AccountId: 011433970860
ContactId: 884812a0-3ed0-45cc-a597-e48f12f57698
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 229929 ms
Total Talk Time (AGENT): 120333 ms
Total Talk Time (CUSTOMER): 64247 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/884812a0-3ed0-45cc-a597-e48f12f57698_20250429T16:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I had submitted a claim the other day, and I got it. It's actually for 3 different visits, so there were 3 like that I sent all of them in together because they were all on the same bill, um, and I got a text today that said that I could check it that it was processed or something. So when I looked at it, it's not showing me anything, so I didn't know if I'm not doing something right or maybe it just hasn't updated yet.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Hm, yeah, maybe it just hasn't updated. Do you have the claim number or policy number? I'm happy to check on it.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][POSITIVE] And get that for you.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, it is 359-470-7.
[AGENT][NEUTRAL] OK, thank you. Let me just pull this up here.
[AGENT][NEUTRAL] All right. And then [PII] for security, I do need to verify please your date of birth and address.
[CUSTOMER][NEUTRAL] OK, [PII] and [PII].
[AGENT][POSITIVE] All right, thank you so much.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like the claim was denied. Um, it looks like any office visit fee is not covered. That was one of the denials, but
[CUSTOMER][NEUTRAL] OK, I didn't have an office.
[AGENT][NEUTRAL] It wasn't? OK. The majority of these, there was [PII].
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] So the majority of this is denied just stating that we need the explanation of benefits and diagnosis. So in order to provide further consideration to the claim.
[AGENT][NEUTRAL] We need explanation of benefits from your primary insurance carrier and then the diagnosis for which the treatment was provided on the date of service.
[CUSTOMER][NEUTRAL] OK, so I just need to call them and ask them for explanation of benefits and diagnosis.
[AGENT][NEUTRAL] So explanation of benefits would come from whoever your primary insurance is for that date of service. You should be able to either get those online or contact them directly.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then the diagnosis for the date of service, that would come from the actual doctor, hospital provider office and just let them know that you need uh something showing the diagnosis for the date of service for the diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then is there a fax number that I can have them fax this to?
[AGENT][NEUTRAL] Mhm. Absolutely. The fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you can just submit those um the explanation of benefits and the diagnosis you don't need to resubmit everything else they'll just go ahead and complete processing this claim, so.
[CUSTOMER][NEUTRAL] OK, alright, well I will try to get a hold of them and track all this down.
[AGENT][POSITIVE] All right, not a problem. Is there anything else I can do for you today?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEGATIVE] No thank you bye bye.
[AGENT][NEUTRAL] Bye bye.