AccountId: 011433970860
ContactId: b8ec4c4e-2c17-48b4-8e8e-d0207a04124f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 326000 ms
Total Talk Time (AGENT): 107652 ms
Total Talk Time (CUSTOMER): 139291 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/b8ec4c4e-2c17-48b4-8e8e-d0207a04124f_20250417T16:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hi, [PII]. I'm here with a co-worker. I'm just calling in reference to a bill that we received from our insurance.
[AGENT][NEUTRAL] OK. May I have your name, please?
[CUSTOMER][NEUTRAL] Uh, it's under [PII] Last name, excuse me, [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, may I have your name?
[CUSTOMER][NEUTRAL] I'm [PII].
[AGENT][NEUTRAL] And [PII], may I please have a callback number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you're calling from the group?
[CUSTOMER][NEGATIVE] Um, I'm actually calling for, um, an employee who used the benefit card, had a doctor's appointment, and had a physical done, and we turned in the bill and this thing that we just got in the mail says it was denied, and I was just wondering why.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so what I'm asking, are you the HR or are you calling from the group? What is your title?
[CUSTOMER][NEUTRAL] I'm the uh yeah, I'm the office manager. This is for one of my the employees.
[AGENT][NEUTRAL] And may I have that policy number, please?
[CUSTOMER][NEUTRAL] We have
[CUSTOMER][NEUTRAL] Yeah, uh, [PII].
[AGENT][NEUTRAL] OK, that's not a policy number.
[CUSTOMER][NEUTRAL] Alright, um, that's his number number. I have a claim number.
[CUSTOMER][NEUTRAL] Oh, here's his policy number. I apologize. 025.
[CUSTOMER][NEUTRAL] 92076
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I speak with the policy holder please?
[CUSTOMER][POSITIVE] Yeah, he's right here. Yeah, I'm here.
[AGENT][NEUTRAL] OK. [PII], could you please verify your date of birth with me?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] And [PII], I do need to verify the mailing address that is listed on file.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And it does look like we do have an email address as well. Could you verify that for me please?
[CUSTOMER][NEUTRAL] Yup, yup, it's [PII].
[AGENT][NEUTRAL] And is it OK for me to speak with [PII] in regards to your policy and claim?
[CUSTOMER][NEUTRAL] Yeah, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], may I please have either the claim number or the date of service?
[CUSTOMER][NEUTRAL] Uh, let's see, the claim number is 358-6207.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] The date of service was [PII].
[AGENT][NEUTRAL] And I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] I see
[AGENT][NEUTRAL] So I did pull that claim up and the reason for the denial, it is requesting the diagnosis code for that date of service.
[CUSTOMER][NEUTRAL] And how do we obtain that?
[AGENT][NEUTRAL] You will get that from the provider that rendered the services.
[CUSTOMER][NEUTRAL] So they would have to send us something via email and we would have to go forward it back to you. Is that how that works?
[AGENT][NEUTRAL] Yes, it would have to be something with their letterhead stating that it is for that date of service and it would have to be submitted back over to us.
[CUSTOMER][NEUTRAL] Alright, now do I send that? I mean, the only thing I have on here is the website and then I have the [PII] phone number. Is there an easier way to get this moving like an email or something?
[AGENT][NEGATIVE] We don't accept emails. It's only through the secured portal, fax or mail, and the reason no emails is because it is not secured.
[CUSTOMER][NEUTRAL] OK, all right, for HIPAA. I get that. All right, so now we have to just call his doctor's office and just ask them to get a diagnosis code on letterhead for his physical, correct?
[AGENT][NEUTRAL] Yes, because what is stating on that EOB for the denial, it is requesting documentation may include an itemized bill with the diagnosis, super bill, or office notes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Do you have that with you? Did you? He's [PII]'s saying he already sent all that.
[AGENT][NEUTRAL] Let me pull that image up.
[CUSTOMER][NEUTRAL] But maybe it wasn't the right thing it did have a list of it.
[CUSTOMER][NEUTRAL] With
[CUSTOMER][NEUTRAL] That's what they sent me.
[AGENT][NEUTRAL] OK, so what we received was a billing statement. The billing statement does not indicate the diagnosis code, so he would have to get that from that provider.
[CUSTOMER][POSITIVE] OK, that's, that's not a problem. I'll call them. Thank you so much.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day, [PII].
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][POSITIVE] Thank you, bye.