AccountId: 011433970860
ContactId: cdc08a45-1b6a-41bd-94f2-305c12f42dd1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 749200 ms
Total Talk Time (AGENT): 381450 ms
Total Talk Time (CUSTOMER): 294195 ms
Interruptions: 7
Overall Sentiment: AGENT=1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/cdc08a45-1b6a-41bd-94f2-305c12f42dd1_20250625T18:05_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, um, I had put some, uh, claims in on [PII] and.
[CUSTOMER][NEUTRAL] I just keeps showing that it's pending and I was just wondering, it never really took this long. I was just wondering what was going on with it.
[AGENT][NEUTRAL] OK, so you're wanting to check claim status on some claims that you submitted, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, I can help you with that and who am I speaking with please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you. And Mr. [PII], what is a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is your policy number, please?
[CUSTOMER][NEUTRAL] Um, hold on one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's 0247.
[CUSTOMER][NEUTRAL] 3098
[CUSTOMER][NEUTRAL] M as in Mary. L as in Larry 8.
[AGENT][NEUTRAL] OK, thank you. Give me a moment please to get your information pulled up, Mr. [PII], and then I will have to verify several things with you first for security and also any information that's provided today would be a verification of benefits and not a guarantee of payment. So just one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so first off, Mr. [PII], if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and then also your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you gave me, so that is the best number that we should have, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Thank you and the last thing is your email address and this does appear to be your work email.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Alright, so did you log into your portal today?
[AGENT][NEUTRAL] And see that
[CUSTOMER][NEUTRAL] I'm here right now
[AGENT][NEUTRAL] OK, and what do, what is it showing you in the portal?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Now this is weird because I'm seeing the ones that were approved and everything from before and it says insured and it says [PII] with this number next to it and then the pending ones.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The pending ones say insured, undefined, the two of them that are there.
[AGENT][NEUTRAL] OK, let me make a note of that.
[CUSTOMER][NEUTRAL] Is there something wrong?
[AGENT][NEUTRAL] Um, OK, so you had set up your profile in our new portal and so there have been some technical issues that our IT department is currently working on. So the last, can you see an OSC number or anything else? You said that it's showing as pending and insured unidentified is that or undefined was that what you said?
[CUSTOMER][NEUTRAL] Uh, could you hold on one second? I just wanna grab this call. Hold on one second.
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Oh, he got it. Somebody else got it. OK, so which, which number are you asking for? A C number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so do you see a claim number or do you see an OSC number? What type of number are you seeing next?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now when I actually sent this in, I, I wrote down the uh OSC numbers. Let me just make sure I'm giving you the right one.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I don't know why it's showing what was this one? Oh, OK, there's two of them. There's one that's 99454 and another one that's 99455.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and so in your portal currently, do you see a claim number or do you just see that message stating pending insured undefined?
[CUSTOMER][NEGATIVE] Correct, that's all I'm seeing um it doesn't show a confirmation, it doesn't show nothing, no claim number at top, nothing.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] And it says status is uploaded.
[AGENT][NEUTRAL] OK, but it
[CUSTOMER][POSITIVE] And you can let them know that that I like the old the old way better.
[AGENT][POSITIVE] Oh, yes, I'm going.
[CUSTOMER][POSITIVE] I like the old way it was displayed.
[AGENT][NEUTRAL] So there's.
[AGENT][NEUTRAL] Yes, sir, anytime, unfortunately, with techno technology, there's always the growing pains of change. So I completely understand your sentiment. Um, trust me, so give me just a second so that I can look at a few things and make a couple of notes here, OK?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, great.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on those OSC numbers because this is something I am gonna report um to IT.
[AGENT][NEUTRAL] On the 99454, is that all you see or do you see some additional numbers after that?
[CUSTOMER][NEUTRAL] Well, no, this is, this is what I wrote down when I did the claim, and you know how it pops up and gives you the OSC. I don't, I'm not seeing any OSC numbers here on the pending claims.
[AGENT][POSITIVE] Oh, OK. But you said that you're right.
[CUSTOMER][NEGATIVE] I'm not seeing nothing here. It's something that I wrote down when it was when I submitted it, it gave me those numbers, nothing after it, just that.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Sure, OK.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And even in the past I have other ones that I, I keep everything and it's exactly the same thing there's no numbers after that.
[AGENT][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] It just said OST 99454.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so, um, and which browser are you using when you sign in?
[AGENT][NEUTRAL] Mr. [PII].
[CUSTOMER][NEUTRAL] I'm on um Google. It's the Google browser.
[AGENT][NEUTRAL] OK, Chrome, OK, yes, OK, and that is the preferred browser, but I again there are just some pieces of information that I need to get from you so that I can pass this along to IT so I can see Mr. [PII] that we did review those two uploads under the same claim number and they were processed on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim has been denied.
[AGENT][NEUTRAL] And the reason for the denial on the claim, and I can give you this claim number if you would like also.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So just let me know when you're ready.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] Alright, the claim number is 361-5121.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And each of the line items were denied with the same remark, and I'm gonna read you that remark, OK?
[AGENT][NEUTRAL] Receipt of your claim is acknowledged. However, in order to provide further consideration of this loss under this policy, we will need supporting documentation to evidence the accident or sickness.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Supporting documentation may include but is not limited to.
[AGENT][NEUTRAL] Itemized bills with the diagnosis code, super bills, office notes, hospital admission and discharge summaries, and or diagnostic testing results.
[AGENT][NEUTRAL] So it appears that based on this information, uh, Mr. [PII] we are missing a diagnosis code.
[CUSTOMER][NEGATIVE] OK, so here's the thing, every time that I've sent these in, the first time I ever sent it in, they denied it and what, what they told me to do is every time I send it in, and I've been sending this in for the past year, diagnosis sleep apnea, they told me to write that down on the thing. I don't know if you see the claim form, and I wrote diagnosis sleep apnea and they've never questioned it before.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And even in here.
[CUSTOMER][NEUTRAL] I'm even submitting, you know, because I have a CPAP machine that's what it's for.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And I'm I'm even showing the what you call it the um Florida blue.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, explanation of benefits it's in there too, so I mean what more do they want? They never questioned it before.
[CUSTOMER][NEUTRAL] Is it somebody new that all of a sudden is changing it?
[AGENT][NEUTRAL] No, sir. No, sir. We've always required the diagnosis code, which that would not be on the explanation of benefits from your primary insurance due to HIPAA.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] So I, I can't explain that.
[CUSTOMER][NEUTRAL] Yeah, because uh when I, when I, when I first started doing this on, I don't know if you could see the claim form, they always told me to put diagnosis sleep apnea at the bottom.
[CUSTOMER][NEUTRAL] And it always went through every single one.
[AGENT][NEUTRAL] OK. So we can no longer accept the handwritten diagnosis on the document, Mr. [PII], so that may have something to do with it. In the past, at one point, yes, sir, we were able to do that, but we, we can't do that any longer.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you would just, so the doctor that prescribes.
[CUSTOMER][NEUTRAL] OK, so in other words.
[CUSTOMER][NEUTRAL] Uh, so in other words,
[AGENT][NEUTRAL] I'm sorry, go ahead with your question.
[CUSTOMER][POSITIVE] Got you. So I need something.
[CUSTOMER][NEUTRAL] I need something from the doctor. Now, do I have to resubmit these over again completely?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] Not everything. No, no, absolutely not. So when you get, all you will need to do is to upload that information when you get it from the doctor into your portal just like you did these, OK? Um, now, you can't you can, you can just write on whatever you upload that claim number because in the portal, you cannot
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And then put the claim number on it.
[AGENT][NEUTRAL] Add documents to a claim number but internally once we receive that missing information, we will know what it goes with.
[CUSTOMER][NEUTRAL] OK, so I need to get.
[AGENT][NEUTRAL] So you're just gonna upload like you're filing a new claim, essentially, but just the information that's needed.
[CUSTOMER][NEUTRAL] OK, sir.
[CUSTOMER][NEUTRAL] OK, so basically I need to get something from the doctor stating a diagnosis code and it needs some kind of a print out from them, some kind of a form from them is that what it is?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, so the, right. It's right. You can um you can provide either the office notes or it can just be something that they provide you on their letterhead with the doctor's information and everything on there and the diagnosis.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] To upload.
[CUSTOMER][NEUTRAL] But it has to have a, a code or something or just the diagnosis description on it?
[AGENT][NEUTRAL] No, it needs to have a diagnosis code. Mhm.
[CUSTOMER][NEUTRAL] OK, let me see if I can find that on my um.
[CUSTOMER][POSITIVE] Uh, from the hospital, everything that I have there, right, no problem, I'll get that done. All right, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right. Well, you're very welcome, Mr. [PII]. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Uh, no, that's it. Thank you very much.
[AGENT][POSITIVE] Uh, well, you're certainly welcome and thank you for calling APL. I hope you have a very nice afternoon.
[CUSTOMER][POSITIVE] OK, great. Thank you. Bye-bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] OK.