, no, that, yeah, it will, it needs to come directly from the surgeon.
[CUSTOMER][NEUTRAL] OK, well this is where he works, but I will um contact Doctor [PII] and get uh the detailed billing and coding from him.
[AGENT][POSITIVE] OK, great. Well, that's good. OK. Is there anything else I can help you out with, Ms. [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, no, I believe that'll be all for today. Thank you so much. I appreciate your time.
[AGENT][POSITIVE] You're welcome. My pleasure, and you have a wonderful day and thank you for calling American Public Life.
[CUSTOMER][POSITIVE] You too. You're welcome. Thank you. Bye-bye.
[AGENT][POSITIVE] Mm, you're welcome. Goodbye.