AccountId: 011433970860
ContactId: bfc3a7e6-25ef-4484-bdfa-925787637362
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 379220 ms
Total Talk Time (AGENT): 107389 ms
Total Talk Time (CUSTOMER): 192660 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/bfc3a7e6-25ef-4484-bdfa-925787637362_20250217T18:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] and Broker Resources. How are you?
[AGENT][POSITIVE] I'm good. How are you doing?
[CUSTOMER][NEUTRAL] Good. Um, I've got a broker's office online. I was speaking with [PII]. She's with World Insurance. I'm calling about a claim for one of their members. Um, policy is 1678852 for a [PII]. Can you speak with her?
[AGENT][POSITIVE] Yes, I can. Thank you.
[CUSTOMER][POSITIVE] Perfect. Thanks. Bye-bye.
[AGENT][NEUTRAL] Bye.
[AGENT][POSITIVE] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Hi, good afternoon. I'm sorry, I didn't catch your name.
[AGENT][NEUTRAL] Um it's [PII]. It's spelled [PII] and my last initial is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Sorry, I just wanted to make sure I had um.
[CUSTOMER][NEUTRAL] I could call you by your correct name. Um, Ay, my name is [PII]. I'm calling from World Insurance on behalf of the member [PII]. Um, let me know how much more information you need from me before I can, before I start speaking.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, just to verify her date of birth.
[CUSTOMER][NEUTRAL] Her date of birth, give me one second, I'm sorry about that.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] OK. It is uh [PII].
[AGENT][POSITIVE] OK. Yes, ma'am. And how can I help you?
[CUSTOMER][NEUTRAL] This is in regards to a claim. Uh, and, uh, I mean, I have the claim number a second ago. I'm sorry.
[CUSTOMER][NEUTRAL] Uh, where did it go?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Oh my God. I'm, I'm so sorry. I literally had it on me so.
[CUSTOMER][NEUTRAL] Oh, here it is. Um, claim number 3541361.
[AGENT][NEUTRAL] OK. Yes, ma'am. I'm showing that this claim is benign because we need the EOB from the primary insurance company and we also need the diagnosis code.
[CUSTOMER][NEUTRAL] OK. So we need the ELB from insurance company.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And we'll need the diagnosis code.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Diagnosis code. Um, is that usually, does that usually show up on the ELB or not necessarily?
[AGENT][NEUTRAL] No, ma'am. There are codes on there, but um it's usually the procedure code and we'll need the diagnosis code. The diagnosis code is the code for the illness. We'll just need to verify um the members being seen for illness or an injury.
[CUSTOMER][NEUTRAL] OK. Did you say you already have the procedure code or you need that as well?
[AGENT][NEUTRAL] Um, no, we don't need the procedure code. We just need the charges, which is on the explanation of benefits.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] I see. OK. And uh can you let me know, um, when was this claim submitted and when was it denied when was the last update on it just so I have an idea.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And we received this claim on [PII] and it was processed and denied on [PII].
[CUSTOMER][NEUTRAL] And the number uh would have been um notified correct?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And um in order to submit that information that you'll be in the diagnosis code um what's the best way for the member to do that? Is there any way I can expedite it? is it the member that needs to submit it? How does it, um, how does it work?
[AGENT][NEUTRAL] Well, I'm showing that the members submitted the claim online and what they'll do is resubmit the claim online again with that same information and they can basically get the diagnosis code and write it on the explanation of benefits along with the claim number, so we'll know that they're resubmitting information for that claim number and just resubmit it online um the way that they did the first claim.
[CUSTOMER][POSITIVE] Uh, I'm sorry, I'm, I'm so sorry. I'm just taking notes, um.
[CUSTOMER][NEUTRAL] All right, so you said write the diagnosis code on the EOB, correct?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, and resubmit.
[CUSTOMER][NEUTRAL] All right, I will get in touch with the number and um and let her know. um, and I'm sorry, is for the diagnosis code is that um the best way for for her to get that in case she doesn't have it it uh it would be to call the, um, the provider's office.
[AGENT][NEUTRAL] Yes, ma'am. She would need to call the provider's office and they should be able to give her that information.
[CUSTOMER][POSITIVE] OK, got it. [PII], thank you so much for your help. I really appreciate it.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Um, if you can just check for me, does she have any other claims at all or is this the only one that's, um, has there been any other claims since then?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Um, no, I'm not showing anything pending since that one.
[CUSTOMER][POSITIVE] All right, perfect. Thank you so much. I appreciate your help.
[AGENT][POSITIVE] OK, thank you again, [PII] for calling ATL. You have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] Thank you, you so good bye.
[AGENT][POSITIVE] Thanks.