AccountId: 011433970860
ContactId: be3a3735-1201-4317-97e0-a8b1519e990f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 351839 ms
Total Talk Time (AGENT): 158145 ms
Total Talk Time (CUSTOMER): 147713 ms
Interruptions: 2
Overall Sentiment: AGENT=1.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/be3a3735-1201-4317-97e0-a8b1519e990f_20250605T17:51_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] with APL. How are you and broker resources.
[AGENT][POSITIVE] I'm good [PII], thanks for asking how are you?
[CUSTOMER][NEUTRAL] Good, um, so I have um a broker on the line and she's calling in regards to a claim. She wanted to know the status of it. She submitted it and they said to, I guess, have her call back in 24 hours to see where it was at, um, and 24 hours was yesterday, so she just wanted to make sure, um, and I have the policy number and group number for you.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] What's the policy number, [PII]?
[CUSTOMER][NEUTRAL] It's gonna be 2456692.
[AGENT][NEUTRAL] And what is the broker's name?
[CUSTOMER][NEUTRAL] Her name is [PII], but she, I don't think she's the broker. I think she's the assistant.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] But her email is the email that is on the group uh broker account.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And did she verify the information of the patient, the insured, or do I need to get that from her?
[CUSTOMER][NEUTRAL] Um, she provided me with his name, uh, and that was all, all we got too.
[AGENT][POSITIVE] Uh, you can send your going over. I'll be able to assist you.
[CUSTOMER][NEUTRAL] OK, I'll introduce you to and then I'll hop off the phone, OK?
[AGENT][POSITIVE] Thank you, [PII]. Have a good one.
[CUSTOMER][NEUTRAL] Of course, you too.
[AGENT][POSITIVE] Thanks. Goodbye.
[CUSTOMER][NEUTRAL] [PII], are you still there?
[CUSTOMER][NEUTRAL] I am.
[CUSTOMER][POSITIVE] OK perfect I have [PII] on the phone from our claims department and she'll be able to assist you with that OK? Thank you so much have a good day. Of course you as well bye bye.
[AGENT][NEUTRAL] Hello [PII], so you're calling about a claim that you submitted on yesterday on [PII]. The claim is currently waiting to be processed. It has not been processed yet.
[CUSTOMER][NEUTRAL] So what it was was the plane had a running
[AGENT][NEUTRAL] But it has been uploaded in the system.
[CUSTOMER][NEUTRAL] The claim had already been up had already been submitted prior to that, but um I guess there was um diagnostic codes that were missing even though we sent it in prior um so we resent them in on the [PII] and I just wanted to make sure you know you guys got that resubmission of the diagnostic codes.
[AGENT][NEUTRAL] OK, so let me see, do you know what was the date of service that you're calling about?
[AGENT][NEUTRAL] Do you have that?
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] So I can see which claim actually we're requesting information for.
[CUSTOMER][NEUTRAL] Yeah, let me dig back a little because on, on [PII] we were told um that the claim was being processed, so that was, you know, a month ago, um.
[CUSTOMER][NEUTRAL] Da da da shoot hold on.
[AGENT][NEUTRAL] Well, every claim gets processed. It's just a matter of being denied or approved.
[CUSTOMER][NEGATIVE] Yeah, but nobody said nobody contacted us. It was [PII]. I called [PII]. Nobody contacted the member us, nobody to say, hey, we're still missing information to complete the claim. When we were when we called in on April it's the.
[AGENT][NEUTRAL] But when the claim is processed, the EOB is sent out, so I'm not sure how else we're supposed to communicate with them. We don't make phone calls, but we definitely send EOBs out requesting information, but.
[AGENT][NEUTRAL] We're here today, so I'm gonna assist you today. What is the date of service? Do you have that?
[CUSTOMER][NEUTRAL] I'm looking, ma'am.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I didn't think you're gonna need all this. Like I said, it was.
[AGENT][NEUTRAL] I do look up the claim because there's multiple claims on file, so for me to be able to assist you, I would like to verify which claim we requested the information on so that I can know what they were requesting to make sure that the information that you sent in on the [PII] is actually the information that we need to process the claim.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Of [PII] for the looks like there is um.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] 22 claims, one for $2000.01 for $90.
[CUSTOMER][NEUTRAL] OK. I, I just wanna make sure.
[AGENT][NEUTRAL] And I see that you guys did upload the EOB. You, you did send something in with the diagnosis codes, however, we need this the information that we were requesting still has not been sent in. We're requesting, so on the claim.
[AGENT][NEUTRAL] For 357-438-2 that we sent out, we're requesting the diagnosis codes. So what we need is something from, it may include like an itemized bill with the diagnosis codes.
[AGENT][NEUTRAL] Some type of hospital admission and discharge summary, diagnostic testing results. We need like an itemized bill listing those diagnosis codes.
[AGENT][NEUTRAL] We just can't accept the diagnosis codes that you someone put inserted on the EOB that we sent over to you guys in regards to the claim requesting the information.
[CUSTOMER][NEUTRAL] Yeah, that's how they sent it over to us so you need an itemized bill with the discharge summary.
[CUSTOMER][NEUTRAL] And the
[AGENT][NEUTRAL] No, we just need an itemized bill with the ICD codes. That's it, just the itemized bill for those data services with the ICD codes listed on them.
[CUSTOMER][POSITIVE] OK, no problem. I will call the provider again.
[AGENT][NEUTRAL] Alright, yep, they should know what an itemized bill is with the ICD codes included in them.
[CUSTOMER][POSITIVE] Yeah, they should, um, OK, I appreciate your help today. Thank you so much [PII].
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APL. Have a great day. Goodbye.
[CUSTOMER][NEUTRAL] You too. Bye.