AccountId: 011433970860
ContactId: b5231e73-de3a-4c3e-8795-d2cd4d3bb22a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1029650 ms
Total Talk Time (AGENT): 390422 ms
Total Talk Time (CUSTOMER): 614529 ms
Interruptions: 6
Overall Sentiment: AGENT=0.9, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/b5231e73-de3a-4c3e-8795-d2cd4d3bb22a_20250310T14:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, sorry, I'm calling because I called in this morning in regards to a claim I submitted. I've been having some difficulties with it and the girl gave me a list of items that I needed, um, but one of the items, she said the ICD 10 code, when I called my insurance company, she said, um.
[CUSTOMER][NEGATIVE] When I called everybody, they said they don't do a call. This is an emergency room visit that landed me from a fall.
[CUSTOMER][NEUTRAL] So, what do I do? Just submit everything else?
[AGENT][NEUTRAL] OK, um, I can help you with your claim. First I'm going to need for you to give me your name and your policy number.
[CUSTOMER][NEGATIVE] Oh God, my name is I don't let me look at this policy number, shoot.
[CUSTOMER][NEGATIVE] I'm so tired of this already. My name is [PII].
[CUSTOMER][NEUTRAL] What am I calling? APL.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And my, uh, hold on, I'm gonna give you my number.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] Shoot, I have to find out who I'm calling. Shoot, I'm calling so many dang on people.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Trying to get this worked out, man.
[CUSTOMER][NEGATIVE] They got me in collections behind this mess.
[AGENT][NEGATIVE] Oh no.
[CUSTOMER][NEGATIVE] Yeah, it's messing up my credit and I'm trying to buy a house and this is like this is not good. OK, so my policy, let me see here, policy number is 244-73993.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, Miss [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, ma'am. And then I'm also going to need for you to verify your address, phone number, and email address that we have on the policy for you.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, and then one last verification, can you give me your phone number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, ma'am. And then if we get disconnected, is it OK for me to call you back on that number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you so much. OK, so for your claim, you said that the ICD-9 code, they are not giving it to you because you went through the emergency room?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Ask them for a diagnosis code.
[AGENT][NEUTRAL] That's what you need is the, the ICD 9 is diagnosis.
[CUSTOMER][NEUTRAL] Oh [PII].
[CUSTOMER][NEUTRAL] She said they don't put them on none of the itemized bills.
[AGENT][NEUTRAL] OK. What you'll need is a diagnosis code.
[AGENT][NEUTRAL] What they diagnosed while you were there at the ER.
[CUSTOMER][NEUTRAL] OK, so, OK, so I mean I understand what you're saying, and I called her and I think I called the billing department. She emailed me the itemized bill, but she said once again this is Moses Cone Hospital. We do not do, we don't put an IED on the code. So I don't know anything but to go to the hospital and stand to find a code when it's like when I called several people and they say you went to an emergency room, they didn't diagnose you, you failed.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] So the diagnosis is I failed.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, I'm gonna see if there's somebody that is available in the claims department to talk to you since you've been trying to get this taken care of this morning, see if there's any more information that we can get from them as far as them telling you that they can't give you a diagnosis code OK?
[CUSTOMER][NEUTRAL] OK, yeah, because I've got the itemized bill. I have the um.
[CUSTOMER][NEGATIVE] The, uh, for my primary insurance company, I have the EOBs, so like I did everything that she's saying and I'm down to the ICD 10 code and the lady said you went to the emergency room, you failed, correct? I said, yeah, I failed. And she said, we don't have a code, we don't put a code on on the bill, so I'm, I'm lost. It's like I'm being asked for something that they don't even in their policy they don't do.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] OK all right well I'm gonna get us some help um as far as you know what your next step is if there's any or if what you have is OK to go ahead and send in, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, it's gonna be a brief hold while I transfer you on over. Thank you so much for calling APL. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Ferring
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], it's [PII]. I've got, um, hey, I've got Miss [PII] on the phone. She's called already a couple of times this morning. That's why I'm calling you instead of sending it through the hub. She's trying to get her information together. Her policy number is 244-73993.
[CUSTOMER][NEUTRAL] Hey, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And she has a claim that she's that um she's going to resubmit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And she did call this morning and she was told that she needed to get um an ICD 9 code.
[AGENT][NEUTRAL] She went to the emergency room that she visited. She's got the itemized statement. She's got the EOB from the primary, but the emergency room told her that there, that it came through the emergency room and they can't give her a diagnosis code because she just failed and came to the ER. She's not able to get that and she's wondering if the itemized statement and the EOB along with the claim form would be enough to send in for her claim to reprocess.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um, let's see, well, nobody uses ICD 9 anymore, so I don't.
[AGENT][NEUTRAL] That's what she was told.
[CUSTOMER][NEUTRAL] Yeah, nobody, nobody would be able to provide that. Um, it's ICTN now, um, it has been for years, so I don't really know why she was told that, um, but so that sorry about that miscommunication, but, um, as far as I'm trying to see what we have because the let's see, the remarks says an EOB and a diagnosis for which treatment was provided.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So my own base would load this document I could see what we have going on here um because it looks like where we see that she had like an X-ray I'm assuming and then on one day and then she went to the ER on a different day so it looks like we have two different dates going on here.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm trying to see what we have. Oh my goodness, is your own pace this slow this morning?
[AGENT][NEUTRAL] My on base is always slow. It always gives me fit.
[CUSTOMER][NEUTRAL] It is just spinning today.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Oh goodness, OK, um.
[CUSTOMER][NEUTRAL] Oh, here it goes, finally. OK, all right, so she had an MRI. OK, so an MRI back in [PII].
[CUSTOMER][NEUTRAL] And then.
[CUSTOMER][NEUTRAL] With no diagnosis codes, OK, so that it is the need for diagnosis code there it looks like we have.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Kind of, I mean the EOB is appreciated. It looks like we if she can provide that, that would be great. If not, we may be able to do that, but we do need a diagnosis code for that ICD 10.
[AGENT][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] ICD 10
[CUSTOMER][NEUTRAL] Not 9. I do 10. Um, I will say that sometimes you can obtain like your medical records, um, and
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] If she has access to like.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I don't know what it's called with them, but it could be like a my chart or something like that. Sometimes you can get like an aftercare summary or an after visit summary or something like that and it will provide what your final diagnosis or what you were seeing for um to indicate if you're unable to obtain your actual the actual code from the facility that you've received services at whether that be.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] An outpatient MRI facility or imaging facility or whether that be an ER sometimes you can do that um yeah because.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you want me just to, you want me to just go ahead and go back to her and let her know this information and then if she has further questions transfer her.
[CUSTOMER][NEUTRAL] Yeah you can do that like let her know that um that it is actually I said 10, but if they were unable to provide a diagnosis code at all, if she could obtain any type of after visit summary that indicates why she was saying that we, we usually can use that too and if she still has more questions if you wanna just put me on hold so I'm available, um, yeah, I'll, I'll stick around just in case.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, I'll do that. I'll be right back. Hopefully, hopefully not, but if I do this, let me, hopefully to tell you that she's OK now.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. OK, I'll hang on for a sec.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, thank you.
[AGENT][POSITIVE] Hi, Ms. [PII], I've got some answers for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so if they're not able to give you the ICD 10 code, ICD 9 codes are no longer, they don't use those anymore. It's an ICD 10.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, for the MRI that you had, the claims department told me that if you can get them to give you an aftercare.
[AGENT][NEUTRAL] Um, sheet that says why you had the MRI.
[AGENT][NEUTRAL] That, that, that can also
[CUSTOMER][NEUTRAL] Oh, I, I mean, I, my doctor, my, I, oh, so I can just call the doctor's office and ask them why did they send me over there, get what they sent me over there for.
[AGENT][NEUTRAL] Well, they need to have a document for that to go with your claim.
[CUSTOMER][NEUTRAL] OK, I got what you're saying. OK.
[AGENT][NEUTRAL] So it needs, they need to document that for you, OK?
[CUSTOMER][POSITIVE] OK, alright, thank you.
[AGENT][POSITIVE] You're very welcome, Miss [PII]. I hope everything goes well for you and you're able to get that stuff quickly.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEGATIVE] Well, she hung up
[CUSTOMER][NEGATIVE] Oh no.
[AGENT][NEUTRAL] On me. I told her the information and she said, I'm just gonna go to my doctor and have them tell me why and I'm gonna tell you why. So, well, you need to have the document to come with your claim.
[CUSTOMER][NEUTRAL] Yeah, because if she just calls and says.
[CUSTOMER][NEUTRAL] Hey, I was seeing, you know, for this we still can't accept that we still have to have a document so hopefully she obtains an actual document.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Goodness, I mean, I understand the frustration, but at the same time like.
[AGENT][NEUTRAL] Well, yeah.
[CUSTOMER][NEUTRAL] We're just doing our job, you know what I mean? we're just doing our job.
[AGENT][NEUTRAL] Yeah, we're just doing our job, right?
[AGENT][NEUTRAL] And she said this has got me upset because um I'm trying to get a house and I've got this has gone against my credit and I said I am so sorry to hear that. I hope you can get it quickly and and get it turned into us.
[CUSTOMER][NEUTRAL] I mean
[CUSTOMER][NEUTRAL] Here's the thing, and this is just a personal opinion obviously this doesn't have anything to do with APL, but you shouldn't be waiting on us to pay your bills.
[AGENT][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] I mean, because what if, what if it's not payable at all? I mean not um this is a gap plan so it's, it's far less likely when you have a gap plan for us to not pay unless you've just maxed out, you know, but I mean, I know, I know some of this money isn't, I mean personally I, I have 3 kids, you know, and a husband, so you know I get it. Money, money just ain't sitting around waiting.
[AGENT][NEUTRAL] And, and if
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] Right
[CUSTOMER][NEUTRAL] But to be spent, but I mean set up a payment plan until you know for sure or something because.
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][POSITIVE] Yeah, I agree, I agree, plus if you've gone to collections you've had a few notices before it took you to collections, so you should have already.
[CUSTOMER][NEUTRAL] That's just personal, so.
[CUSTOMER][NEUTRAL] Um, Rock.
[CUSTOMER][NEGATIVE] Right, and we're just, I mean you were saying in October and we're just now getting your bills in March so and for outpatient she only gets $500 per day so if she was staying in the hospital on that $1000.01 it's still, still not gonna pay for all of it.
[AGENT][NEUTRAL] That's what I feel.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So I don't, OK, well, I can't do anything about that, so.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Oh, we can't. We're, I think we've helped her as much as we can help her. I think the rest is just her footwork getting what she needs to send in.
[CUSTOMER][POSITIVE] You're right.
[CUSTOMER][NEUTRAL] Yeah hopefully she doesn't just call with a diagnosis code because whoever answers is just gonna have to turn around and tell her, you know, we appreciate that and we'll make a note, but we need a physical document we can't accept it over the phone.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, and I went ahead and put that in my notes that she needs to send a document to so that we have that.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, and right, OK, well.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Maybe she'll be able to get what she needs and just send it in and maybe her call will be like hey I'm sending this in and not and it looks like we have two new documents so.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Hopefully
[CUSTOMER][NEUTRAL] I don't know if that's.
[CUSTOMER][NEUTRAL] Going to be
[CUSTOMER][NEUTRAL] In relation to this or if it's going to be.
[AGENT][NEUTRAL] She said that um she had to get the EOB and the itemized statement. So she sent that in already.
[CUSTOMER][NEUTRAL] OK, so let me, I'm going to look at that and see because I haven't looked at that.
[AGENT][NEUTRAL] So that's probably what that is.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] One of them hasn't been transferred over to or from indexing so I just see one but.
[CUSTOMER][NEUTRAL] I EOBs rarely have, and out of my statements truly rarely have everything we need. Sometimes they do, but oftentimes they don't, yeah, like this is from her ER visit in October.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And it has, you know, the same thing that her thing has the balance that she owes, payments that were made, um, basically stating that, you know, her co-pay is this, and so, but it still doesn't say why. I mean we can make assumptions because they were taking images of her leg, but.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] We, we don't actually have a diagnosis code, so yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Well, I'm hoping that she gets it together and gets it put, sent in so that she can get a little bit of help. And if she doesn't, then
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] Ma.
[AGENT][POSITIVE] You know, don't be upset with us because you're having to rush at the last minute to get it all done.
[CUSTOMER][NEUTRAL] I know, I know exactly. I mean, like I said, both of these bills are from the October visit it looks like so she's had 6 months, well, not quite 6 months, but.
[AGENT][NEUTRAL] You know,
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Like 5 months so and then they usually file pretty quick because those, you know, they can't be waiting around for payment either so she at least would have had something by December I would say so yeah I mean that's at least 3 months that this could have already been submitted and handled at least partially so I don't, I don't really know what to do from there. There's not anything we can do so hopefully she gets it and we can turn that around and get it out to her but you know.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] I would think so, yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] I don't either. I think, I think we've
[AGENT][NEUTRAL] I think
[AGENT][POSITIVE] Right. And I think we've done what we can to help her, um, the rest is up to her, you know.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Absolutely, absolutely.
[CUSTOMER][NEUTRAL] All right.
[AGENT][POSITIVE] OK. Well, I hope you have a good rest of your day. Hopefully, I won't have to bother you again and I'm sorry to, normally I would have sent a hub, but she was a little spicy and she's already called this morning. So I thought, you know what, I need to go ahead and help her now.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][POSITIVE] Yeah, no, that's fine. I don't mind at all. Just when if you need anything give us a call.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. All right. You take care. Bye-bye.
[CUSTOMER][POSITIVE] All right. Have a good day.
[CUSTOMER][POSITIVE] Thanks. Bye.