AccountId: 011433970860
ContactId: a13d31f3-a341-4112-86cd-894900231856
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 412790 ms
Total Talk Time (AGENT): 147088 ms
Total Talk Time (CUSTOMER): 210933 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/a13d31f3-a341-4112-86cd-894900231856_20250116T21:16_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, good evening. Um, I'm calling because I have gap insurance through you, and unfortunately I have not been able to process a few claims, and I was trying to see if you can help me because when I called the insurance company, they only say you can download the EOB from the website. However, the EOB doesn't have those diagnosis codes that you require.
[CUSTOMER][NEGATIVE] And when I contact the doctors, the doctors, their billing company or processing company, it's not at the office. They're like remotely in another state, another city, which I personally don't have access to them. So it's like a really to me it's really so difficult.
[CUSTOMER][NEUTRAL] Um, so I don't know if there's a way for me to obtain this information.
[AGENT][NEUTRAL] OK, yeah, um, do you, let's look at that policy real quick together. Um, I do just have to verify some information, but then as far as getting forms from the doctor, I can help you figure out like exactly what form we need, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So let's see, uh, real quick, do you mind if I get your, just your first name and your policy number?
[CUSTOMER][NEUTRAL] Of course, my first name is [PII] and my policy number is 02140827M Mike Lima 7.
[CUSTOMER][NEUTRAL] And the only item number 8.
[AGENT][NEUTRAL] Thank you. And would you be able to verify for me, please, your date of birth?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you. I appreciate that. Hang tight.
[AGENT][NEUTRAL] All right, and then I do just need to verify just a couple of quick other pieces of information, your mailing address if you can.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Alright, perfect. And then the last two things is just the phone number on file and the email on file.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, the email on file should be [PII].
[AGENT][POSITIVE] Perfect, I see that. And then just the phone number, my friend.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII]. Mhm.
[AGENT][POSITIVE] Thank you. I appreciate you going through that verification process with me and.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] All right. So,
[AGENT][NEUTRAL] You said you were able to get your EOB from your, your primary insurance, but it doesn't have your diagnosis form. So I know getting it through the provider is a struggle. Um, hopefully it will help to just request this one form, and they'll be able to like send it to you and instead of trying to search through all their documents. But the form you can ask for from a physician's office is a CMS 1500.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Mm mhm.
[CUSTOMER][NEUTRAL] OK. Give me one. S like Sierra.
[AGENT][NEUTRAL] Yes. So, C like cat, M like Mary, S like Sierra, 1500.
[CUSTOMER][NEUTRAL] 1500. Mhm mhm.
[CUSTOMER][NEUTRAL] OK, so let me see if I can get it because the health insurance told me they cannot give me anything besides the EOB and when I called the insurance and I explained, as I explained to you, they go, this is the number in [PII] or they're in [PII], uh, you need to contact them. So however, I do not have a relationship with them, so they don't, they can't verify who am I, so they tell me that they can't give me any information.
[CUSTOMER][MIXED] And it's really, really a struggle. So if you see my account, I have, I have a few pendings from [PII], and I also have the whole year of [PII]. I mean, there, I said the whole sounds like a lot, but just thankfully we're, we're very health you know healthy. But you know, like a, a little, a few, I have a few from [PII], and from [PII].
[CUSTOMER][NEUTRAL] So I'm trying to get that um done.
[CUSTOMER][NEUTRAL] So I'm gonna see if that works then I'm gonna call them and see if they can provide it to me. Um, my last question, I'm afraid that from [PII] I might not have the co-payments um.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I received anymore if they don't give me a duplicate, which my bank statement was sufficient, you know, if I show you a copy of the bank statement or no?
[AGENT][NEUTRAL] Oh, OK, um, so.
[AGENT][NEUTRAL] I believe we need the itemized bill, but let me, let me just double check that real quick, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] All right, and so it is an itemized bill we would need um from your.
[AGENT][NEUTRAL] From your
[CUSTOMER][NEUTRAL] From the doctor.
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] OK, the bill or the proof of payment? because I'm sure they can't give me the itemized bill, but the proof of payment.
[CUSTOMER][NEUTRAL] I was asking if you need that too. Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It
[AGENT][NEGATIVE] Really just needs to have the procedure codes and what was charged for each procedure code um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the proof of payment, I mean, I don't think we require that because you can submit a claim and not pay them until you got your benefits paid to us. We don't require to see proof of payment, uh, we just need to know what was charged for each procedure.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I see. OK, good. OK. So I'm gonna give them a call now to see if I have better luck, OK?
[AGENT][POSITIVE] Yes, I wish you the best of luck. I absolutely understand it's really difficult to get documentation through them, but I wish you the best of luck. And then, um, if you need anything else please reach out to us, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Of course. Thank you. Thank you again. Bye.
[AGENT][POSITIVE] My pleasure. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Mm bye.