AccountId: 011433970860
ContactId: 92645fd1-8109-45ba-a12a-7d96eaa10f9f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 434260 ms
Total Talk Time (AGENT): 172428 ms
Total Talk Time (CUSTOMER): 138111 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/92645fd1-8109-45ba-a12a-7d96eaa10f9f_20250211T20:44_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, I need some information about a claim.
[AGENT][NEUTRAL] OK, um, and you're calling for a provider's office or this is your policy?
[CUSTOMER][NEUTRAL] This is my policy.
[AGENT][NEUTRAL] OK. Uh, may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and may I have the policy number?
[CUSTOMER][NEUTRAL] 01888560
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You want the reference number?
[AGENT][NEUTRAL] Um, no, it's fine. Bear with me.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh it's the same.
[AGENT][NEUTRAL] Mhm, yeah.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK. May I have your date of birth for security followed by the mailing address and email address on file.
[CUSTOMER][NEUTRAL] Uh, reverse, uh.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And address is [PII].
[AGENT][POSITIVE] Alright, thank you.
[CUSTOMER][NEUTRAL] You want my email?
[AGENT][NEUTRAL] Yes, please. Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Email is [PII].
[AGENT][POSITIVE] Perfect thank you. All right and let's see.
[AGENT][NEUTRAL] OK. So is the most recent one, the one we processed on [PII]?
[AGENT][NEUTRAL] You send in an electronic through our website.
[CUSTOMER][NEUTRAL] Yeah, and I wanna call, I'm calling to ask you.
[CUSTOMER][NEUTRAL] But this explanation of benefits.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm, OK, so what is um basically your question about it because it's asking for the diagnosis code. It looks like we're missing the diagnosis code.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEGATIVE] I'm having a little trouble getting cause the ER doctor, they process their separate from the hospital and I'm having.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Difficult getting that.
[CUSTOMER][NEUTRAL] And uh I wanna know uh what is this that explanation of benefits that y'all sent me, sent me what's that for?
[AGENT][NEUTRAL] It's just explaining to you that we process the claim and if it's missing any information it's gonna be um requested in that explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. Yes, which in this case.
[CUSTOMER][NEUTRAL] Oh, so I, I, uh, y'all thinking that my insurance pay for this bill?
[AGENT][NEUTRAL] Um, at this time, um,
[AGENT][NEUTRAL] We did receive the explanation of benefits. We're missing the diagnosis code. Um, let me look at the paperwork, bear with me.
[AGENT][NEUTRAL] See.
[CUSTOMER][NEUTRAL] Cause I was wondering if this letter saying that.
[CUSTOMER][POSITIVE] My insurance paid for this bill. I paid this bill.
[AGENT][NEUTRAL] Mm, let me check the paperwork because uh we're asking for the diagnosis code that means that there's an amount to pay. We just need to know what the diagnosis code, so let me just go ahead and check and see exactly.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] How to do everything different.
[CUSTOMER][NEGATIVE] Different building and stuff and have trouble getting it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm waiting on the system so I can see the documents. one moment.
[AGENT][NEUTRAL] OK, let me review the documents really quick. Do, do you mind holding for me?
[CUSTOMER][NEUTRAL] I can tell you what's going on with it. They told me yesterday that I needed the doc uh uh that I need the diagnosis code and I need the form CMS 1500.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I just want, and that's all I want and I itemized list. I just want to know what this meant that's all.
[CUSTOMER][NEUTRAL] I know what I mean.
[AGENT][NEUTRAL] OK, so what.
[CUSTOMER][NEUTRAL] I was wondering what
[AGENT][NEUTRAL] When you say what this meant, what do you mean by what this meant?
[CUSTOMER][NEUTRAL] This, uh, uh, the, uh, explanation of benefits, that's all.
[CUSTOMER][NEUTRAL] I got this in the mail yesterday after I had talked to y'all. It's a.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yes, the explanation of benefits is just letting you know exactly what we told you yesterday that we still need those diagnosis codes in order to process the claim. If you see it on the second page or the back of that page, it's gonna give you the description remarks code indicating what we need and it's gonna ask you for that diagnosis code. So it's just it's the same document. It's the same information basically we gave you yesterday. We need to send it by mail. It's just a requirement. Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, so I can send it, I can take a picture off and then send it by my phone?
[AGENT][NEUTRAL] Of the 1500 form or of the explanation of benefits?
[CUSTOMER][NEUTRAL] Uh, the, uh, 15004.
[AGENT][NEUTRAL] Yes, if you have the 1500 form from the provider, you can take a picture and send it through like you uploaded this other claim, or you can scan it in, or you can send it by fax or mail. Yes, those are your options.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] No, ma'am and you have a good day.
[AGENT][POSITIVE] You as well. Thank you for calling ATL. Bye-bye.
[CUSTOMER][NEUTRAL] No.