AccountId: 011433970860
ContactId: c01c6579-53fb-4be3-8e90-672e7c81d655
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 303820 ms
Total Talk Time (AGENT): 109771 ms
Total Talk Time (CUSTOMER): 79290 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/c01c6579-53fb-4be3-8e90-672e7c81d655_20250610T20:44_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yes, ma'am. Um, I just recently got a letter, um, in the mail of, um,
[CUSTOMER][NEUTRAL] stating that y'all needed the diagnosis code.
[CUSTOMER][NEUTRAL] Or something. I need to see because Mr. [PII] told me what I needed and I got the itemized copy and then the um
[CUSTOMER][NEUTRAL] The doctor's summary or whatever.
[CUSTOMER][NEUTRAL] Um, of what he had done to my legs.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what
[CUSTOMER][NEUTRAL] What else is it that I need?
[AGENT][NEUTRAL] What's your name and policy number, please?
[CUSTOMER][NEUTRAL] OK. The policy number is 0225.
[CUSTOMER][NEUTRAL] 8955
[AGENT][NEUTRAL] OK. And your name is?
[CUSTOMER][NEUTRAL] And my name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, and Ms. [PII], verify your date of birth and the mailing address, please.
[CUSTOMER][NEUTRAL] [PII] and it's [PII].
[AGENT][NEUTRAL] OK, and on the EOB that you received, you show claim number 360.
[AGENT][NEUTRAL] 8961.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Is this something you recently submitted?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] OK give me one moment. I do show a claim being received on the [PII]. Give me one moment to look at it.
[CUSTOMER][NEUTRAL] Oh, that's fine.
[CUSTOMER][NEUTRAL] I know, I, I gave it to Mr. [PII] in May.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] OK. The billing or the billing that you sent that we received on the [PII], it didn't have the diagnosis codes needed, but the information we just received on the [PII] does have, doesn't have the diagnosis code, but it does have the description of the diagnosis, which can be used, stating the reason for the surgery.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, OK. So do, what do I need to do?
[AGENT][NEUTRAL] Uh, nothing at the moment since, uh, the information you just submitted has that, so what they'll do is go back and reprocess the claim.
[CUSTOMER][NEUTRAL] Oh, OK. OK. I just wanted to know because it said something about appealing it and whatever else, so.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] I'm having a lot of trouble with insurance right now, so.
[AGENT][NEUTRAL] And I understand.
[CUSTOMER][NEUTRAL] I just wanna make sure.
[AGENT][NEUTRAL] And I understand because sometimes the billing that the provider may give you, it does not have that diagnosis code and that is essential in order to process the claim because it's gonna give us the reason for.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] And make sure and also give us a way to make sure that it's not an exclusion out of the policy.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] So I'm good, I'm good for right now.
[AGENT][NEUTRAL] I know.
[AGENT][NEUTRAL] You're good cause I'm looking at it and it has the diagnosis and it has the date, it looks like [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] So you are good to go, yes ma'am.
[CUSTOMER][POSITIVE] OK. Well, thank you so much. I appreciate your help.
[AGENT][POSITIVE] Oh, you're welcome. Of course, and thank you for calling APL. You have a great day.
[CUSTOMER][POSITIVE] And you too, babe. Bye-bye.
[AGENT][POSITIVE] Thank you, ma'am bye.