AccountId: 011433970860
ContactId: 7be30d77-a84d-4070-9f69-385b1317cb9c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 765869 ms
Total Talk Time (AGENT): 350589 ms
Total Talk Time (CUSTOMER): 232381 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/7be30d77-a84d-4070-9f69-385b1317cb9c_20250310T18:56_UTC.wav
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[AGENT][NEUTRAL] Good afternoon thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] This is [PII]. This is a round tree. I had filed a claim, but they told me that they need the uh.
[CUSTOMER][NEUTRAL] Exploration of benefits.
[AGENT][NEUTRAL] Explanation of benefits?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh-huh, yes, sir. So you're wanting to find out how to submit that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, yes, sir. And I'm so sorry, what was your name again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you. And Mr. [PII], what is a good callback number for you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and your policy number please, Mr. [PII].
[CUSTOMER][NEUTRAL] Um, you want the
[CUSTOMER][NEUTRAL] The outpatient or the in hospital?
[AGENT][NEUTRAL] Uh, but if you will notice both of those numbers, the very first part of each number is identical.
[AGENT][NEUTRAL] So you can give me either one. Just give me that first part of that number.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] 02.
[CUSTOMER][NEUTRAL] 19
[CUSTOMER][NEUTRAL] 2119.
[AGENT][NEUTRAL] OK, thank you. So give me a moment please, Mr. [PII], to get your information pulled up. Once I do, I will have to verify several things with you first for security and also Mr. [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. So one moment please.
[AGENT][NEUTRAL] OK, so first off, Mr. [PII], if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. Also your home mailing address, please.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you gave me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you. And lastly, your email address, please, Mr. [PII].
[CUSTOMER][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] OK, thank you very much for verifying all of your information. OK, so Mr. [PII], have you ever set up your profile in our portal called the online service center?
[CUSTOMER][NEUTRAL] No, I never did that because I'm not that good with a computer so I don't mess with it.
[AGENT][NEUTRAL] OK, so if you don't want to set up your profile in the portal where you can upload it directly there, you, the other only two options you would have would be to mail it or fax it.
[CUSTOMER][NEUTRAL] OK, I think I will fax it.
[AGENT][NEUTRAL] We can't accept, yes sir, because we can't accept claims information via email.
[CUSTOMER][NEUTRAL] OK, I could fax it.
[AGENT][NEUTRAL] OK, so the secured fax line that you would send it to?
[CUSTOMER][NEUTRAL] I'm trying to
[AGENT][NEUTRAL] Just let me know when you're ready and I'll give you that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You ready?
[AGENT][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942-3 attention claims.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Please include your policy number, Mr. [PII].
[AGENT][NEUTRAL] On your facts?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now I can see that yes sir we were in need of your explanate on the most recently processed claim. This is for data service in January.
[CUSTOMER][NEUTRAL] Yes, that's what
[CUSTOMER][NEUTRAL] OK, and I also filed a claim for the date of service in February.
[AGENT][NEUTRAL] OK, so as of, let me look because I only see a claim, the most recently processed claim, we needed your primary insurance explanation of benefits and a diagnosis code.
[AGENT][NEUTRAL] So the only claim I see is for data service January 6.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK OK I got, I thought I filed a claim for data service of [PII].
[CUSTOMER][NEGATIVE] Because both of them appointment I had to come out of pocket $500 something dollars.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yes, sir, at this time, if you sent them separately, we have not received the one for February.
[CUSTOMER][NEUTRAL] OK, so how do I send the one for February?
[AGENT][NEUTRAL] You would send that the same way. It could be faxed your claim form, you would need to send your claim form, your primary insurance company's explanation of benefits, and then, you know, your itemized bill, including the diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have the bill and on the back it says.
[CUSTOMER][NEUTRAL] Service type and date.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Just give me a bunch of numbers on the back.
[AGENT][NEUTRAL] OK, you would just need to make sure that it has the diagnosis code and in addition to the procedure codes, because I can see on this one claim that we were just talking about, we needed two things for this claim. One of them was your primary insurance company's explanation of benefits, and the other one is the diagnosis code which it states that you can attain that um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me go back. Give me one second. And yes, the diagnosis for the treatment which was provided on this data service, and that is something that, you know, we also have to have.
[CUSTOMER][NEUTRAL] OK, so I have to go back to them and see if I can get that?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Because I'm looking.
[AGENT][NEUTRAL] We do have to have both things.
[CUSTOMER][NEUTRAL] Right, because I'm looking at uh.
[CUSTOMER][NEUTRAL] It's, it's just gave me a bunch of.
[CUSTOMER][NEUTRAL] This is Plan share.
[CUSTOMER][NEUTRAL] The mountain name so a.
[CUSTOMER][NEUTRAL] Member rate uh about bill.
[CUSTOMER][NEUTRAL] Yes yeah.
[CUSTOMER][NEUTRAL] OK, it's not giving me, OK, I got them codes on one of these.
[CUSTOMER][NEUTRAL] And it says uh.
[CUSTOMER][POSITIVE] Let me give you this so I can make sure I'm getting the right thing.
[CUSTOMER][NEUTRAL] This one says.
[CUSTOMER][NEUTRAL] CTP
[AGENT][NEUTRAL] No, sir, that's the procedure codes. That's not, we need the diagnosis code.
[AGENT][NEUTRAL] Not the CPT codes.
[CUSTOMER][NEUTRAL] That's what the paper said. It says the CPT.
[AGENT][NEUTRAL] Correct. And so that's what I'm saying. That's why I'm letting you know. You can go ahead and send us your EOB if you have that, but you will still have to get your
[CUSTOMER][NEUTRAL] No, that's I said it, excuse me, I said it wrong, it's the CPT.
[AGENT][NEUTRAL] That is correct. That is not what we need. We need the diagnosis code.
[CUSTOMER][NEUTRAL] OK, now.
[AGENT][NEUTRAL] The CPT codes or what they did to you, and you know, what they did. We need to know the why, and that is what the diagnosis code is. That's the procedural. CPT codes are the procedure codes.
[CUSTOMER][NEUTRAL] OK, but I got a letter that was sent to me from y'all.
[CUSTOMER][NEUTRAL] And it says remark.
[AGENT][NEUTRAL] Mhm. And it's got 2.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] It has two things.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] It says in order to provide future consideration to this claim, please submit explanation of benefit.
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Diagnosis for which treatment was provided.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir. So it's
[CUSTOMER][NEUTRAL] But how do I get that?
[AGENT][NEUTRAL] You would get that also from the provider? Was, was this a doctor's appointment or was this something at a hospital?
[CUSTOMER][NEUTRAL] Well, I did a uh.
[CUSTOMER][NEUTRAL] Well, the one that I submitted before.
[AGENT][NEUTRAL] This is for the [PII].
[CUSTOMER][NEUTRAL] I did an X-ray.
[CUSTOMER][NEUTRAL] Yes, I, that was for X-ray and uh I guess it's called.
[AGENT][NEUTRAL] OK, so what
[AGENT][NEUTRAL] So did your doctor order that for you?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. So you would contact the doctor that ordered that?
[AGENT][NEUTRAL] And tell them that you're needing a diagnosis, you're needing a document that has your diagnosis code on it for those dates of service that you're going to be filing your claims for.
[CUSTOMER][NEUTRAL] So I need that from both of them.
[AGENT][NEUTRAL] Uh-huh. Yes, sir.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So actually I don't need the CPT.
[AGENT][NEUTRAL] That's, we already have that information. We're missing the diagnosis code and the proceed and the, excuse me, the explanation of benefits from your primary insurance company.
[CUSTOMER][NEUTRAL] OK, that's for the first one I file, right?
[AGENT][NEUTRAL] Yes, sir. The only one that I see.
[AGENT][NEUTRAL] As of right now that we have.
[CUSTOMER][NEUTRAL] You need the diagnosis so and
[CUSTOMER][NEUTRAL] Patient client.
[CUSTOMER][NEUTRAL] Reconsideration number.
[CUSTOMER][NEUTRAL] Hard codes standard accountant.
[CUSTOMER][NEUTRAL] No, so.
[CUSTOMER][NEUTRAL] I gotta go to both of the doctor's office.
[CUSTOMER][NEUTRAL] And get
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, sir. And you can take that document that you received from us with you so that they can read on there what, what exactly is needed.
[CUSTOMER][NEUTRAL] Alright
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] OK. Well, is there anything else that I can help you with this afternoon, Mr. [PII]?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK then, well thank you so much for calling APO and I hope that you have a very nice and safe afternoon.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right then.
[CUSTOMER][NEUTRAL] 00, excuse me, you, you said I need to uh.
[CUSTOMER][NEUTRAL] OK, you said I need to have the uh.
[CUSTOMER][NEGATIVE] Yeah, I I messed up.
[CUSTOMER][NEUTRAL] Diagnosis
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, sir. We need those two things that are listed on your explanation of benefits should have a number. 1 that says explanation of benefits from the primary, and number 2 says the diagnosis for which treatment?
[AGENT][NEUTRAL] Was provided.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir. I would just take that form with you so that they can see exactly what you're needing. If you're, you said you were gonna be going to those doctor's offices.
[CUSTOMER][POSITIVE] Yes, uh, so, alright, thank you.
[AGENT][POSITIVE] Well, you're welcome. And again, thank you for calling APL. I hope you have a nice afternoon, Mr. [PII].
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][POSITIVE] All right then, you're welcome.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Right.