AccountId: 011433970860
ContactId: 8ab40738-8946-452d-851e-b94c7b992763
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 320519 ms
Total Talk Time (AGENT): 162192 ms
Total Talk Time (CUSTOMER): 183721 ms
Interruptions: 7
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/8ab40738-8946-452d-851e-b94c7b992763_20250219T15:08_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APO. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Um, I am, I, I have some confusion about the claim submission process, so I submitted a claim and it was not paid because it was lacking the um diagnosis code, so I received the official paperwork from the hospital with the diagnosis code information but.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] I there was there was nowhere to upload it to the original claim. I just uploaded the form again, but what what's the what's the better way to do that?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEGATIVE] Like I expected when I when I went to when I went to click on upload files I expected the system to ask me which do you want this associated with but it didn't it just uploaded it as a brand new whatever claim I guess.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm. Yes, um, and that is correct. Um, may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] [PII] and my name is [PII].
[AGENT][NEUTRAL] [PII]. OK, um, Miss [PII].
[CUSTOMER][NEUTRAL] Right, you want my policy number?
[AGENT][NEUTRAL] Yeah, go ahead.
[CUSTOMER][NEUTRAL] OK. 247.
[CUSTOMER][NEUTRAL] 8716.
[AGENT][POSITIVE] OK, thank you, Miss [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and that is correct. Once we process the claim, it, it locks because um we have to pull all the documents and look into it and see if it's payable so it will lock that one whenever you submit additional information, it will have to go into a new claim, but once we receive we open the claim and we see that it's related to the other claim, we'll go ahead and put it together, um, but that's why yeah.
[CUSTOMER][NEUTRAL] OK, I, I also have, um, I also have the radiology facility is, um, faxing you the um additional information. They said that they've dealt with you very often so I'm assuming that's gonna work out OK too, but, uh, you know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, I can check and see if we got it or not, but yeah, if they send it directly from the provider's office if you have not made a payment, if you have not paid fully, uh, we'll go ahead and process and pay them directly, um, let me go ahead and just.
[CUSTOMER][NEUTRAL] OK, so you will pay them directly. OK. I, I submitted the claim, but they're submitting the additional documentation, so.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So you submitted the um original claim.
[CUSTOMER][NEUTRAL] I did. I submitted the original claim, um, and that I believe is, I don't know which one that is but oh I think it's a confirmation number OCS.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, 93755 I think it is. I could be wrong. I think that's it, um.
[AGENT][NEUTRAL] Yeah, let me check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think that's the one.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Maybe not.
[AGENT][NEUTRAL] Um, what is your date of
[CUSTOMER][NEUTRAL] So basically I, I had the [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I had to contact the hospital to get the um.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] The code forms with the diagnosis codes on them in order to then submit them and then when I called the radiology um office they said oh well we deal with this all the time we'll submit it for you so I just gave them the information.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm, yeah, and that's right, that's fine, yes, um, now, um, it really depends on the paperwork. If the paperwork is indicated that um you did sign over um for them to collect more than likely it's gonna be sent out to them, OK, if you did have a signature there. OK. All right, no problem. Do you have any other questions, any other go ahead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I have no no problem with that.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] But like, but like the um the MRI that I had, I've already paid that.
[AGENT][NEUTRAL] OK. The MRI, OK, and that's, um, that's a different claim or that's part of?
[CUSTOMER][NEUTRAL] And I, I think I uploaded, I think, no, that was, well that was one of the claims filed that you guys said you needed more information so I just uploaded the additional information with the diagnosis codes, but I, I've already paid that $500.
[AGENT][NEUTRAL] OK, but it's not part of the claim that.
[CUSTOMER][NEGATIVE] But that information is not coming.
[AGENT][NEUTRAL] It's not coming from the provider, got you, yeah, mm.
[CUSTOMER][NEUTRAL] Yeah, it's a different claim.
[CUSTOMER][NEUTRAL] Correct, correct, it came from me, so I guess you'll see that it came from me.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] Yes, correct, yes.
[CUSTOMER][NEUTRAL] I mean whatever you can OK.
[AGENT][NEUTRAL] Yeah, we'll go ahead and review the claim. Got you. Yeah, we'll go ahead and review the claim and see exactly who's asking or who's charging who's who's trying to submit the claim and who do we need to pay based on that information. Um, but yeah, if you're the only one sending a claim for that part of your claim, then it should be processed and pay under your yourself which is just gonna go ahead and generate any payments under yourself, OK?
[CUSTOMER][NEUTRAL] I, I, I owe them a lot of money, so.
[CUSTOMER][NEUTRAL] OK, well,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, no problem, thank you so much I appreciate it.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] Nope, I'm good.
[AGENT][POSITIVE] OK, well, thank you for calling [PII]. Have a good day, Ms. [PII].
[CUSTOMER][POSITIVE] OK thank you bye bye.
[AGENT][NEUTRAL] Yeah.