AccountId: 011433970860
ContactId: 8ec20523-bb94-42b1-b9d5-ab9e8d3d88f6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1039098 ms
Total Talk Time (AGENT): 309390 ms
Total Talk Time (CUSTOMER): 257997 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/8ec20523-bb94-42b1-b9d5-ab9e8d3d88f6_20250603T12:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEGATIVE] Hi, I received a notice a while back, um, that you guys needed an itemized statement which I had sent in, and then you sent it back saying you wanted an itemized statement with the diagnosis code and I keep asking my doctors. I keep asking my doctors for this information, and they keep sending me the everything that you I already sent you. I don't understand why you guys are requesting that when there there should be some type of HIPA.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] That that should be a HIPAA violation if you ask me. I mean, you guys know that it's an office visit and you know you're required to pay office visits, so I'm not sure why you're questioning what my diagnosis.
[AGENT][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] So I want to know why it's not being paid.
[AGENT][POSITIVE] OK, I'm happy to look at the claim. Do you have your policy number? I can pull all this up.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Claim I have a claim number.
[AGENT][POSITIVE] OK, that works. I can pull it with the or yeah.
[CUSTOMER][NEUTRAL] Policy numbers. OK, I'll get, OK, I'll give you the claim number 358.
[CUSTOMER][NEUTRAL] 1309.
[AGENT][NEUTRAL] OK, let me pull this up. Give me just a second.
[AGENT][NEUTRAL] All right. So I just need to verify your first and last name and date of birth, please.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so I do see where it is asking for that let me.
[AGENT][NEUTRAL] Look to see.
[AGENT][NEUTRAL] I'm just pulling up the claim and like everything, so I apologize for the hold here.
[CUSTOMER][POSITIVE] No, that's fine. I appreciate you looking.
[CUSTOMER][NEGATIVE] I like, I, I got this. I lost my job and I took this plan under the like assumption because it was told to me that this was an actual insurance plan, but until I went to the doctor and found out that it was a uh discount plan, I'm like, well shoot, I might have got a better discount if I would have went in and self pay.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, these, um.
[CUSTOMER][NEGATIVE] I'm hit with like all these bills.
[AGENT][NEUTRAL] Yeah, because a lot of these things on here show like just not covered.
[AGENT][NEGATIVE] Unfortunately,
[AGENT][NEUTRAL] So I was trying to look and see exactly what on here is asking for an itemized statement with a diagnosis code cause
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] Just the office visits, just the office visit.
[AGENT][NEUTRAL] Yeah, there's just 2.
[AGENT][NEUTRAL] Two lines, let's see.
[CUSTOMER][NEUTRAL] Yeah, I, I think they're two offices at least that's what I was told when I called the last time.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] They said that's all they cover which is pretty much useless.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm, I, I'm still hit with a $200 bill from one of those offices.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] OK, yeah. And then
[AGENT][NEUTRAL] See, that's what they both are.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, yeah, and
[AGENT][NEUTRAL] What you had submitted was.
[AGENT][NEUTRAL] Quite a few pages actually.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] How, what was it?
[AGENT][NEUTRAL] All the stuff that was submitted with the claim, I mean, there were still, there were quite a few pages submitted with the claim.
[CUSTOMER][POSITIVE] Yeah I know it was literally everything, everything that I ever got.
[AGENT][NEUTRAL] What, when you, yeah, when you.
[AGENT][NEUTRAL] Not had that.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] So, yeah, I mean, it looks like on the [PII] and the [PII] for the office visit.
[AGENT][NEUTRAL] Those are the two things that are just asking for the itemized receipt, um.
[CUSTOMER][NEUTRAL] And I sent that in.
[CUSTOMER][NEUTRAL] I did send that in.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I, I actually sent it in with all of this, so that's what whatever you guys have got is what I was given. I cannot get anything else. Everything they keep sending me is the same thing. I don't know what more you people want from me and an itemized statement of an office visit is just an office visit. It's not like they did anything else there.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, so I don't know what they're looking for. It's, uh, uh, look, they're looking to try to get away without paying it, what they're looking for.
[AGENT][NEUTRAL] OK. So, yeah, I, I mean, I'm scrolling through all of it. So what I mean, what I can do [PII] is
[AGENT][NEUTRAL] You know, I can reach out to a claims examiner and have them relook at this and if, you know, there's something specific and then just have them reach out to you and tell you exactly what it is to get it paid so you can be done with it and move along.
[AGENT][NEUTRAL] So if you're open to a
[CUSTOMER][NEGATIVE] Well, they told me the last time that they wanted a diagnosis code. There should be a diagnosis code on it already one. So, it's really, it's a violation of HIPAA if you're asking me for that. You're not an insurance company. So like you can't, you're not paying any of my bills technically, you're just reimbursing me for a couple offices. It's almost like a, like an insurance policy, like, uh, not an insurance policy, like a, um.
[CUSTOMER][NEGATIVE] I don't know, like, uh, runners thing. I don't know, bu[PII] I'm, I paid well into this and you guys are fighting me over $100 110 dollars.
[CUSTOMER][NEGATIVE] Making it extremely difficult for me to get paid. I mean, you ask, you pay office visits, you got a bill that says office visits. I, I don't know why you need to have every little detail, what my blood pressure was and everything, nor should you be allowed to have that.
[CUSTOMER][NEUTRAL] Office visit is an office visit.
[AGENT][NEUTRAL] So I can have somebody from the claims department call you back on this or I can transfer you to somebody now um it's up to you as.
[CUSTOMER][POSITIVE] I'll, I'll, I'd prefer to get transferred. I'd prefer to get transferred because I'm on my way to work.
[AGENT][NEUTRAL] OK alright hold on the line just one moment please.
[CUSTOMER][NEUTRAL] Right. You are on hold.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] Seriously.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[AGENT][NEUTRAL] To really for all those.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][POSITIVE] Good morning. Thank you for calling ATO. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Good morning, [PII]. This is [PII]. How are you?
[CUSTOMER][NEUTRAL] Good morning. I'm fine. How about you?
[AGENT][MIXED] Good, it's too early. I need more coffee.
[AGENT][NEUTRAL] Um, alright, I have an insured on the line. She's like all upset about this claim. Do you want her policy number to start with?
[CUSTOMER][NEUTRAL] Yes, what's the policy number?
[AGENT][NEUTRAL] 025472227.
[CUSTOMER][NEUTRAL] And that was 025472227?
[AGENT][NEUTRAL] should be
[AGENT][NEUTRAL] Yeah, for [PII].
[CUSTOMER][NEUTRAL] For just
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what claim is it in regards to?
[AGENT][NEUTRAL] And the
[AGENT][NEUTRAL] It's claim ending in 1309. I didn't check to see how many she has. It's 358.
[AGENT][NEUTRAL] 1309.
[CUSTOMER][NEUTRAL] OK, let me take a look.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So, you know, she's upset about the two denial lines where we're asking for an itemized statement with diagnosis codes.
[AGENT][NEGATIVE] She says that she sent that, you know, I pulled up what was sent and I don't see that. She did send us like 42 pages, but I haven't found anything as of yet.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then she's going on about, well, you know, I don't even know why you guys need that. It's just an office visit. Like an office visit is an office visit, like, you know, why do you need a diagnosis code? It's nothing else, you know. And I'm like, OK. And, and she's like, it's none of your business going on and on and she's like, OK, you know, so, anyhow, that's kind of where we're at.
[AGENT][NEGATIVE] I told her we needed it to continue processing it, but she doesn't wanna really give it to us so.
[CUSTOMER][NEUTRAL] OK, let me see what we got. Yeah, it is 42 pages. Let's see real quick.
[AGENT][NEUTRAL] I know.
[AGENT][NEUTRAL] Like I said, I was like, I, my, my coffee is not quite moving in all directions. Yeah, goodness gracious.
[CUSTOMER][NEUTRAL] And that's the only date that she's questioning? Is that one that we're asking for the.
[AGENT][NEUTRAL] It's just, yeah, those two office visits for [PII]. She's like.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Yeah, and honestly, she's one of those BWA people where she got it through Business Workers of America, and she didn't really understand what an HI plan was. That's why it's not, it's not even active anymore. She canceled it because it wasn't what she thought it was.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You know.
[CUSTOMER][NEUTRAL] Yeah, so far, I'm definitely not seeing no diagnosis information.
[CUSTOMER][NEUTRAL] Just only the CPT code.
[CUSTOMER][NEUTRAL] Nope, you are right. I don't see any diagnosis code.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I don't, we don't have a diagnosis code for either of these um office visits.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah. I can tell her the same thing. You can send it to me and I can tell her again that in order to consider those dates, we need the diagnosis code.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'd appreciate you if you could just retell her that.
[CUSTOMER][POSITIVE] Yeah, I don't have no problem doing it.
[AGENT][NEUTRAL] OK, um, do you want her callback number or it's the one she's calling from.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, I'm gonna let her know. Alright, let me just let her know I'm gonna transfer one second.
[CUSTOMER][NEUTRAL] You can send her to me.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] [PII], I appreciate your patience. I have claims on the other line. I'm gonna go ahead and transfer you over.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Claims department, this is [PII].
[CUSTOMER][NEUTRAL] Hi, I'm not sure if she told you why I was calling um I just wanted to see if you guys could.