AccountId: 011433970860
ContactId: 96e31238-85a1-42af-81be-ca15bc71209a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1389569 ms
Total Talk Time (AGENT): 224838 ms
Total Talk Time (CUSTOMER): 766729 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/96e31238-85a1-42af-81be-ca15bc71209a_20250428T21:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], uh, my name is [PII]. I'm a, uh, I have lapse coverage with you guys, but I've been since [PII] or I think the service may have even been rendered earlier. Let me see, uh, basically I've been seeking reimbursement for, uh, for, for my gap insurance payments. I think there's maybe $2000 remaining of reimbursement that I never received.
[CUSTOMER][NEUTRAL] Um, for services rendered quite a while ago, but anyway, um.
[CUSTOMER][NEGATIVE] I have had issues getting diagnosis codes which were required by you guys, uh, and it's been frankly like a nightmare working with uh my provider to try and get them to release these to me um and when I spoke with someone, a representative not too long ago, maybe 2 months ago, uh, they told me that.
[CUSTOMER][NEUTRAL] Uh, I could just fax my diagnosis like the names of my condition to you guys and you guys could submit with the appropriate diagnosis code for me or something to that effect, but anyway, I'm following up now, um, to see if maybe you can help me out.
[AGENT][NEUTRAL] OK. Do you have your policy number?
[CUSTOMER][NEUTRAL] I do, yeah, uh, my policy number is 2321238.
[AGENT][NEUTRAL] OK, and do you have your
[CUSTOMER][NEUTRAL] And I believe if I'm not.
[CUSTOMER][NEUTRAL] Sorry, go ahead.
[AGENT][NEUTRAL] I just want to get your date of birth and needed a few other pieces of information before we start researching.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, my date of birth is [PII].
[AGENT][NEUTRAL] And your callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And what is your address?
[CUSTOMER][NEUTRAL] Uh, you probably have on file [PII], but I have a new address if you want that.
[AGENT][NEUTRAL] Uh, yeah, it looks like we have a different address.
[CUSTOMER][NEUTRAL] Oh then then then you probably have [PII].
[AGENT][NEUTRAL] Yes, that's correct. And then your email address?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Uh, looks like I've got a different email.
[CUSTOMER][NEUTRAL] Oh, OK, um.
[CUSTOMER][NEUTRAL] I may have given you an [PII] email. Uh, oh yeah, that's probably what you have because that was what was associated with this, uh, insurer. OK, yeah, so you probably have, uh, decon at [PII].
[AGENT][NEUTRAL] OK, yep, that's what I have. OK, and so what date of service are we looking at?
[CUSTOMER][NEUTRAL] Uh, looks like the date of services were.
[CUSTOMER][NEUTRAL] Uh, for a few billings between [PII].
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] And I think that the related submission, uh, sorry, the claim number is probably the one that is 34 I can't see now because I can't see which files I actually uploaded, but I, uh, I think it's probably 340-1682 at least I think that's what the woman I spoke with last told me. I have that note written down here. I don't know.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. Yes, that is correct. So, yeah, it looks like, and so you were able to get documentation from your healthcare provider or, or no?
[CUSTOMER][NEUTRAL] No, I, I sent them, uh, I spoke to people on the phone at the billing department and even sent them. They had me fill out a release form, and they were supposedly going to fax you guys the, um, they said per HIPAA guidelines.
[CUSTOMER][NEUTRAL] Uh, UBOB04 forms are sent directly to the insurer insurer, not the patient. If you would like us to fax a UB04 to your insurance attached to the 30 card third party authorization form. I went ahead and I filled this out and sent it to them, and I followed up with you guys and you guys never seem to have received.
[CUSTOMER][NEUTRAL] Any facts from them, so I'm, uh, I don't know, I was kind of at my wits end trying to deal with my provider to get them to release this information. And if I recall correctly, the woman I spoke with last said something to the effect of you guys, uh, uh, or she basically said you don't need to get the diagnosis quote directly from the insurance. You, uh, you can just provide them to us or something like that. Do you have any idea what what you're talking about?
[AGENT][NEUTRAL] I mean, we, we do have to get documentation. It can't just be like you saying, hey, hey, this was my diagnosis. It has to be, you know, either something printed off from hospital portal.
[CUSTOMER][NEUTRAL] Right. Well, yeah, so I, I
[CUSTOMER][NEUTRAL] Right, I, I, uh, sent you guys, uh, several documents that included apparently CPT codes, uh, itemized statements that included CPT codes for procedures, billings and payments.
[CUSTOMER][NEUTRAL] Uh, it just did not include diagnosis code they said, and then, uh, so, so are you telling me that I need to continue to hound my provider to get them to send, send these to you is that the?
[AGENT][NEUTRAL] Yeah, so it looks like, so do you have access to like their online portal at the University of Miami?
[CUSTOMER][POSITIVE] Yeah, yeah, I do. I do, yeah.
[AGENT][NEUTRAL] Have you looked through that to see sometimes it does have diagnosis listed where you could just kind of like screenshot it or that date of service um because there's like typically they'll have like after visit notes um or something like.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, OK, OK, um, so that's a good idea. Let me see.
[AGENT][NEUTRAL] Might try looking.
[AGENT][NEUTRAL] Yeah, try looking at that um on your portal for the hospital um because like I said some, you know, as long as it states.
[CUSTOMER][NEUTRAL] Oh, you know, if I, yeah, I think if I recall correctly, I may have gotten, uh, I have to think back. I, I think, I think my estimate of benefits from my health insurance at the time may have listed the diagnosis codes. Uh let me see. One moment. Um, will you bear with me? I should I call you back? What, uh, what's best here?
[AGENT][NEUTRAL] No, you, you can, you can look um at what you have, sure.
[CUSTOMER][NEUTRAL] It's just
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Trying to remember, um, I think I had him in at the time, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for, for, uh, being so courteous and patient with me. I have to admit I feel kind of.
[CUSTOMER][NEUTRAL] Ridiculous for having let this go on for so long, but it just, you know, when you meet a million obstacles.
[CUSTOMER][MIXED] In the past, to getting something like this done, it's like really easy to just kind of give up on it, but it's, you know, it's $2000 so I like keep wanting to.
[AGENT][NEUTRAL] I understand.
[CUSTOMER][NEUTRAL] Circle back and and figure it out um.
[AGENT][POSITIVE] Yeah, I understand. No problem.
[CUSTOMER][NEUTRAL] OK, yeah, I'm logging in now let's see if I can find it.
[AGENT][NEUTRAL] I'm looking through what we received too just to make sure that I do see.
[CUSTOMER][POSITIVE] Thank you. I appreciate that. Yeah.
[CUSTOMER][NEUTRAL] The new claims.
[CUSTOMER][NEUTRAL] I know, I, I want EOBs probably.
[CUSTOMER][NEUTRAL] I just feel like a date range forget that um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Do and.
[CUSTOMER][NEUTRAL] Let me just see an old EOB sorry.
[CUSTOMER][NEUTRAL] Uh, sorry, what was the date range I gave you? Do you remember?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] I'm sorry for, uh, hold on, let's see, I'm looking at your.
[CUSTOMER][NEUTRAL] 42 I think it's [PII].
[AGENT][NEUTRAL] Or
[AGENT][NEUTRAL] We had gotten about um let's see.
[CUSTOMER][NEUTRAL] Yeah, I know you've got a lot there's like.
[AGENT][POSITIVE] I to make sure we didn't miss anything, um.
[CUSTOMER][NEUTRAL] Uh, I might need to call Humana to get this because it looks like their, their date range maxes out [PII], and I think, I think my claims were from a little before that.
[AGENT][NEUTRAL] Yeah, it looks like service date uh was [PII].
[CUSTOMER][NEUTRAL] Like 2 weeks before that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But like I said, I would try if you have if you don't have an online portal created with the University of Miami, um, if you
[CUSTOMER][NEUTRAL] No, yeah, let me try that. I, I do have a portal. Um, I'll, I'll try that now, uh, because it looks like you, it looks like going through my insurance is a dead end unless I try to call them and get access to some really old records, but, um, but maybe you help has longer.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Records, uh, so I guess billing or.
[AGENT][POSITIVE] Should be like a visit.
[CUSTOMER][NEUTRAL] Or no, you're saying like after, after visit, yeah, OK, visit, yeah, let me just go through visits to see how far back this goes.
[AGENT][NEUTRAL] Yeah, after his
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh, oh, OK, supposedly, let's see.
[CUSTOMER][NEUTRAL] Oh yeah, let's take it back, OK.
[CUSTOMER][NEUTRAL] Uh, here we go. [PII], that's it.
[CUSTOMER][NEUTRAL] And I have anesthesia. They're they're separate EOBs. Let's see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So there are diagnoses, but I don't know if there's diagnosis close one moment, let me see.
[CUSTOMER][NEUTRAL] Yeah, like
[CUSTOMER][NEGATIVE] So annoying every time I hit the back button I have to scroll to infinity to get back to.
[AGENT][NEUTRAL] You're fine.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Alright, I'm gonna take a different strategy. I'm gonna open all these in separate tabs and then.
[CUSTOMER][POSITIVE] And then hopefully it'll let me look through them all.
[AGENT][NEUTRAL] Yeah, I've double checked everything that we received and I don't see a diagnosis. And typically explanation explanation of benefits don't usually include a diagnosis, but like I said, sometimes that after visit summary will, um.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] That's OK. Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] That's where you, hopefully, hopefully it'll be in there.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] 7.
[CUSTOMER][NEUTRAL] Oh yeah, OK.
[CUSTOMER][NEUTRAL] Here you go, uh, alright, I already have one diagnosis code here, um, this is so, so that just for your reference, the, the, um.
[CUSTOMER][NEUTRAL] The procedures and billings were, were all surrounding a colonoscopy and a related um a colonoscopy for ulcerative colitis. So one of the diagnosis codes I have here is K51.919.
[CUSTOMER][NEUTRAL] Ulcerative colitis with complication unspecified location um.
[AGENT][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] And then I probably can get more here just yeah give me more, um, but so so it's just that I let me see if I can download this and like send it to you or something, yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yeah, either download or if you can take a good screenshot, either way will work um but that's that's exactly what we're seeing right there.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so let me see. Oh print this page. OK, there we go, print to Pia.
[CUSTOMER][POSITIVE] Nice
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, this is 421.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh I can do.
[CUSTOMER][NEUTRAL] OK this one I got saved and go to the other one.
[CUSTOMER][POSITIVE] Thank you you've been really helpful thus far. I really appreciate it.
[AGENT][POSITIVE] Yeah, absolutely, no problem.
[CUSTOMER][MIXED] I mean, most of the people that I spoke with at APL were helpful. It was, it was more on the other side that I ran into a lot of issues.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEGATIVE] Yeah, it can be frustrating talking to hospitals and the billing departments.
[CUSTOMER][NEUTRAL] Yeah, exactly, I think they're probably perpetually swamped, understandably, but like.
[CUSTOMER][NEGATIVE] Mm, they just, I would ask, you know, they'd say we're gonna do it. Well, first they say, oh, it's actually it, it takes up to 6 months after you submit the uh approval for what do you call it, the, the UB yeah for them to actually fax the thing. So I had to wait 6 months just to follow up and ask you guys if you had ever received during that 6 month interval of fax and of course you guys are like, no, we never got anything it's like.
[AGENT][POSITIVE] Wow.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] We go on forever um.
[CUSTOMER][NEUTRAL] OK, I found another one.
[CUSTOMER][NEUTRAL] This is for the ER visit. This also was like all following just just to, to share with you for fun. Uh, this is all following like, like this colonoscopy. I, when I first went to get it, I had some kind of uh.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] That
[CUSTOMER][NEGATIVE] Electrolytic imbalance because uh I guess I was like not replacing enough electrolytes to stay hydrated and I ended up having like a cardiac event and going to the ER and having like they, they diagnosed me with an anxiety attack and other cardiac stuff and, and so I had to delay my colonoscopy a day.
[CUSTOMER][NEGATIVE] And so I had to stay fast in another day, another 24 hours for them to do it the following day and I like had a huge hospital bill and like couldn't do any of this stuff. OK, uh, I found another one, so I'm gonna send this to you too.
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Um, this one, yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh wait, it's under notes I think that's where I found the last one.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So this one it's interesting. The diagnoses don't have codes next to them. I mean, it says what they are, so you guys can presumably can do both both lookups, but uh.
[AGENT][NEUTRAL] You can.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, this one, yeah, this one says.
[CUSTOMER][NEUTRAL] It just has my all my issues. OK, great. So I'll, um, yeah.
[AGENT][NEUTRAL] And you have our online portal, correct, where you can upload these?
[CUSTOMER][POSITIVE] I do. I do, yeah. Thank you for asking.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And, and tell me when I, when I go ahead and do that um.
[CUSTOMER][NEUTRAL] Do I, is there a place for me to like reference the claim that these are attached to or or I don't know how does this work?
[AGENT][NEUTRAL] Yeah, let me give you the claim number and you can just write that on there.
[CUSTOMER][POSITIVE] OK, perfect. Uh, one second.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yeah, wait, actually I think I have the portal open right now. Let me just pull it up and then, uh, so, so I click the upload file button.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, and then it says enter claim detail. So sorry, select me as the claimant. OK, the policy is selected next.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It says upload the documents, so let me select the two files I have.
[CUSTOMER][NEUTRAL] And I think, I think these two files should probably exceed the 2K that I'm that I'm still roughly 2, it's a little less than 2K. It's like 1.89 or something that, um, I think we we should suffice, but if you need more, I can go back and and find more codes for, you know, but it would help us like if you do still need more for example you if you could tell me which uh procedure or like yeah does that makes sense which um.
[AGENT][NEUTRAL] Yeah, but our our claims department, yes, they would.
[CUSTOMER][NEUTRAL] Anyway.
[CUSTOMER][NEUTRAL] I think this should be enough, but.
[AGENT][NEUTRAL] OK, yeah, we'll review it and then if there's something missing, of course we'll let you know so.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] All right, I
[CUSTOMER][NEUTRAL] OK, 48, like which one did I attach? Is it where I make this bigger.
[CUSTOMER][NEUTRAL] Alright, I'm just gonna do them both one at a time let me.
[CUSTOMER][NEUTRAL] like to.
[CUSTOMER][POSITIVE] OK, yeah, I got them both.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Oh, OK, it's just.
[CUSTOMER][NEGATIVE] Assigned a new confirmation number but it doesn't have a, it didn't actually give me an opportunity to enter the claim new claim number or an old claim number but did I do that wrong or something? What happened?
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] Oh, no, it's we'll be able to look at the date of service you're submitting the information for and match it up to this denied claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, it should, that should be fine, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, thanks so much. um, I guess that's, that's all we need to do for now, but I guess I should write down just for my references just for my conversation with you, um, some stuff here. Let me see what, what, what's your name?
[AGENT][NEUTRAL] My name is [PII], and then my [PII] my [PII] [PII], and then um
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][POSITIVE] I would give this about call us back in about a week and see where it's at and then processing it typically takes about 77 working days or so, so maybe um mid next week um and we should hopefully have like a determination made so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, awesome. So 340 1682 was the claim number for these particular things, and I submitted diagnosis codes obtained.
[CUSTOMER][NEUTRAL] From you Health.
[CUSTOMER][NEUTRAL] Portal after visit summaries.
[CUSTOMER][NEUTRAL] Which should hopefully.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh, to cover remaining.
[CUSTOMER][NEUTRAL] 1.9K 0.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Awesome and I'll follow up in a week or so, OK.
[AGENT][POSITIVE] OK, perfect. Anything else I can help you with today, [PII]?
[CUSTOMER][POSITIVE] No, thank you so much, [PII]. Uh, you know, you're really, you're, you're awesome. Thank you.
[AGENT][POSITIVE] Thank you so much. I hope you have a good evening and thank you for calling APL.
[CUSTOMER][POSITIVE] You too take care bye bye.