AccountId: 011433970860
ContactId: acbde8d5-ffd4-4c06-bf07-4dde3bb0ca6c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 757840 ms
Total Talk Time (AGENT): 257451 ms
Total Talk Time (CUSTOMER): 202577 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/acbde8d5-ffd4-4c06-bf07-4dde3bb0ca6c_20250207T21:52_UTC.wav
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[AGENT][NEUTRAL] [PII], how may I help you?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Thank you for calling APL this is.
[CUSTOMER][NEUTRAL] Can you hear me? Oh.
[AGENT][NEUTRAL] I can.
[CUSTOMER][NEUTRAL] OK, good, um, we're breaking up so I didn't know if it's me or you. So my name is [PII], and I'm just checking on a claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't hear anything on my end.
[AGENT][NEUTRAL] But it could be my end. I don't know, um, are you the policy holder, [PII] or calling on behalf of a provider's office?
[CUSTOMER][NEUTRAL] No, I'm the policy holder.
[AGENT][NEUTRAL] OK, what's your policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 01 minute.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 152-876-1
[AGENT][NEUTRAL] 876-4 or 61?
[CUSTOMER][NEUTRAL] 876 1
[AGENT][NEUTRAL] One OK and what's a good call back, [PII] in case callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And verify your date of birth and your mailing address for me please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] My address is [PII].
[AGENT][NEUTRAL] OK, thank you and what's your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and you said that you're checking claim status?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I can help you with that information. What's the date of service?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Like the date you received it?
[AGENT][NEUTRAL] The date that you went to the.
[AGENT][NEUTRAL] Doctor.
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] Uh, this year?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And was it a surgery that you had?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so it looks like we're requesting a copy of the diagnosis. Let me see. Give me a sec.
[CUSTOMER][NEUTRAL] I've seen all that, yeah.
[AGENT][NEUTRAL] Let's see, when did you send it in?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] I downloaded it.
[AGENT][NEUTRAL] OK, I see something received on [PII].
[AGENT][NEUTRAL] Let me see. Does that sound about the time?
[CUSTOMER][NEUTRAL] That that might have been when, yeah, probably.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] Yeah, full claim
[CUSTOMER][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I just sent that whole thing because it was.
[CUSTOMER][POSITIVE] Has everything on it.
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] About 22 pages or so, give or take.
[CUSTOMER][NEUTRAL] Yeah, and
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It was just it has the codes and everything, the date of the surgery and all that on it. I was in the hospital overnight and then released the next day and
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm at home and I don't know how to break it down to just send one or two pages so I just send it all.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, I do see the diagnosis on this in this document and it's, it's here, um.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Hold on 1 2nd.
[AGENT][NEUTRAL] Did you send in an itemized bill? I see is Blue Cross your primary?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] I sent that ELB
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it's in line for processing.
[CUSTOMER][NEUTRAL] What is that?
[CUSTOMER][NEUTRAL] Like to be paid or?
[AGENT][NEUTRAL] It's in line
[AGENT][NEUTRAL] It's in line to be processed so it hasn't been processed yet because we just received it on the [PII], so allow about 7 to 10 days.
[CUSTOMER][NEUTRAL] Oh, OK, well, because it said processed on on this when I'm in the APL.
[AGENT][NEUTRAL] For processing?
[CUSTOMER][NEUTRAL] Online, so, and then I was like, well, I don't know.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] It says medical notes without claim. Did you fill out a claim form?
[CUSTOMER][NEUTRAL] I thought I did.
[AGENT][NEUTRAL] Like an APL claim form, Medley claim form.
[CUSTOMER][NEUTRAL] I, I'm pretty sure I did, yeah.
[AGENT][NEUTRAL] OK, give me 1 2nd.
[AGENT][NEUTRAL] It also looks like your day of service shows [PII]. Was the surgery on the [PII] or the [PII]?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It's on the [PII].
[AGENT][NEUTRAL] the ELB
[CUSTOMER][NEUTRAL] I'm not sure. I
[AGENT][NEUTRAL] Yeah, the ELB that you sent, it shows the date of service is the [PII].
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Of January
[CUSTOMER][NEUTRAL] Well that was my pre-admission stuff I had to do.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The week before the surgery, so I don't, I mean, I don't know. I just sent both of those.
[AGENT][NEUTRAL] OK, I know that the that we will need the the ELB that matches the date of service of the claim.
[CUSTOMER][NEUTRAL] But uh
[AGENT][NEUTRAL] That's what that tells us.
[CUSTOMER][NEUTRAL] You should have
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You should have 2 of them, do you?
[AGENT][NEUTRAL] I'm showing date of service [PII]. Let me go back and take a second look.
[CUSTOMER][NEUTRAL] Yeah, the surgery I sent to it for $1,636.
[AGENT][NEUTRAL] OK, I do see the looks like this could be the physician's fee for 6,818.
[AGENT][NEUTRAL] And then the deductible amount is 1636, is that what you're talking about, the deductible amount?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the other one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I do see the surgeons for the [PII].
[AGENT][NEUTRAL] But as you were stating, the one that you called on, it says uh medical notes without claim, so give me a second, let me clarify what that is and what is needed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you're gonna be receiving an explanation in the mail, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Shortly.
[AGENT][NEUTRAL] Uh, just stating what I said, but let me see specifically what we're looking for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII]. How are you?
[CUSTOMER][POSITIVE] I'm doing good, [PII] how are you?
[AGENT][NEUTRAL] [PII] is answering the phones. I don't believe it.
[CUSTOMER][NEUTRAL] Yeah, only because I was getting ready to get out of here and didn't log out in time.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] You're doing more important things, right? So this is a quick one, the policy number is 152.
[CUSTOMER][NEUTRAL] I am.
[AGENT][NEUTRAL] 876 1.
[CUSTOMER][NEUTRAL] OK, 152-8761.
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And she's calling about claim number 3559448.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that remark code.
[CUSTOMER][NEUTRAL] DM 25, let me put the claim up one second.
[AGENT][NEUTRAL] Is that, is that the
[CUSTOMER][NEUTRAL] That's just saying that we received miscellaneous correspondence, but let me see what she sent in to us one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Come on, they, I know it's time for it to go, but I'm not going in.
[CUSTOMER][NEUTRAL] So you've been doing OK?
[AGENT][NEUTRAL] I have been.
[CUSTOMER][POSITIVE] Good.
[AGENT][NEUTRAL] And yourself?
[CUSTOMER][POSITIVE] Can't complain.
[AGENT][NEUTRAL] Uh-huh. Yeah, yeah.
[CUSTOMER][NEUTRAL] Medical notes without the claim. Let's see what she got.
[CUSTOMER][NEUTRAL] Oh wow, so she requested, you requested the diagnosis code and she sent in the medical records.
[AGENT][NEUTRAL] And the code is on there I believe or within.
[CUSTOMER][NEUTRAL] I'm sure.
[AGENT][NEUTRAL] Yeah, I saw 2 codes in there, 2 diagnosis codes.
[CUSTOMER][NEUTRAL] And I think the person who did this is gone.
[CUSTOMER][NEUTRAL] Ah.
[AGENT][NEUTRAL] Do I need to?
[CUSTOMER][NEUTRAL] We got the diagnosis code. I've seen them. Tell her that we will give her claim reprocessed and I'll send it back to the uh examiner for her to reprocess the claim.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK. All [PII]. Thank you.
[CUSTOMER][POSITIVE] Alright, no problem.
[AGENT][POSITIVE] Uh huh bye bye. Have a good weekend.
[CUSTOMER][POSITIVE] You too thank you [PII] bye bye.
[AGENT][NEUTRAL] Uh bye-bye.
[AGENT][NEUTRAL] All right, [PII], thank you for holding. So, um, they're, they're going to send your claim back through the diagnosis are on that that the what you sent in, uh, on the [PII] they're within the medical records that you sent and so they're going to send the claim back through, uh, to be reprocessed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So both of them are good to go?
[AGENT][POSITIVE] All righty.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, sounds like a winner.
[AGENT][NEUTRAL] I know it's like she'll be happy to hear this. It's just kind of what I thought, but I was seeing something else on that EOB that uh you're gonna be receiving says something different, so that's what threw me a little bit, but we're gonna send it back and have it reprocessed, OK?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Awesome thank you so much for your help dear.
[AGENT][NEUTRAL] You're, you're welcome. Any other questions?
[CUSTOMER][POSITIVE] No ma'am, thanks a lot though.
[AGENT][POSITIVE] Oh, OK, [PII], thanks for calling APL. Have a good weekend. Bye-bye.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] You too bye.