AccountId: 011433970860
ContactId: ce1d6bfd-ce5a-4c4f-82c3-25e9f275f7da
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 973080 ms
Total Talk Time (AGENT): 308204 ms
Total Talk Time (CUSTOMER): 299022 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/ce1d6bfd-ce5a-4c4f-82c3-25e9f275f7da_20250314T20:44_UTC.wav
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[AGENT][POSITIVE] Afternoon, thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, hi, yes, ma'am. I'm calling on, uh, my husband's policy. Um, I submitted a claim for him. He got treatment of, of a, um,
[CUSTOMER][NEUTRAL] He had a healthcare problem with his uh private area and um he has this gap insurance and they denied the claim and I'm reading the explanation and I'm not really understanding it.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, let's see what we can do. Um, may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII]
[CUSTOMER][NEUTRAL] And my phone number is [PII].
[AGENT][NEUTRAL] OK, and may I have the policy number?
[CUSTOMER][NEUTRAL] Um, 02537756, and it's under [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] One moment, let me see if I can find that authorization.
[CUSTOMER][NEUTRAL] I just, uh, I sent it back in with, I guess it, it looks to me like there was medical billing codes that were missing from it because I got an EOB on there and then the actual, um, you know, billing statement from uh Cleveland Clinic, which is where you had the procedure done. And then I also attached the United Healthcare form, the uh medical billing code one. I just submitted all that in just before I called you, so I don't know if you can see that in there, but
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I'm not sure. Like I said, from reading the explanation, I'm, I'm new, he's new to this policy, so we're not exactly sure what it does and doesn't pay. We think we've been paid out once on it for, you know, just his regular, um, checkup, but I guess I'm not understanding why the claim was denied.
[AGENT][POSITIVE] Thanks.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, I'm, I'm not finding the authorization form. Did, um, did you fill out the authorization form or did he fill out the authorization form and send it to us?
[AGENT][NEUTRAL] Or is he available?
[CUSTOMER][NEUTRAL] Uh, which one?
[AGENT][NEUTRAL] For you to get information. Yeah. Mhm. Yeah. OK. Sure.
[CUSTOMER][POSITIVE] Oh, I can call him. You need, you need to speak. Yeah, no problem. I can put him on the line with us. Hang on one second. He's at work, so normally your business hours are during the day, but yeah, I can get him on there. Hold on.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. All right. Thank you.
[CUSTOMER][NEUTRAL] Hang on one second, he didn't answer. Hold on.
[AGENT][NEUTRAL] Mhm. Yeah, it's OK. Take your time. I'm, I'm waiting on some documents as well.
[CUSTOMER][NEUTRAL] He's probably busy, yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I'm on the phone with your uh APL insurance, your gap insurance, trying to get your paid and they need they need you to authorize me to talk to her about it. Right.
[AGENT][NEUTRAL] OK, Mr. [PII], this is so with APR. I need to verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the email address on file.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Email address on file.
[CUSTOMER][NEUTRAL] Uh, it's.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and you're giving me permission to release information to your wife about the claims.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you. You still need him on the line or can I drop him?
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] No, you, you can drop him. Thank you.
[CUSTOMER][POSITIVE] OK, all right, thank you, baby. All right, thanks. Bye.
[AGENT][NEUTRAL] All right. And um let's see. So let me have the uh mailing address, um, if you can verify the mailing address for me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh yes ma'am, it's [PII].
[AGENT][NEUTRAL] OK, thank you. So I'm looking at the claim, um, the AOB, the explanation of benefits is indicating that, um, OK, so we need the itemized bill with the diagnosis code.
[CUSTOMER][NEUTRAL] So the information that I just sent you, is that what they're looking for? Because I just sent you three documents. Um, like I said, the Cleveland Clinic bill, the United Healthcare, uh, EOB and which I sent originally. And on top of that, I, I called United Healthcare and made the Cleveland Clinic and had them send me the form that they send United Healthcare. Are you able to pull that up? Cause I, those, it, it looks foreign to me. I don't, I don't know how to read that. I just want to make sure you have the correct information.
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm waiting on the documents to upload, OK, one more.
[CUSTOMER][POSITIVE] No problem. Thank you.
[AGENT][NEUTRAL] Hm
[CUSTOMER][POSITIVE] I appreciate your help. It's just he owes money on this bill and we really don't have it, and that's why we took the gap insurance. We're hoping to get it so we could pay the bill because he still owes a balance on it, so.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] All right and um so this was a procedure done in the office, correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] It's gonna take a minute because it looks like his pictures, so bear with me.
[CUSTOMER][POSITIVE] No problem.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, it kind of look a little bit, but it went away, um.
[AGENT][NEUTRAL] I did not see the diagnosis code, but let me look into it again.
[AGENT][NEUTRAL] Because this is a
[CUSTOMER][NEUTRAL] It should be the
[CUSTOMER][NEUTRAL] 3rd documents sent.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] The 31, OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Because this one is.
[CUSTOMER][NEUTRAL] Yeah, because the first two I don't see, I don't see any kind of funky codes on those, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] On the explanation of benefits from United Healthcare, but then they sent me like a uh PDF of, it looks like a, it actually looks like a typewriter wrote it.
[CUSTOMER][NEUTRAL] But it should be the 3rd 1 that I sent through.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Bear with me
[AGENT][NEUTRAL] Yeah, the 3rd page is an itemized bill and it does have the codes, um.
[CUSTOMER][POSITIVE] OK. OK, good.
[AGENT][NEUTRAL] Mhm. So I'm just gonna make sure that the EOB matches that information really quick.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so here's the.
[AGENT][NEUTRAL] What is the date on this thing.
[AGENT][NEUTRAL] Really
[AGENT][NEUTRAL] That's fine.
[AGENT][NEUTRAL] Same thing.
[AGENT][NEUTRAL] 9206.
[AGENT][NEUTRAL] OK, so the EOB you submitted is the incorrect one. the explanation of benefits you submitted from the primary insurance is for January. This one is for February. Um, so if you can submit the explanation of benefits for [PII].
[AGENT][NEUTRAL] That will match the information.
[CUSTOMER][NEUTRAL] Very well, this matches this has the doctor's information on it.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] 2.
[CUSTOMER][NEUTRAL] There's a couple of pages to this.
[CUSTOMER][NEUTRAL] it says from [PII] is the date of the.
[CUSTOMER][NEUTRAL] And in a scopy.
[AGENT][NEUTRAL] OK, so these are 2, yeah, these are two different charges, two different things, um.
[AGENT][NEUTRAL] Mhm, if you see the page through the third page, the page number 3, which is the itemized bill, you're gonna see the date of service. The date of service is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The coding and the charges are different from what you're trying to send in in the beginning. So basically we're gonna need either.
[CUSTOMER][NEUTRAL] Oh, I see it now, yeah.
[AGENT][NEUTRAL] The itemized bill something just like this for this one for January.
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] And, yeah.
[AGENT][NEUTRAL] Uh, and we also need, if you're trying to get um this um February paid, then we're gonna need the explanation of benefits that matches that [PII], OK?
[CUSTOMER][NEUTRAL] OK, so it's
[CUSTOMER][NEUTRAL] Oh, that's weird cause the numbers are the same on this one.
[CUSTOMER][NEUTRAL] 87 6 92.
[AGENT][NEUTRAL] The coding is different. Um, if you see uh the coding for the 120 of 25 is 4,646,600, and this one is different. This one is gonna be G2222211 and 99406, which is not the same thing. It's a different procedure.
[CUSTOMER][NEUTRAL] 20 or 2.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Oh you have because this one's from Marinelli. Yeah, this one's from Marinelli. This is a different, this is the first doctor. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so this one is different.
[CUSTOMER][NEUTRAL] OK perfect so I will get so now when I upload this again I just do it the same way or can I add it to the current claim or should I just put in another claim with it in it?
[AGENT][NEUTRAL] Another claim, yeah, it's not gonna let you add to the one we already started, so you're just gonna go ahead and and send it as a new claim and we'll go ahead and put it all together here. Um, so yes, if you can just get um like an itemized bill like you did with the 210 with the 120, that's, that's what we're gonna need, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, now let me ask you a question. If I have to call you back again, do you need, is there something like am I authorized to talk to you or do we have to call him back again? I just try not to bother him at work.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Understand. Well, he needs to go to our website or you can go and get it and have them have him sign it, but you're gonna need a third party authorization form. Um, if you go to our website at [PII].
[CUSTOMER][NEUTRAL] OK, I'm on it.
[AGENT][NEUTRAL] OK, so you go under claims and forms and you're gonna go ahead and click on the one that says authorization to disclose information, which is the second one in the road and download that form.
[CUSTOMER][NEUTRAL] Second floor.
[CUSTOMER][NEUTRAL] Oh it says I have to sign in first, correct?
[AGENT][NEUTRAL] No, um, you just go to the homepage. So you will go to [PII] and you will click on claims and forms.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The claims and forms.
[CUSTOMER][POSITIVE] I have it, but you don't worry we got your back claim your phone just.
[AGENT][NEUTRAL] Just keep scrolling down until you see the forms.
[CUSTOMER][NEUTRAL] Let's find.
[CUSTOMER][NEUTRAL] Oh, OK, alright, alright, I didn't go down far enough. I download and complete the appropriate form and mail just necessary documentation because I might be in action.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] No fax document.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Policy change authorization OK download form.
[CUSTOMER][POSITIVE] OK, perfect. I think I got it.
[AGENT][NEUTRAL] OK, so just have him to complete that and and just send it over to us. Um you can send it with the claim or separate, whichever is easier for you and we'll put it in the system. So when you call again, you don't have to have him on the line.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. All right, I will have to do that. Thank you so much for helping me. I appreciate your help.
[AGENT][NEUTRAL] You're welcome, [PII]. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] No, ma'am, that's it. Thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good afternoon.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye.