AccountId: 011433970860
ContactId: a3f216ef-e6c5-4aa8-88e7-e01b13f8f76c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 421179 ms
Total Talk Time (AGENT): 171777 ms
Total Talk Time (CUSTOMER): 132613 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/a3f216ef-e6c5-4aa8-88e7-e01b13f8f76c_20250428T22:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. Hey, I'm struggling to get my claim paid, um.
[CUSTOMER][NEGATIVE] And they asked for additional information and I sent the additional information. It looks like they declined it again.
[AGENT][NEUTRAL] OK. Do you have your policy number?
[CUSTOMER][NEUTRAL] Uh, policy number 02 0 hold up there.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] 02340625
[AGENT][NEUTRAL] OK, and your first and last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is your date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's like
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Do you have a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And then just need two other pieces of information, [PII]. What is your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm near the city and state.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And then lastly your email address?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Or [PII].
[AGENT][NEUTRAL] OK, let's see
[AGENT][NEUTRAL] And what date of service are we looking at?
[CUSTOMER][NEUTRAL] Um, this is.
[CUSTOMER][NEUTRAL] Let's see [PII] it says check date [PII].
[CUSTOMER][NEUTRAL] I don't know what that means.
[AGENT][NEUTRAL] Um, let me see, so.
[CUSTOMER][NEGATIVE] Yeah, they asked for information now it's asking for more information and they didn't tell me about this information now that.
[AGENT][NEUTRAL] OK, let me pull up what we received. Um, let's see.
[CUSTOMER][NEUTRAL] Service date [PII].
[AGENT][NEUTRAL] Getting that pulled up, just give me one moment.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, so it looks like you uploaded it from on your online portal, is that right?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so, OK, we've got.
[AGENT][NEUTRAL] Like an account
[AGENT][NEUTRAL] Statement from Lee Health, um, let's see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And they wanted an itemized bill and everything so I provided that.
[AGENT][NEUTRAL] So it looks like you have United Healthcare, is that right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Do you have the explanation of benefits that you could provide from them?
[CUSTOMER][NEUTRAL] Oh, where do I get that?
[AGENT][NEUTRAL] Do you have an online account with United?
[CUSTOMER][NEUTRAL] I do
[AGENT][NEUTRAL] You should be able to log in and get a um explanation of benefits because it'll, it's something you can print out from UnitedHealthcare that shows what they paid. Um, we actually have to have that explanation of benefits. I see that it says hospital payments and adjustments, but we do need the actual explanation from UnitedHealthcare.
[AGENT][NEUTRAL] And then there is a second piece of information that's needed. So it looks like on this bill,
[AGENT][NEUTRAL] or invoice that they sent, it's, it's got everything listed out that that you had done, but what it doesn't show is the explan or the uh diagnosis. So like what, what was the diagnosis you were seen for.
[AGENT][NEUTRAL] Um, and that's a piece of information we'll need too.
[AGENT][NEUTRAL] Um, usually, do you have, have you created an online account with Lee Health?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so, um, you should be able to probably go onto their online account too and look at, look at for like your visit summary for this date and it should.
[CUSTOMER][NEUTRAL] I'm in there now.
[AGENT][NEUTRAL] Yeah, it should have like a diagnosis listed um that shows, you know, why you went to the hospital.
[AGENT][NEUTRAL] after visit summary or um
[CUSTOMER][NEUTRAL] My chart.
[AGENT][NEUTRAL] Under the visits, there should be some type of documentation in there that shows what diagnosis you were seen for, for that date.
[CUSTOMER][NEUTRAL] Appointments and visits, surgery.
[CUSTOMER][NEUTRAL] Uh, [PII], [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And nothing. I'm in the help now.
[CUSTOMER][NEUTRAL] View after visit summary, view clinical notes.
[AGENT][NEUTRAL] I might check those. There could be something in there.
[CUSTOMER][NEUTRAL] After visit notes from caring notes to self, H&P.
[CUSTOMER][NEUTRAL] The past
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Provisional diagnosis, bleeding internal and external hemorrhoids.
[AGENT][NEUTRAL] OK, yeah, that's what we're looking for the diagnosis, so documentation that can provide that it's tied to that [PII]:14 visit and then going on to United Healthcare's website or their their portal that you have with them, and then getting that explanation of benefits that shows a breakdown of how UnitedHealthcare paid.
[CUSTOMER][NEUTRAL] So from care team, um.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, OK, so print, so I need to just upload it back into that filer.
[AGENT][NEUTRAL] Yes, uh-huh.
[CUSTOMER][NEUTRAL] OK, and will all these join together in my little APL app so when I up because it only lets you upload one thing at a time.
[AGENT][NEUTRAL] Yes, yeah, so you'll, we'll be able to put it with this claim, um, because we'll see that it's for the same date.
[CUSTOMER][NEUTRAL] Got it. OK. All right. And then explanation of benefits. OK dokey, I'll send these tonight.
[AGENT][NEUTRAL] OK. Anything else I can help with today, [PII]?
[CUSTOMER][NEUTRAL] That'll be it.
[AGENT][POSITIVE] OK. All right. Well, thank you for calling APL. Have a great evening.
[CUSTOMER][POSITIVE] Thank you, bye.