AccountId: 011433970860
ContactId: aeb3e0c3-5059-495a-bd68-35b7dfb6673b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 634619 ms
Total Talk Time (AGENT): 150265 ms
Total Talk Time (CUSTOMER): 153674 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/aeb3e0c3-5059-495a-bd68-35b7dfb6673b_20250624T17:24_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. We filed a claim for my daughter, [PII], because she was injured playing lacrosse. And um there was a request for additional documents, and I uploaded those, the best way I knew how, and I just want to make sure that you all have everything and if you needed anything else.
[AGENT][NEUTRAL] OK, do you have the policy number?
[CUSTOMER][NEUTRAL] Sure. One second.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] 231-0083
[AGENT][NEUTRAL] OK, what was your, uh, I, I'm sorry, I missed your name, first and last name and then your date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. And then can you verify your address and email address?
[CUSTOMER][NEUTRAL] It's [PII], and the email is [PII].
[AGENT][POSITIVE] OK, thank you so much. And then lastly, do you have a good call back in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Thank you. And then you said it was for your daughter, is that right?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, let me pull up what we received.
[AGENT][NEUTRAL] OK, it looks like we're requesting charges, diagnosis code and procedure codes. Let me get this pulled up. Let's see.
[AGENT][NEUTRAL] And then you submitted a claim for UPMC is that right?
[CUSTOMER][NEUTRAL] Yeah, I, I still waiting on the hospital.
[CUSTOMER][NEUTRAL] And the PT, but I did get these ones done, so.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, I see the statements. Um, it does have the procedure codes.
[AGENT][NEUTRAL] I'm not seeing the diagnosis though. Let me see.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK. And then I've got a quest diagnostics.
[AGENT][NEUTRAL] Let's see that one.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK, this Quest Diagnostics, it doesn't look like that has a diagnosis either. Most of these won't have diagnosis on them.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You'd have to like obtain it from.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The healthcare provider or maybe a patient portal if you have access to a patient portal, um.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] What's the diagnostic code? I'm
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, I, I get these statements and then I asked for the more detailed statement, and I sent the form to the doctor to fill out. I'm hopeful that you've got that.
[AGENT][NEUTRAL] It it
[AGENT][NEUTRAL] OK, um, let me see if he's got the.
[AGENT][NEUTRAL] Do you know when the physician sent the foreman?
[AGENT][NEUTRAL] It
[CUSTOMER][NEUTRAL] I don't know when he sent it in if if you don't have it all.
[AGENT][NEUTRAL] OK, that looks like.
[AGENT][NEUTRAL] Yeah, we don't have that. Um, so a diagnosis is, there's a procedure code that tells us what was done, and then there's the diagnosis that says if she, whatever her diagnosis was like if she broke a bone or, um, you know, strained a muscle, etc. um.
[CUSTOMER][NEUTRAL] The to or ACL.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So that, that's what we're missing is the, the diagnosis that shows she tore her ACL.
[AGENT][NEUTRAL] We, we see the services that were rendered.
[AGENT][NEUTRAL] But it doesn't say anything about torn ACL.
[CUSTOMER][NEUTRAL] OK. So that form that the doctor needs to fill out?
[CUSTOMER][NEGATIVE] Would that be sufficient, or what do I do here? I've never had to do this. All I know is they want their money. I am submitting it so I can pay the bill, and I've been going back and forth between you and the insurance company and the healthcare company, and I'm just, I have, I don't even, what do you want? Just let me know that and I'll try to find something.
[AGENT][NEUTRAL] OK, um, let me see what the attending physician let me pull that up real quick.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Yes, so the attending physician statement, it does have a spot for the diagnosis. Um, let me make sure if we actually need something else though, or if that will suffice. Can you, can I place you on a brief hold?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] OK. Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, I'm so sorry about that. Thank you for holding. Um, yes, so we, we still need the documentation, uh, documentation that shows.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I was just gonna say
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] I just found all her, her appointment summaries where it tells you exactly, like, you know, her initial visit, need this. And then when she got diagnosed with that, and when she was scheduled for surgery, like all the notes, is that what you need? from the doctors.
[AGENT][POSITIVE] Oh, perfect.
[AGENT][NEUTRAL] Yes, that if, if that shows what the diagnosis is, then that would, that would be sufficient. We just need something uh medical records that indicate what the diagnosis was.
[CUSTOMER][NEUTRAL] All right, then I am going to um.
[CUSTOMER][NEUTRAL] Just upload all of these.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] To you and then um I'll call back and make sure that's acceptable and um after I do that, um.
[CUSTOMER][NEUTRAL] Hopefully that's everything, but how long does this take to get processed?
[AGENT][NEUTRAL] Uh, typically it takes up to 7 working days, uh, if we've received all the information that we need.
[CUSTOMER][POSITIVE] All right, perfect. I'm gonna do it right now and then I'll call back and make sure this is good enough.
[AGENT][POSITIVE] OK. All right, that sounds good. Anything else I can help with at the moment?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][POSITIVE] No, that's all thank you.
[AGENT][POSITIVE] OK, thank you for calling API. I hope you have a good afternoon.
[CUSTOMER][NEUTRAL] It