AccountId: 011433970860
ContactId: 7e4ae81e-c8c8-4bb9-8867-96dbd6c71ba4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 329670 ms
Total Talk Time (AGENT): 145601 ms
Total Talk Time (CUSTOMER): 144024 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/7e4ae81e-c8c8-4bb9-8867-96dbd6c71ba4_20250512T20:31_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting A. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, I can't hardly hear you. Um, but I was calling about, uh,
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Yes, so, how can I help you?
[CUSTOMER][NEUTRAL] Yeah, I was calling, I called earlier about um a claim I submitted, um, so she was saying that it needed the other information with it like the diagnosis code, but it's related to the, the claim, the, the same claim, so um.
[CUSTOMER][NEUTRAL] I don't know if I need to ask you to put a link in it or something like that, but they're they're they're together.
[AGENT][NEUTRAL] OK, let's look that up. And what is your policy number, please?
[CUSTOMER][NEUTRAL] Uh yes, it's 256.
[CUSTOMER][NEUTRAL] 9252.
[AGENT][NEUTRAL] OK, thank you. If I could verify your name, uh date of birth and the phone number, please?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And is there a phone number that you a phone number, please?
[CUSTOMER][NEUTRAL] And what else did you say?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][POSITIVE] I appreciate that. Thank you. Is this for an ER visit for, uh, March, excuse me, [PII]?
[CUSTOMER][NEUTRAL] No, not
[CUSTOMER][NEUTRAL] Not that one, but is that one done yet?
[AGENT][POSITIVE] Yes, that one has been completed.
[CUSTOMER][NEUTRAL] OK, is it gonna pay?
[AGENT][NEUTRAL] Uh, yes, it looks like you will be receiving a $500 for that that has just been processed.
[CUSTOMER][NEUTRAL] Oh, that's the most they can do, right?
[AGENT][POSITIVE] Yes, that's correct. It's.
[CUSTOMER][NEUTRAL] Based on my plan.
[AGENT][NEUTRAL] But it's, yeah.
[CUSTOMER][NEUTRAL] OK, but I was calling about the one.
[CUSTOMER][NEUTRAL] On, um, so the claim number is 359.
[CUSTOMER][NEUTRAL] 963-3.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that one is directly late.
[AGENT][NEUTRAL] Now this one
[AGENT][NEUTRAL] Oh, please go ahead. Mhm.
[CUSTOMER][NEUTRAL] That would be directly related to the 359-962-6. So the first one I submitted was the uh the itemized bill and the EOB that was just for the office visit and the X-rays, right? And then the next one I submitted was for the DME equipment, but it was all the same, you know, uh, bill.
[AGENT][NEUTRAL] Right, I, I understand they, they will usually do that, um, they'll put it all on the same bill and it's, uh, but what we have to do is we have to look at it, um, individually, so it, it, uh, what they do, they go through the, the bill, uh, just to see um what can be paid and what can't be paid and even though it's on the same bill.
[AGENT][NEGATIVE] Because your policy doesn't cover durable medical equipment, it's, it's not going to be paid. Now, the, the other services look like they were paid. Yeah, so it doesn't matter whether it was related to the same bill or not, it's just not going to, it's, it's not covered.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, OK, because when I looked at the, um, you know what y'all said it said that y'all needed the diagnosis code and the itemized bill for the DME or whatever, but I'm like it's all related to the same thing, you know how they send you the um.
[CUSTOMER][NEUTRAL] I guess the denial in a sense.
[AGENT][NEUTRAL] Right, what it looks like what we were looking for was for the, and I don't know the the OB can be kind of confusing, but it looks like what we were looking for was the uh information for um.
[AGENT][NEUTRAL] Uh, for the ER visit, uh, and it, it looks like it was all kind of stuck together and that's probably what the problem is that, um.
[AGENT][NEUTRAL] Yeah, what we're what we were needing is the information for the for the ER visit, uh, in particular, and that was the one that we were able to take.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, OK, because when I looked on my claim, I clicked on the claim number and it says equipped for life. It says outpatient benefits doable, doable DME and then it says at the bottom explanation it says in order to complete the process of the claim we need an itemized statement of service providing a list of charges, diagnosis codes and procedure codes.
[CUSTOMER][NEUTRAL] So you're saying that this is basically they sent this.
[AGENT][NEUTRAL] Yeah, that
[AGENT][NEUTRAL] Yeah, that's basically what that was. It was, it was for the, um, it was for the other information and, and not for the, the, and it is confusing. I understand that, um, but it's for, it's for the other services that's not it, but it won't be for the durable medical because that's not gonna be covered under your policy.
[CUSTOMER][NEUTRAL] OK, OK, but I keep asking the same question. The lady did tell me that they will, you will cover my lab work.
[AGENT][POSITIVE] Yes, it looks like uh let's see what we have here we have.
[AGENT][NEUTRAL] See what things we have here because so the the.
[CUSTOMER][NEUTRAL] No, I haven't, I haven't, I haven't filed that one. I haven't filed the lab work cause I don't have the bill yet.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Oh, I see. OK. So let's see. Yes, um, outpatient is gonna be covered.
[CUSTOMER][NEUTRAL] I was just asking for future, for future.
[AGENT][POSITIVE] Uh, yes, absolutely. Outpatient lives are covered.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] Alright, sounds good. Well, thank you so much for your help, and now I get it. The the the DME, the DME does not pay.
[AGENT][NEUTRAL] OK, there's nothing else you have, yeah.
[AGENT][POSITIVE] Yeah, it's, I wish that it were, uh, but thank you very much for contacting APL. If, if there's anything I can help with, and thank you for calling us. I hope you have a very good day. If you have any other questions, please let us know.
[CUSTOMER][NEUTRAL] Alright you as well.