AccountId: 011433970860
ContactId: 83fe0e2e-06e0-4b15-8204-c250e71985f1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 447220 ms
Total Talk Time (AGENT): 157163 ms
Total Talk Time (CUSTOMER): 159390 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/83fe0e2e-06e0-4b15-8204-c250e71985f1_20250219T16:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], um, I'm calling for my husband. Um, his name is [PII], and I did an electronic.
[CUSTOMER][NEUTRAL] Uh, submit an electronic documents to y'all from Quest for his lab work.
[CUSTOMER][NEUTRAL] I think on the [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Yes, ma'am. I can assist you with the status. Well, first, can I get your name and a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] OK. My name is [PII]. My husband's name is [PII].
[CUSTOMER][NEUTRAL] Um, call back number [PII] and the policy number is.
[CUSTOMER][NEUTRAL] 023212-17 and the group number is 13531 through Marvin's Electric.
[AGENT][NEUTRAL] OK. Thank you, ma'am. And unfortunately, since you're not on the policy, I can't give you any information.
[CUSTOMER][NEUTRAL] I signed the paper, baby. If you look on it, I signed, we signed the paper and we faxed it in.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Please verify his date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And please verify your mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, one moment now.
[CUSTOMER][NEUTRAL] And my date of birth is [PII].
[AGENT][NEUTRAL] OK. One moment. I'm looking for that documentation. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment, I'm gonna place you on a brief hold.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], thanks for your patience. I did um find your HIPAA form and I can relay this information to you. Um, I do show that we received the claim on [PII] and it processed on [PII]. It's denying because we need the diagnosis code. So if you can get the diagnosis code and write it on the documentation and resubmit it, we can get this.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] It did not, well, I received, I received something in the mail yesterday from Quest, so can I just take a picture of that bill and send it to you or what? I don't understand what you mean.
[AGENT][NEUTRAL] Um, the
[AGENT][NEUTRAL] Yeah, the diagnosis code is probably not on there. The, the diagnosis code is the code for the illness or the injury, the reason why your husband is um seeing this provider. And once you get that information, um you can simply call the doctor and get that information.
[CUSTOMER][NEUTRAL] Yeah, well it can't.
[CUSTOMER][NEUTRAL] OK, so does the doctor need to give you that because it was Doctor [PII] say that um he hit, he's gonna do lab work. He's got rheumatoid arthritis every 6 months. He's gonna do lab work.
[AGENT][POSITIVE] OK. Well, it doesn't have to come directly from the doctor. You can actually get that information from the doctor and write it on the documentation and resubmit it, and we can get this processed and paid for you.
[CUSTOMER][NEUTRAL] Can I have them submit it to y'all? Can I well.
[AGENT][NEUTRAL] Well, yeah, they can submit.
[CUSTOMER][NEUTRAL] See because I got that information from, I got that information from uh from his old insurance website it said explanation of benefits. I thought that was what you needed.
[AGENT][POSITIVE] Yes, ma'am. That's what we need. We need the EOB that's correct. So if you can take that.
[CUSTOMER][NEUTRAL] Isn't that what I sent in?
[CUSTOMER][NEUTRAL] Is that what I sent in?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] That's what you sent in, but we also need the diagnosis code. The diagnosis code is not on the EOB. So, um, you can, you can.
[CUSTOMER][NEUTRAL] Uh-huh. OK, so I'll get the doctor.
[CUSTOMER][NEUTRAL] Go ahead. I keep cutting you off. Go ahead.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, you can get the diagnosis code from the doctor, write it on the EOB and resubmit it.
[CUSTOMER][NEUTRAL] OK, so a diagnostic code.
[AGENT][NEUTRAL] Diagnosis code.
[CUSTOMER][NEUTRAL] Do they know what that is?
[AGENT][NEUTRAL] Yes, ma'am. It's a diagnosis code. It's the code, it's the code for the illness or the injury. And I can also give you the claim number. You can also write this claim number on that documentation so we'll know that this is the um information we need to get this claim paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and what is that claim number missing?
[AGENT][NEUTRAL] It is 356.
[AGENT][NEUTRAL] 4759.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, alright then I'll do that right now, Miss [PII], and I'll resubmit it to you when I get home tonight. No, that was it. Now, does he have enough on there to, I didn't know if he even had anything left over out of the.
[AGENT][NEUTRAL] OK. Is there anything else?
[CUSTOMER][NEUTRAL] Whatever. Um
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Now this is with the old insurance company because on the [PII] he swapped to a new insurance company.
[AGENT][NEUTRAL] Right. And yes, I'm showing that under this policy, it's a calendar year policy. So we'll cover up to $6000. So he has $6000 under our policy, but there is a 100, there is a $100 deductible that needs to be met first. So the 1st $100.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Oh, so we would have to pay that regardless, right?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, but y'all need it for y'all's record to show that we paid it right to deduct it from the $100 deductible.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, OK, I'll go ahead and pay it and then I'll get the code and I'll send it to you so you can make a notation of it, OK.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] Thank you for helping me.
[CUSTOMER][POSITIVE] No, thank you, Miss [PII]. You have a wonderful day and thanks for your help.
[AGENT][NEUTRAL] You do the same, Ms. [PII]. Thank you for calling ATL.
[CUSTOMER][POSITIVE] All right. Thank you. All right. Bye-bye.
[AGENT][NEUTRAL] Mm bye.