AccountId: 011433970860
ContactId: b1bffb6e-30f5-4e28-9921-3e6ef6c3f126
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 437149 ms
Total Talk Time (AGENT): 155345 ms
Total Talk Time (CUSTOMER): 121069 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/b1bffb6e-30f5-4e28-9921-3e6ef6c3f126_20250226T22:53_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I just had a question with regard to some claims I had.
[AGENT][NEUTRAL] OK, thank you. And Mr. [PII], what's that policy number, please?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it here somewhere.
[CUSTOMER][NEUTRAL] I think I left that card at home.
[AGENT][NEUTRAL] OK. Uh, what's your last name?
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][POSITIVE] OK, thank you, give me one moment.
[AGENT][NEUTRAL] OK, and Mr. [PII], what state are you from?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And verify your date of birth, mailing address and email address for me, please.
[CUSTOMER][NEUTRAL] Sure, date of birth is [PII].
[AGENT][POSITIVE] Bless you.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] The home address is [PII].
[CUSTOMER][NEUTRAL] And the email address is [PII].
[AGENT][POSITIVE] OK, thank you so much. And Mr. [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Sure, it'll be this number uh [PII].
[AGENT][NEUTRAL] 6, OK.
[AGENT][POSITIVE] OK, thank you so much. You said you had a question about claims that were processed or checking status of claims?
[CUSTOMER][NEUTRAL] Uh, just a question with them they were declined, but I think I might have just not provided enough information.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I wasn't sure exactly what information you guys are gonna need. I sent the explanation of benefits.
[CUSTOMER][NEUTRAL] Um, I didn't have the receipts on hand.
[CUSTOMER][NEUTRAL] And then I was out of state for a week so I wasn't able to upload those.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And obtain them from the uh.
[AGENT][NEUTRAL] Because I'm showing some claims that were received, um, like they were processed on the [PII] as needing the diagnosis codes.
[AGENT][NEUTRAL] like for physical therapy?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Where would I find that? Would that be on the receipt that I get from the physical therapy or do I have to call them to get it?
[AGENT][NEUTRAL] Um, you have to contact that, um, contact them and request the billing showing the diagnosis code.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And they may um have a printout for each one of these days to service for physical therapy you receive, but yeah, you will contact them and they should be able to give you the billing with the diagnosis code.
[CUSTOMER][NEUTRAL] OK, and then in addition to that I had a MRI done.
[CUSTOMER][NEUTRAL] For request from a uh.
[CUSTOMER][NEUTRAL] So both physical therapy and the orthopedic.
[AGENT][NEUTRAL] Uh, do you remember what date of service that one was for?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Little unprepared at the moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Don't know that one at the moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It does seem like most of them are just looking for that diagnosis code.
[AGENT][NEUTRAL] Yes, sir. And
[AGENT][NEUTRAL] Most times if it's for um if you can get that diagnosis code or the billing for the MRI uh with the diagnosis code or the billing for the physical therapy with that information, um, it looks like that's all we're needing.
[CUSTOMER][NEUTRAL] OK and then.
[CUSTOMER][NEUTRAL] Would I just attach that online?
[AGENT][NEUTRAL] Uh, you would have to do it as a new claim, since the other claims have been processed, uh, you wouldn't be able to attach anything to them.
[CUSTOMER][NEUTRAL] OK, so I put a new claim in with that and when I was reading online it seemed like.
[CUSTOMER][NEUTRAL] They wanted them all to be individual.
[AGENT][MIXED] Not really. I mean, if it's too big, um, it probably won't, you probably get an error message when trying to upload, but if you want, you can do them individually, but if you can put them all together and it doesn't go over the certain amount of megabytes, you should be fine.
[CUSTOMER][NEUTRAL] OK, yeah, that would make more sense to me, but the way I was reading it, I thought they wanted it all separate.
[AGENT][NEUTRAL] Oh, no, sir. And the examiners where they can go back in the history and see which one those dates of service and verify them.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So that
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Alright, so I'm just gonna call.
[CUSTOMER][NEUTRAL] The physical therapy and the orthopedic then and see.
[CUSTOMER][NEUTRAL] If they can give me that diagnostic code.
[AGENT][NEUTRAL] Yes, sir. If you can ask them for like a walkout statement or billing showing the diagnosis code, that's all I'm sure we're needing.
[CUSTOMER][NEUTRAL] And then if I attach that again should I attach it with.
[CUSTOMER][NEUTRAL] The explanation of benefits.
[AGENT][NEUTRAL] Um, I don't, I wouldn't, no, sir. I would say just to attach that uh just to send that information because we uh apparently already have the EOBs in our system, so you don't have to send them again.
[CUSTOMER][NEUTRAL] For my insurance as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Uh, no, I think that's it. I appreciate your help.
[AGENT][POSITIVE] Uh, yes, sir. Thank you for calling APL. You have a great day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Bye.