AccountId: 011433970860
ContactId: 957207c3-0187-4f3c-8a4d-7e77eb48da61
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 625140 ms
Total Talk Time (AGENT): 214104 ms
Total Talk Time (CUSTOMER): 200985 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/957207c3-0187-4f3c-8a4d-7e77eb48da61_20241230T14:03_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. This is [PII]. How are you this morning?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][NEUTRAL] I'm doing fine thank you. So I have a broker on the line, uh, [PII], and he wants to, uh, go over two claims for a member please.
[AGENT][NEUTRAL] Uh, let's see
[AGENT][NEUTRAL] OK, what is the policy number?
[CUSTOMER][NEUTRAL] Alrighty, it is 244.
[CUSTOMER][NEUTRAL] 6222 for part one, Miss [PII].
[AGENT][NEUTRAL] See here.
[CUSTOMER][NEUTRAL] You sound a little under the weather, [PII].
[AGENT][NEUTRAL] Uh, yeah, I was, I have COVID.
[CUSTOMER][POSITIVE] Bless your heart.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] There's a lot of sick people around right now.
[AGENT][NEUTRAL] Yeah, my daughter has COVID and flu.
[CUSTOMER][POSITIVE] Oh, well, we'll certainly be praying for y'all. I'm so sorry to hear that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you, so the top two claims?
[CUSTOMER][NEUTRAL] Um, yes, uh 354-525-4 and 354-4815. They were denied for the same reason.
[CUSTOMER][NEUTRAL] But he thought that he sent everything that we would have needed and you know, he just wants to double check what we're missing that wasn't included.
[CUSTOMER][POSITIVE] Nice guy.
[CUSTOMER][NEUTRAL] And she's.
[AGENT][NEUTRAL] 8258.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, sorry, I was just reading the uh.
[CUSTOMER][NEUTRAL] No, yeah, you're fine.
[AGENT][NEUTRAL] OK, yeah, you can send it through. I'll have to take a look. I don't.
[CUSTOMER][NEUTRAL] Cause he
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's a lot, that's a broad span of documentation that's needed.
[CUSTOMER][NEUTRAL] Right, but he said that he included the UBO4 and something else. I checked a couple of claims for him, but this was the only one, and this was the first one we did to, to go over, but anyway.
[AGENT][NEUTRAL] Yeah, that's a broad plan.
[CUSTOMER][NEUTRAL] Yeah, pretty big is it?
[AGENT][NEUTRAL] Yeah, uh, yeah, that's, that's like listing everything basically.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, yeah, you can send it through. I'll take a look at the documents.
[CUSTOMER][NEUTRAL] OK, and um, again he's verified his callback number for you [PII] should something happen is [PII].
[AGENT][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK. Well, again, I would tell you to have a good day, but I'm just gonna tell you I'm praying for you and I hope you feel better.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] You're welcome. OK, so here we go.
[AGENT][POSITIVE] Alright thanks.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Hey, [PII].
[CUSTOMER][NEUTRAL] Hey how you doing?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][POSITIVE] Doing great.
[AGENT][NEUTRAL] So I understand you wanna go over some claims here that was processed.
[CUSTOMER][NEUTRAL] Please.
[AGENT][NEUTRAL] OK, give me just a second. I'm taking a look at this remark code that was used. Um, this is a pretty broad span remark code, so bear with me for just a minute.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, OK.
[AGENT][NEUTRAL] So an evidence accident and when it occurred. Let's see. I'm gonna pull up this first claim.
[AGENT][NEUTRAL] And then we'll go from there on the 2nd claim.
[CUSTOMER][POSITIVE] Yeah, no problem.
[AGENT][NEUTRAL] So this is the one ending in 4815.
[CUSTOMER][NEUTRAL] Let's take a look.
[CUSTOMER][NEUTRAL] 4815 yes.
[CUSTOMER][NEUTRAL] So if you look, we have the claim form and then right underneath it says North Oaks physician Group.
[CUSTOMER][NEUTRAL] And it states
[CUSTOMER][NEUTRAL] The date of the injury?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Keep scrolling. Let me see, uh, of course I jumped off in under encounter diagnosis, um, on the second tab it says insight, uh, insect bite of neck initial encounter.
[CUSTOMER][NEUTRAL] And then if you scroll to the next page.
[CUSTOMER][NEUTRAL] It says encounter diagnosis and it says insect bite of neck initial encounter.
[CUSTOMER][NEUTRAL] And then on that final after visit summary on today's visit it says.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Insect bite.
[CUSTOMER][NEUTRAL] And on the
[CUSTOMER][NEUTRAL] Second attachment you'll see there's uh UBO4 switch back up the charges and the diagnosis codes.
[AGENT][NEUTRAL] OK, bear with me, I'm still going through these.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Let me skip to the next one on this because I do see I don't see a UB4 1 for this one.
[CUSTOMER][NEUTRAL] There's a it's on the 2nd attachment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The one that says um.
[CUSTOMER][NEUTRAL] It's the same claim, but for some reason I have two claim numbers. It says 354-525-4.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Let me see if she's in.
[AGENT][NEUTRAL] She is not in yet.
[CUSTOMER][POSITIVE] And normally I could tell there's an issue. I'll look at and I can say OK this is what the issue was, but this one's pretty clean. It states it on the form on the diagnosis and all the codes match with the charges on the on the bill.
[AGENT][NEUTRAL] OK [PII], this is what I'm gonna do, um, because I do see that the office notes are here, the diagnosis notes here, um, this is what I'm gonna do, um, let me just read your callback number to you. I have [PII]. Is that your direct line?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, this is what I'm gonna do. I'm gonna have the examiner once she comes in. I'm gonna have her just kind of take a quick glance over this.
[AGENT][NEUTRAL] If there's something else that's still needed um.
[AGENT][NEUTRAL] I'm gonna have her tell me what it is because from what I'm from what I'm seeing I see everything's here.
[AGENT][NEUTRAL] If I'm missing something that I'm not seeing.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] I need I'm gonna need her to tell me what it is but because I see everything's here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] You got it. And, and I understand, look, it's the busiest time of year and, uh, they're probably running through a bunch of these, so things happen, you know.
[AGENT][NEUTRAL] Right, um.
[AGENT][NEUTRAL] Like I said, from what I'm seeing, everything's here, but.
[AGENT][NEUTRAL] I'm gonna need some second pair of eyes on this and maybe it maybe it's, you know, maybe it could be that, you know, she just needed a second pair of eyes on this. We, we have that happen all the time where we just need to take a pair of eyes on these things, um.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So what I'm gonna do is I'm gonna send her a quick message so when she gets in she'll see this and I'll just have her take a quick glance at it.
[AGENT][NEUTRAL] And once I hear back from her, is it OK if I give you a call back?
[CUSTOMER][POSITIVE] Sure, absolutely I'll be available all day.
[AGENT][NEUTRAL] OK, um, what I'll do is if you don't answer I will leave you a voicemail and I will leave you my direct line.
[AGENT][POSITIVE] And that way you can just call me back whenever you get back to it.
[AGENT][NEUTRAL] And I'll leave you the insured's policy number and that way, you know, it'd just be a quick reference for you to, you know, we can get it pulled back up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] You got it you got it sounds great.
[AGENT][NEUTRAL] And that way we're not just kind of tag team back in.
[CUSTOMER][POSITIVE] Sounds great.
[AGENT][POSITIVE] Um, and we'll definitely get this taken care of that way if there is something missing, you know, you can definitely get back with your insured and say, hey, this is what we need to get that way we can definitely get this taken care of.
[CUSTOMER][POSITIVE] That that sounds great. I appreciate your time.
[AGENT][POSITIVE] You're welcome. Is there anything else I can take a look at for you?
[CUSTOMER][POSITIVE] Uh, no, that's it. Hope you have a great day.
[AGENT][POSITIVE] OK, well thank you for contacting APL and I hope you do the same.
[CUSTOMER][POSITIVE] Thank you take care bye bye.
[AGENT][NEUTRAL] Alright you too bye bye.