AccountId: 011433970860
ContactId: 9fddc9f8-cdd8-4978-8928-e5f52954c749
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 615640 ms
Total Talk Time (AGENT): 195756 ms
Total Talk Time (CUSTOMER): 273089 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/9fddc9f8-cdd8-4978-8928-e5f52954c749_20250331T22:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is um [PII], and I'm calling to check on the status of a claim, please.
[AGENT][NEUTRAL] OK, I'm happy to check on a claim status. What's the patient's policy number?
[CUSTOMER][NEUTRAL] It's 1579332.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Alright, give me just one moment.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] I'm just.
[AGENT][NEUTRAL] Can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And data service.
[CUSTOMER][NEUTRAL] Um, date of service, I don't know the date of service. Oh, I think it was [PII] or [PII].
[CUSTOMER][NEUTRAL] I got a claim number if that'll help.
[AGENT][NEUTRAL] OK, yeah, what's the claim number that you have?
[CUSTOMER][NEUTRAL] 3583582495
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And are you the insured, you're the patient?
[CUSTOMER][NEUTRAL] I am, yes ma'am.
[AGENT][NEUTRAL] OK, thank you, [PII]. All right, so let's see here.
[AGENT][NEUTRAL] So it looks like we got the claim. It was for an ER visit and it says um we received this claim, how, however, in order to provide further consideration, we need supporting documentation um of evidence to the accident or sickness. Supporting documentation may include an itemized bill with diagnosis codes, an office note.
[AGENT][NEUTRAL] Um, hospital admission or discharge summary.
[CUSTOMER][NEUTRAL] OK, the records were sent with this claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They were sent separately.
[CUSTOMER][NEUTRAL] OK, so it was sent on look like on this claim.
[CUSTOMER][NEUTRAL] I don't know. Give me one moment.
[CUSTOMER][NEUTRAL] It looks crazy. Um.
[CUSTOMER][NEUTRAL] The notes were already sent with it.
[CUSTOMER][NEGATIVE] Um, let me see. Jesus, hold on. This thing on this online portal keep flickering. I'm wondering why is it doing that? Cause I can't see cause I went back and uploaded them um to the claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It was, it was uploaded already. They were already sent.
[CUSTOMER][NEUTRAL] They were saying at two separate times.
[AGENT][NEUTRAL] Let me look
[AGENT][NEUTRAL] Yeah, I see the 2 uploads. Let me
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] They.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] OK, so I see.
[AGENT][NEUTRAL] Itemized hospitalization.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I think that itemized bill, it was like 3700 and something.
[CUSTOMER][NEUTRAL] And also the medical records, something from the, it was uploaded, so it was two different uploads sent along with first I sent just uh 3 pages. I think I just sent the um what did I say? the application where you get your signature and something else. Then I turned around and sent the itemized bill along with the records.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They were saying a day apart.
[AGENT][NEUTRAL] Yeah, I see
[CUSTOMER][NEUTRAL] Because I had to go.
[AGENT][NEUTRAL] I see the 2nd 1 here.
[CUSTOMER][NEUTRAL] Yeah, I
[CUSTOMER][NEUTRAL] I had to go get it, but I was
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, but it's already there.
[AGENT][NEUTRAL] OK. Yeah, I see.
[CUSTOMER][NEUTRAL] Yeah, I was out to eat. It was raining. I was coming to coming, leaving from dinner, from eating from church, and I stepped down from stairs the heel of my shoe.
[CUSTOMER][NEGATIVE] I got stuck in a crack.
[CUSTOMER][NEGATIVE] Well, the stairs is causing me to fall.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, what I think we need to do with this cherish is, it's the end of the day for us, unfortunately. I'm on Central time. I'm not sure where you're at.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I'm central as well.
[AGENT][NEUTRAL] OK, um, I need to reach out to the claims examiner that processed this and see um what additional information is needed on it because I do see the two uploads and it's not clear to me. I don't process claims unfortunately.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I don't think they even saw it actually.
[AGENT][NEUTRAL] So I
[AGENT][NEUTRAL] OK, um, I can.
[CUSTOMER][NEUTRAL] Because when I'm trying to look at it really, yeah, what they're asking for is the itemized bill which is 00 I'm sorry, we're talking at the same time.
[AGENT][NEUTRAL] So I can send them.
[AGENT][NEUTRAL] That's OK. I was just gonna say.
[CUSTOMER][NEUTRAL] And I'm trying, I'm not trying to talk over you.
[AGENT][NEUTRAL] I was just gonna say what I can do is just send them a message and then have them give you a call tomorrow at a um good time to see if they missed something then reprocess the claim and if they didn't then they can advise you on exactly what it was that was missed if anything.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Well, we asked for an itemized bill which was not attached to the initial first claim.
[AGENT][NEUTRAL] Yeah, but that shouldn't.
[AGENT][NEUTRAL] That should be
[CUSTOMER][NEUTRAL] Well, yeah, because the itemized bill is needed, but, and then the other, the um
[AGENT][NEUTRAL] That shouldn't matter.
[CUSTOMER][NEUTRAL] I didn't have the um discharge, but I have the um
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, I have what they're looking for, so.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Now do I need to, cause that, the diagnosis code is written on the paperwork that was sent in. Now, do I give it to you verbally or do you want me to go back and fax it in to not go fax it, and it'll show up tomorrow because this is.
[AGENT][NEUTRAL] Yeah. I mean, if you have something with diagnosis codes on them, you can fax it, absolutely. Um, I can't take it, unfortunately over the phone.
[CUSTOMER][NEUTRAL] Yeah, but it's already.
[CUSTOMER][NEUTRAL] Yeah, that's fine, but what I'm saying it's already listed on the paperwork that y'all have.
[CUSTOMER][NEUTRAL] That I sent here.
[CUSTOMER][NEUTRAL] But I'll make sure you guys get them. I'm trying to get to that email. But I, it's already there, so, but I'll just resend it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] A matter of fact, I'm just gonna reupload it.
[CUSTOMER][NEUTRAL] But you still need to have them to look at it because it's already there.
[AGENT][NEUTRAL] Is this
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, is the [PII] a good callback number?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK. Is there a good time to call?
[CUSTOMER][POSITIVE] Anytime is, is good.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I will send a message to the claims examiner and have them look at this and then have somebody call you back at this number um in regards to it, OK?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What's the first name of the examiner?
[AGENT][NEUTRAL] Uh, let me see here one moment.
[AGENT][NEUTRAL] It looks like it's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am. So I will just wait for a call back.
[AGENT][NEUTRAL] So, um, I will send a message over there and then like I said, have them give you a call from the claims department, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Great. Did you have anything else, yeah. Did you have anything else you want me to check on?
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][POSITIVE] OK, thank you for calling APL Church. Have a good night.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you. You too. Bye.
[AGENT][NEUTRAL] Bye bye.