AccountId: 011433970860
ContactId: 8e3e98ea-b09f-4479-9f12-5b787787eaf6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 511239 ms
Total Talk Time (AGENT): 155501 ms
Total Talk Time (CUSTOMER): 118856 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/8e3e98ea-b09f-4479-9f12-5b787787eaf6_20250224T19:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, how you doing? Um, I had submitted a claim and, uh, it didn't say it says process but doesn't say why it was I guess not paid out. Just wanted to get more clarity on that.
[AGENT][POSITIVE] Yeah, absolutely. I'm happy to check a claim for you. Do you have your policy number or the claim number?
[CUSTOMER][NEUTRAL] Yeah, the claim number is Oscar Sam Charlie.
[CUSTOMER][NEUTRAL] 93534
[AGENT][NEUTRAL] OK, yeah, that's your like um online service center confirmation number, not the actual claim number, I'm sorry.
[CUSTOMER][NEUTRAL] Oh, there's another 10, no, sorry. It's uh 3356.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 5117.
[AGENT][POSITIVE] Alright perfect that sounds right let me pull this up here.
[CUSTOMER][NEUTRAL] And I guess it I, I added more um probably a better one. Let me go back to that one instead.
[CUSTOMER][NEUTRAL] Uh, the other one is 356.
[CUSTOMER][NEUTRAL] 5121.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] No, actually, no, no.
[CUSTOMER][NEUTRAL] No, no, ignore, ignore what I just said. The, the, the one I just gave you, the 117 is correct. I'm sorry.
[AGENT][NEUTRAL] No, no worries. OK. Let me pull that up here.
[AGENT][NEUTRAL] OK, and then on the policy, I will need to verify please your first and last name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you, [PII].
[CUSTOMER][NEUTRAL] Oh, here's the other one it's um.
[CUSTOMER][NEGATIVE] So what I did was I submitted I guess the forms and I said oh shit I gotta add this other itemized form and I did and it gave me another claim number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Different what what I gave you. So the, the new one, I guess after I add that that 3 additional invoice.
[CUSTOMER][NEUTRAL] It's 356-512-1.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on the claim, the one that you gave me, uh, [PII], the one that ended in 5117, it looks like this was emergency ER visit for January of this year. Is that correct?
[CUSTOMER][NEGATIVE] Mm no.
[CUSTOMER][NEUTRAL] No, that's why I think I messed up and that so if you scratch that one and go to the 121, it has the correct date and the the the all the files that's in 117 but.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, let me look at that.
[CUSTOMER][NEGATIVE] That one I get why because that doesn't match up.
[AGENT][NEUTRAL] OK, there we go.
[AGENT][NEUTRAL] OK, [PII]. Let me see what this.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it looks like the only other thing, [PII], that they need on this claim is a diagnosis code. And diagnosis codes can be obtained from the physician. So, whoever you had seen or the facility, you would need to contact them. They need um like an itemized bill with diagnosis codes on it.
[CUSTOMER][NEUTRAL] So that that one does it's called itemized bill and I see the codes with everything that they did in the ER.
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] I'm just pulling up the um
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] The upload here so I can take a look.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK [PII], so I see the bill that was submitted and so all those codes there.
[AGENT][NEGATIVE] Um, those are what they call like procedure codes. That's how they like code for what you're being charged for. They just need something stating what you were being seen for. That's what a diagnosis would be. Um, it's con it's
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, so I, I'll call him and get a, get a, get a list of the diagnosis codes.
[AGENT][NEUTRAL] Yeah, just tell them I need a diagnosis code for my secondary insurance for what I was seen for on [PII].
[CUSTOMER][NEUTRAL] Now do I just give you, do I just write the code in the in the in the description or do I have to attach something that they give me?
[AGENT][NEUTRAL] No, I mean you can actually write it on that um first page of the bill if you want to from like Saint Luke's and just resubmit that. You don't have to resubmit everything all again um you can just upload that one piece.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] How, how would they know, how would they know when I upload that? How would I know, I guess to say is it distribute with claim number 121.
[AGENT][NEUTRAL] Yeah, you can absolutely reference the claim number, the 356512-1, uh huh.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK perfect I'll do that.
[AGENT][POSITIVE] OK, sounds good.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] You're welcome. Have a good day. Bye-bye.