AccountId: 011433970860
ContactId: 987a53df-d7f1-4f9a-89c5-d087e2124296
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 887000 ms
Total Talk Time (AGENT): 246933 ms
Total Talk Time (CUSTOMER): 424709 ms
Interruptions: 9
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/987a53df-d7f1-4f9a-89c5-d087e2124296_20250625T22:16_UTC.wav
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[AGENT][NEUTRAL] Good afternoon, [PII] speaking. May I help you?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um, yes, I, I spoke to somebody today about a few claims that I put in, and they said that there was something missing on it and then I could go into the app.
[CUSTOMER][NEUTRAL] And find out.
[CUSTOMER][NEUTRAL] A problem with the claim or anything and there's nothing on there.
[AGENT][NEUTRAL] OK. What's your name and the policy number, please?
[CUSTOMER][NEUTRAL] My name is [PII] and the policy number is 2456796.
[AGENT][POSITIVE] OK, thank you. Give me one moment please.
[AGENT][NEUTRAL] OK, and Ms. [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you, ma'am, give me one moment please.
[AGENT][NEUTRAL] OK, and verify your date of birth, mailing address and email address, please.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you, give me one moment.
[AGENT][NEUTRAL] Because I see a claim information been received today through the online service center and it's been placed in line for processing.
[CUSTOMER][NEUTRAL] OK, what I sent.
[CUSTOMER][NEUTRAL] Well, what I sent was, um,
[CUSTOMER][NEUTRAL] It was what they were asking me for, for the claim.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes ma'am, I'm here. I'm just looking at the information received.
[CUSTOMER][NEUTRAL] Hello? Oh, OK.
[CUSTOMER][NEUTRAL] Yeah, um.
[CUSTOMER][NEUTRAL] Yeah, it, she asked me for something from the doctor. The bill was for $485 from an anesthesiologist from the surgery that I had on [PII].
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So on that paperwork that I just sent, sent, it has the date for [PII] and it has on there, uh, I, it looks like what they did.
[CUSTOMER][NEUTRAL] And the number, and that was from the doctor.
[CUSTOMER][NEGATIVE] Now, the doctor is not the bill that I sent in. The doctor, it was an anesthesiologist's bill. I didn't get the doctor's bill yet.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I was told that they denied the claim because they needed that. So is that the information you need?
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] It has the procedure code, but the information they're needing should have the diagnosis code showing the reason for the surgery.
[AGENT][NEUTRAL] It looks like they also need the primary EOB.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Well, it, it was an oncologist. It was a cancer doctor. There it was.
[CUSTOMER][NEUTRAL] I don't understand what you want, what more you want. I gave you all the codes you need.
[AGENT][NEUTRAL] It has procedure codes stating what procedures were performed, but the diagnosis code is needed as well.
[CUSTOMER][NEUTRAL] That's what she asked me for today. Her exact words were, she needed the procedure code.
[CUSTOMER][NEUTRAL] What procedure did I have that I needed an anesthesiologist. So every time I call, somebody asked me for something different.
[CUSTOMER][NEUTRAL] So now I got to call the doctor back. So in exact words, what exactly do you need?
[AGENT][NEUTRAL] We need an itemized bill showing the, OK, go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Because the diagnosis codes all.
[CUSTOMER][NEUTRAL] Itemized bill, OK.
[AGENT][NEUTRAL] With diagnosis and procedure codes.
[AGENT][NEUTRAL] And the primary explanation of benefits for the data service.
[CUSTOMER][NEUTRAL] Well, hold on a second, because I'm writing this down exactly. Itemized bill of just start all over again now. Itemized bill of.
[AGENT][NEUTRAL] With the diagnosis and procedure.
[CUSTOMER][NEUTRAL] Of with
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK, so itemized, itemized bill of with diagnosis and procedure.
[AGENT][NEUTRAL] Codes
[CUSTOMER][NEUTRAL] So you only want the codes now, not the description.
[AGENT][NEUTRAL] If they have any kind of medical notes that shows the diagnosis, we can accept that.
[CUSTOMER][NEUTRAL] So you want a diagnosis.
[CUSTOMER][NEUTRAL] OK, because I'm getting confused here because when I called this morning, they said they needed a code of the procedure I had done.
[CUSTOMER][NEUTRAL] So, a code of the procedure I had done is on that paperwork. That's a totally different thing of what you're asking me now. So maybe you guys need to put in writing what you need.
[CUSTOMER][NEUTRAL] Because every time I call, I'm getting a different.
[AGENT][NEUTRAL] It's on the claim form stating what information we would need to process claims as secondary.
[CUSTOMER][NEUTRAL] What claim form? Uh, there's nothing on that claim form except asking you for your name and your date of birth.
[AGENT][NEUTRAL] On the first page of the claim form, if you get it from the website, it does have a note or instructions to insured on what information we need in order to process the claim. OK.
[CUSTOMER][NEGATIVE] No, it doesn't.
[CUSTOMER][NEUTRAL] Yeah, and, and I gave you all the information and the information you needed was itemized bill with diagnosis. I gave you the itemized bill.
[CUSTOMER][NEUTRAL] And I gave you the explanation of benefits.
[CUSTOMER][NEUTRAL] So it was an anesthesiologist, an anesthesiologist, an anesthesiologist [PII] is not gonna have a diagnosis. The doctor [PII] is gonna have a diagnosis.
[AGENT][NEUTRAL] The billing information you gave does not have the diagnosis code.
[AGENT][NEUTRAL] Ma'am, anytime you go for any kind of medical service, you always have a diagnosis code. Anytime you go for even an office visit, there's going to be a diagnosis code.
[CUSTOMER][NEUTRAL] OK, and what about an anesthesio or just no?
[AGENT][NEUTRAL] Well, they will need a code as well because it would state the reason for you receiving anesthesiologist. It has a procedure code, but it's not.
[CUSTOMER][NEGATIVE] They had a code on there. They had a code on there, but you guys told me it's not good enough.
[AGENT][NEUTRAL] No, ma'am, it doesn't have a procedure. It has the procedure codes, not diagnosis codes that are needed to process claims.
[CUSTOMER][NEUTRAL] Well, what would the diagnosis code be for an anesthesiologist?
[AGENT][NEUTRAL] It's forever diagnosis that you were diagnosed with, the reason why they had to perform the anesthesiology.
[CUSTOMER][NEUTRAL] OK, but that diagnosis code is on that paper I just sent you.
[AGENT][NEUTRAL] No, ma'am, it's not. If you look at the paper, it's under for the 428 data service that 57522, and then there's a description of it, uh, colonization of cervix with or without. Yes ma'am, that is a procedure code, not a diagnosis code.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, well, did you not just ask me for a procedure code?
[AGENT][NEUTRAL] No, ma'am. I did not ask you for a procedure code. I said we need an itemized bill that shows.
[CUSTOMER][NEUTRAL] It says right here, you said your exact words, your exact words is itemized bill of, with, diagnosis, and procedure codes. So that's the procedure code.
[AGENT][NEUTRAL] Well, it has the procedure codes, but we need the diagnosis codes.
[CUSTOMER][NEUTRAL] OK, so then all you need is a diagnosis code.
[AGENT][NEUTRAL] We diagnosis codes and since we are your secondary, we do need the primary EOB which you said that you submitted.
[AGENT][NEUTRAL] But you can get the diagnosis codes. Usually it's on an itemized bill or any medical notes you can receive from the physician or the anesthesiologist.
[CUSTOMER][NEUTRAL] I gave that to you. I, I gave that to you. But she told me, uh, she told me, when I spoke to [PII] earlier today, he told me that it has to be from the doctor, not the anesthesiologist.
[AGENT][NEUTRAL] OK, ma'am.
[CUSTOMER][NEGATIVE] So, it's very confusing because an anesthesiologist is not really gonna have a diagnosis. They're only there for surgery to put me under anesthesia.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, ma'am, I can transfer you to a claims examiner and they can explain to you exactly what information is needed.
[CUSTOMER][NEUTRAL] OK, now another question I have is she's telling me that on this site that I could look up and see what happens is happening to my clients and I can't.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I'm in it right now. Where do I go to to look up my claims?
[AGENT][NEUTRAL] OK, well, we have been having issues with our um
[CUSTOMER][NEUTRAL] OK, and, and if I do find it.
[CUSTOMER][NEGATIVE] It's not telling me what they need and it's not saying anything.
[AGENT][NEUTRAL] It should show a claim number and then when you click on the claim number it should pull up the explanation of benefits that was sent requesting additional information.
[CUSTOMER][NEUTRAL] I, I don't know, I think this is just like a game.
[CUSTOMER][NEUTRAL] Just again.
[CUSTOMER][NEGATIVE] They're not paying me, it's just an excuse to not pay me.
[CUSTOMER][NEUTRAL] Cause it doesn't have anything on here.
[CUSTOMER][NEUTRAL] Doesn't say anything.
[CUSTOMER][NEUTRAL] Just says the policy number, the number of the claim, the date, it doesn't say anything else. Status, uh, process, co-insurance, medical expense, supplement.
[CUSTOMER][NEGATIVE] Mount page 0 doesn't make any sense.
[CUSTOMER][NEUTRAL] So I'm not seeing where she's saying that I could appeal and that.
[CUSTOMER][NEUTRAL] That you needed more information.
[CUSTOMER][NEUTRAL] It's not telling me that, OK, so now you got the procedure code, am I correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so all you need is a diagnosis code.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] All right, so what would the diagnosis that you're looking for actually be? Why they were doing surgery or what the surgery was?
[AGENT][NEUTRAL] It was, the diagnosis would state the reason for the surgery.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll get that from my doctor. OK, and what is your name?
[AGENT][NEUTRAL] My name is [PII] E.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, so that's all I need is to get paid for this bill. And what was the amount of the bill? Because when I spoke to [PII] this morning, she gave me a totally different amount.
[CUSTOMER][NEUTRAL] That was on the bill that I paid for.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] For the information you submitted to us today, it shows a total charge amount of give me a moment.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Uh, it shows a total charge amount of $740.85.
[CUSTOMER][NEUTRAL] That's not what she told me.
[CUSTOMER][NEUTRAL] He told me it was 4:24.
[CUSTOMER][NEGATIVE] And that's the doctor bill that I didn't even send in yet.
[CUSTOMER][NEUTRAL] So I have no idea.
[CUSTOMER][POSITIVE] I even added the billing that I paid for.
[CUSTOMER][NEUTRAL] And it shows that it was paid.
[CUSTOMER][NEUTRAL] OK, so when I get this diagnosis code, what are they paying me out?
[AGENT][NEUTRAL] Well, I don't know until after the claim has been processed.
[AGENT][POSITIVE] We can't give up
[CUSTOMER][NEUTRAL] Approximately what is it going to be?
[AGENT][NEUTRAL] Ma'am, I cannot give you approximate until the information has been received and processed.
[CUSTOMER][NEUTRAL] Yeah, I, that's what I figured.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that's it, that's it thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL.
[CUSTOMER][NEUTRAL] Right.