AccountId: 011433970860
ContactId: 9206cb7f-f7fd-42bb-8182-618d886318b0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 386839 ms
Total Talk Time (AGENT): 115038 ms
Total Talk Time (CUSTOMER): 163852 ms
Interruptions: 2
Overall Sentiment: AGENT=1.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/9206cb7f-f7fd-42bb-8182-618d886318b0_20250418T19:28_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] from the care team.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Um, and I have an insured on the phone and
[CUSTOMER][NEUTRAL] Um, on her policy it says that they're needing more information and she so she sent in the EOB.
[CUSTOMER][NEGATIVE] Um, but on the claim number she gave me, the, the code says that it's denied and it just states a list of like documentation that she needs, but I can't pinpoint exactly.
[CUSTOMER][POSITIVE] Exactly what she needs to send in for this to be approved or denied.
[CUSTOMER][NEUTRAL] Can, can you look further into her policy?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, sure, what's the policy number?
[CUSTOMER][NEUTRAL] It is 243.
[CUSTOMER][NEUTRAL] 2937 and then I have the claim number too.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the claim number is 358.
[CUSTOMER][NEUTRAL] 8808.
[AGENT][NEUTRAL] OK, let me take a look here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So looks like we're needing the diagnosis codes. Let me see what we received.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it's just like such a generic code and it doesn't tell you exactly so.
[CUSTOMER][NEGATIVE] It's confusing on my end.
[AGENT][NEUTRAL] Right, so cause it's on this med link, it's usually it needs to be like either like like the, if there was an injury or a sickness, it would need to be like the diagnosis code that depicts, you know, the injury or sickness for the claim that they're filing.
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK. MRI due to joint hip pain.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Can I transfer her over really quick?
[AGENT][NEUTRAL] Oh, sure, sorry, I'll just take a look at the claim. That's, that's fine.
[CUSTOMER][NEUTRAL] Sorry, she's, she's just been on the
[AGENT][NEUTRAL] Uh, do you have the callback number?
[CUSTOMER][NEUTRAL] Yeah, she's been on the phone for a little bit. OK.
[CUSTOMER][NEUTRAL] Uh, I do see.
[CUSTOMER][NEUTRAL] I guess not. I just could have swore I got a callback number. No, I don't.
[CUSTOMER][POSITIVE] I'm so sorry. Um, but I can give you the number she called. OK. Thank you.
[AGENT][POSITIVE] Oh, OK, well, I'm ready for her.
[AGENT][POSITIVE] Thank you for holding, this is [PII].
[CUSTOMER][NEUTRAL] Hi, this is [PII].
[AGENT][POSITIVE] Uh yes, Miss [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hi, um, well I was calling on um.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Uh memo I got back from my claim request.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And uh you guys are requesting more information. um I thought that I had sent in an itemized statement with everything on it at least that's what the hospital gave me.
[CUSTOMER][NEUTRAL] Um, so I just, I need to know for sure what you guys need so I can get it from the hospital and give it to you.
[AGENT][NEUTRAL] Yeah, sure, I can help you with that. And this is regarding your most recent claim, um,
[AGENT][NEUTRAL] The claim number is 3588808.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, sure, I can help you with that. Um, bear with me just a moment I'll go ahead and pull up that information for you.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Was it once a day or once every 4 to 6 hours?
[CUSTOMER][NEUTRAL] You take another one, OK.
[AGENT][NEUTRAL] OK, so yeah, I do see that we did receive the itemized charges. Um, it looks like what we're looking for is the diagnosis code. Um, so we need to be able to drive.
[CUSTOMER][NEUTRAL] OK, so they didn't include that on the itemized statement.
[AGENT][NEUTRAL] Right. It, it just, it does have the charges of what they billed you for, but I don't see on any of the documents and I um the, the diagnosis codes.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK, OK, no problem. I'll um I'll get a hold of them and get that diagnosis code and uh I will submit that to you guys as soon as I get it.
[AGENT][POSITIVE] Uh sure Miss [PII] and, and they can provide, oh, I'm sorry.
[CUSTOMER][NEUTRAL] Do I just do I just call you or do I just call you with that or do I need that in a paper form or how do I do that?
[AGENT][NEUTRAL] Uh, sure, yes, that's why I was, I'm gonna let you know that they can, you can provide either like a hospital admission or discharge summary, um, any type of medical records that have a diagnosis code.
[AGENT][NEUTRAL] Um, any testing results that they may have with the code. So yeah, a medical, yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you need some kind of record.
[CUSTOMER][POSITIVE] OK, OK, perfect. All right, that's what I needed to find out so thank you very much.
[AGENT][NEUTRAL] Uh, sure, Miss [PII]. She's anything else I could do to help you today?
[CUSTOMER][NEUTRAL] No, that'll take care of it.
[AGENT][POSITIVE] Oh sure, thanks for calling APL hope you have a good day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][NEUTRAL] OK bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.