AccountId: 011433970860
ContactId: cf19a560-c845-42ae-8e38-7dcf907fe382
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 430890 ms
Total Talk Time (AGENT): 98601 ms
Total Talk Time (CUSTOMER): 203920 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/cf19a560-c845-42ae-8e38-7dcf907fe382_20250612T18:19_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi [PII] calling. It appears that I probably didn't have all the proper information on the bill I sent you guys because you rejected it, trying to find get some help. Can I give you like the claim number or something?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, yeah, I'll take the claim number.
[CUSTOMER][NEUTRAL] 360-1348
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you can please verify your date of birth and email address.
[CUSTOMER][NEUTRAL] [PII] that's [PII].
[AGENT][POSITIVE] Thank you for that information.
[AGENT][NEUTRAL] OK, so I'm showing that we need the diagnosis code.
[CUSTOMER][NEUTRAL] Is this for like 4 claims like from 88 was it 820 24 to 9324 and then the other is 820 24 yeah the diagnosis code.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And I can get that from the clinic. What, what kind of a code, because it seems like they're always confused when I've called them on this in the past, of what you're really looking for. What, what is the what do you mean by the diagnosis code just so that.
[CUSTOMER][POSITIVE] I can try to give them a very clear understanding of what we need.
[AGENT][NEUTRAL] The diagnosis is um the reason you're being treated, what you, what you were diagnosed with.
[CUSTOMER][NEUTRAL] Well, we already, we went through this on the main claim already wouldn't it be the same? Because now these are the anesthesia, um.
[AGENT][NEUTRAL] What's the date of service for the um main claim?
[CUSTOMER][NEUTRAL] Doctor.
[CUSTOMER][NEUTRAL] I'm sorry, what?
[AGENT][NEUTRAL] What was the date of service for the main claim?
[CUSTOMER][NEUTRAL] The, the
[CUSTOMER][NEUTRAL] The date of service um.
[CUSTOMER][NEUTRAL] Uh I think I got it here. There were two dates. It was [PII] and [PII].
[AGENT][NEUTRAL] I'm not showing we received any diagnosis for any claims.
[CUSTOMER][NEUTRAL] They were supposed to send them to you.
[AGENT][NEUTRAL] Who is they? the provider?
[CUSTOMER][NEUTRAL] The hospital.
[AGENT][NEUTRAL] OK, well they didn't let me see, there's one claim that we received yesterday or yeah yesterday. Let me see if that's what it is.
[CUSTOMER][NEUTRAL] Because I didn't know what you.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK. So we have the diagnosis um for [PII].
[AGENT][NEUTRAL] So you'll just need to send this um diagnosis for [PII].
[AGENT][NEUTRAL] Cause the provider for sending a claim for [PII] yesterday, we got that yesterday so when they process that one, they'll be able to go back and process the dates of service for [PII] that you sent in, but we'll still need this um diagnosis for [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Well, it would be the same diagnosis. It was cataract surgery.
[CUSTOMER][NEUTRAL] So they did one eye and then they wait a couple weeks before they do the other eye.
[AGENT][NEUTRAL] OK, well, they'll still need it.
[CUSTOMER][NEUTRAL] Uh, that's hard to understand for me that.
[CUSTOMER][NEUTRAL] think you, I mean, that they're just, they, I would think they're the same.
[CUSTOMER][NEUTRAL] So what I need to do is call the provider and ask them to send the diagnosis code for the surgery on [PII].
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And they can mail that straight to you guys?
[AGENT][NEUTRAL] Yeah, just like this provider sent it straight to us.
[CUSTOMER][NEUTRAL] Oh the same providers, same, same thing.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, yeah, then tell them they need to send the claim for [PII].
[CUSTOMER][NEUTRAL] Same same people.
[CUSTOMER][NEUTRAL] And you guys just received this yesterday because this took place back in May.
[AGENT][NEUTRAL] Yesterday we received the claim yesterday.
[CUSTOMER][NEUTRAL] That they were sending out.
[CUSTOMER][NEGATIVE] I can't believe it took that long for the mail to get there.
[CUSTOMER][POSITIVE] All right, I'll call them and see if I can.
[CUSTOMER][NEUTRAL] Get it figured out.
[CUSTOMER][NEUTRAL] So, but now the, the other, the other form that you like sent me back now for the, the [PII].
[CUSTOMER][NEUTRAL] They're gonna they'll put all these together, right?
[CUSTOMER][NEGATIVE] Because the, the other because of the anesthesiologist bills came way later. I don't know why it took them so long to get here.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] I don't quite understand your question. I'm sorry.
[CUSTOMER][NEUTRAL] OK, I got the, the, the original bill, which was whatever 16 or $18,000 whatever it was, um, and then.
[CUSTOMER][NEGATIVE] I sent all that information into you guys, OK? And then after that was all sent to you, then later on I got the bills from the anesthesiologist. I don't know why they took because but they billed separately and it took them forever to send me those bills. So then I sent them all in.
[CUSTOMER][NEUTRAL] Now, will they, they also be, you know, brought together or there's gonna be another diagnosis code for an anesthesiologist because of the other one was for the doctor.
[AGENT][NEUTRAL] No, it's the data, it covers for the data service so as long as we have a diagnosis for that data service.
[AGENT][NEUTRAL] We don't need each provider to tell us the same thing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But we need at least one provider to tell us.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] I will uh see what they can do for me thank you.
[AGENT][POSITIVE] OK, well thanks for calling APO you have a good day.
[CUSTOMER][NEUTRAL] No.