AccountId: 011433970860
ContactId: 9fb36b68-2926-445f-aff8-f8eed6fd7da5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 927840 ms
Total Talk Time (AGENT): 155771 ms
Total Talk Time (CUSTOMER): 166362 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/9fb36b68-2926-445f-aff8-f8eed6fd7da5_20250415T19:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Oh, recently put in a claim request, um, and I got a notification today that it was completed, but the amount paid says 0. I called earlier and the person said that I, the wrong bill has been inputted like I need a bill with a diagnosis on there. Um, but I spoke to someone, someone who's done this before and they said that that's the bill that they typically turn in.
[CUSTOMER][NEUTRAL] For all of their claims, so I'm trying to see if you can look and see what's exactly is going on.
[AGENT][NEUTRAL] OK, do you have the claim number?
[CUSTOMER][NEUTRAL] Yeah, give me 1 2nd.
[CUSTOMER][NEUTRAL] The claim number is 3588721.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then, uh, what's your policy number?
[CUSTOMER][NEUTRAL] Give me one second, I can pull that up.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Policy number
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] 248-538-6
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] So I submitted the bill that was sent to my um my insurance actually.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] To your, um, your primary insurance?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I just need to verify a couple pieces of information. What is your first and last name and your date of birth, please?
[CUSTOMER][NEUTRAL] First name is um [PII] Last name is [PII] and then date of birth is [PII].
[AGENT][NEUTRAL] OK, just one moment.
[AGENT][NEUTRAL] OK. And then what's your mailing address that we have on file and email, please?
[CUSTOMER][NEUTRAL] [PII]. Email is [PII].
[AGENT][NEUTRAL] OK, and then what's a good callback number in case our call gets dropped?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK, so I have that claim pulled up.
[AGENT][NEUTRAL] See
[AGENT][NEUTRAL] OK. So,
[AGENT][NEUTRAL] So the reason why we're denying this claim is because the service is not covered when performed in a doctor's office or clinic. Did they tell you that earlier?
[CUSTOMER][NEUTRAL] No. The, um,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The in the colonoscopy?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Or are we talking about, cause there was one that was like a total of $800 and something dollars for a colonoscopy and it wasn't performed in the doctor's office.
[AGENT][NEUTRAL] OK, let me look at that one.
[AGENT][NEUTRAL] And you said that one was for $800?
[CUSTOMER][NEUTRAL] Yeah, like $852 I believe.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry, $835.50.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] And then what was the date of service for this?
[CUSTOMER][NEUTRAL] The date of service was [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so for this claim number.
[AGENT][NEUTRAL] And for the colonoscopy, it just says that documentation we need is just the itemized bill with the diagnosis codes.
[CUSTOMER][NEUTRAL] Right. So the, I pulled the, the itemized bill from my primary insurance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] From the bill that they sent them and it's 2 pages. The bottom half.
[CUSTOMER][NEUTRAL] has a um
[CUSTOMER][NEGATIVE] Have like the detailed diagnostic on it, like the, the code and everything. And I was told that that's what I needed to submit, but now they're saying like
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Basically what you just said and I'm just trying to see what is the difference between what I submitted versus what is needed.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] It should just be the itemized bill with the diagnosis codes.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, just a moment. Let me, let me ask a colleague about this, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey, thanks for holding. Um, so we're digging deeper into your policy to figure out exactly why it was denied.
[AGENT][NEUTRAL] Um, since you said you did send in that paperwork, um, sorry, sometimes these codes don't give us a whole lot of information, so we have to dive a little deeper.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's OK. I just wanna, I also just wanna make sure I submitted the right paperwork as well.
[AGENT][NEUTRAL] Right, yeah. I wanna make sure you did too because.
[AGENT][NEGATIVE] Uh, that's frustrating, but.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Yeah, of course I just wanna make sure you're OK on hold, OK?
[CUSTOMER][POSITIVE] Yeah, I'm OK, thank you.
[AGENT][POSITIVE] OK, you're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey, thanks for holding. Um, so, did you only submit the primary insurance EOBs?
[CUSTOMER][NEUTRAL] Yeah, that's the, the document that I submitted. That's the only one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we need the itemized bill.
[AGENT][NEUTRAL] To, um, include the diagnosis diagnosis code.
[CUSTOMER][NEUTRAL] OK, alright, um, let me give them a call and see if I can get that sent over today.
[AGENT][NEUTRAL] OK perfect and then do you need our fax number or do you have that?
[CUSTOMER][NEUTRAL] Would I be able to upload it in the app or would it be faster if I faxed it?
[AGENT][NEUTRAL] Yeah, you can upload it into the app. You have the OSC account.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, yeah, that would be perfect.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] OK. Of course, you're welcome. Um, give us a call back when, whenever you hear back from them, OK?
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] OK, of course, you're welcome. Thanks for calling APL. Mhm, bye.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm bye bye.