AccountId: 011433970860
ContactId: d0d9054d-46c2-4d5e-8700-6690ca4ccd9f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 695179 ms
Total Talk Time (AGENT): 202724 ms
Total Talk Time (CUSTOMER): 155055 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/d0d9054d-46c2-4d5e-8700-6690ca4ccd9f_20250318T14:09_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], my name is [PII]. How are you today?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][NEUTRAL] Good, thank you. I'm calling to check, actually, um, I was online checking out the status of two claims that I have.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I happened to just click on the claim number to see, you know, what popped up and I see that there's a remark um on both of them that you need a diagnosis code.
[CUSTOMER][NEUTRAL] For each claim. Now, when I created both claims, I uploaded all the documentation including the request from the physician that has the diagnosis codes on it.
[AGENT][NEUTRAL] OK, let me take a look at it. Uh, can I get a callback number for you really quick?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, 786.
[CUSTOMER][NEUTRAL] 395
[CUSTOMER][NEUTRAL] 671 2.
[AGENT][NEUTRAL] OK, and what is your policy number?
[CUSTOMER][NEUTRAL] The policy number is 245.
[CUSTOMER][NEUTRAL] 854 6
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I was also trying to, I was hoping that when I clicked on the claim number it would pull up all the documentation that I had included, but it doesn't, so I'm not really sure where that is housed online.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] see
[AGENT][NEUTRAL] OK, so I do see here you, um, uh, let's see, the most recent, these are dates of service of [PII].
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] Uh, the claim number?
[CUSTOMER][NEUTRAL] Yeah, one is for January, it ends in 947 and then the other claim number ends in 006.
[AGENT][NEUTRAL] And look
[AGENT][NEUTRAL] OK. So, uh,
[AGENT][NEUTRAL] When requesting the diagnosis code, um, if you look at that remark code, um,
[AGENT][NEUTRAL] Now, you, you may be speaking of the procedure codes, um, which is like, um, let's see. The diagnosis code, we would need documentation from the provider. So whether it be doctor's notes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I already uploaded all that documentation and there's a section on there that says ICD. 10 diagnosis codes and it has all the diagnosis codes.
[AGENT][NEUTRAL] So, OK, let me take a look because it has to be a, a document from the provider and not just the number code. So let me take a look and see.
[CUSTOMER][NEUTRAL] Correct, it's, I, on each claim I uploaded the provider which is Pingali, and then I also attached the Quest bill. So when I had contacted you guys, the young lady that helped me, because I know Quest is a big problem for everybody, she told me to make sure you upload the Quest, um, invoice as well as your provider invoice and anything else you may have.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me take a look. Do you mind holding one moment?
[CUSTOMER][NEUTRAL] And I also included. Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] No, we cannot not just back and down.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding. I apologize for the wait. I did take a look at the documents and um the procedure codes are on here, but the diagnosis code, uh, providers don't normally put that information due to privacy, so you would have to request your diagnosis code.
[CUSTOMER][NEUTRAL] So which document are you looking at that you're, you're saying it's a procedure?
[AGENT][NEUTRAL] I'm looking at the quest the quest uh statement and then all of your EOBs. They all have the procedure codes on there, but the diagnosis code is a different type of code. All your procedure codes are there.
[CUSTOMER][POSITIVE] Correct. Uh-huh.
[CUSTOMER][NEUTRAL] So, are you able to
[CUSTOMER][NEUTRAL] Are you able to see the Trengali, the provider document that I attached?
[AGENT][NEUTRAL] Let me see, let me go back in here.
[CUSTOMER][NEUTRAL] From the provider which is Trialli.
[CUSTOMER][NEUTRAL] Because I have passed that as well as the I.
[AGENT][NEUTRAL] This is the doctor that um ordered the
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me go to this next document. Give me one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, for each, I uploaded the provider, the quest, and the Aetna.
[AGENT][NEUTRAL] Right, OK, I see Quest and Aetna, which Quest has the uh procedure codes on there and the uh Aetna explanation of benefits also has the procedure codes, uh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, and then you have the valid document, which is a provider.
[AGENT][NEUTRAL] OK, let me go back through here.
[AGENT][NEGATIVE] Sorry it's a little slow loading.
[AGENT][NEUTRAL] 01 moment for me. I apologize for that. 01 moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, thank you so much for holding. I do apologize for the wait. I was
[AGENT][NEUTRAL] to locate the list of uh icy boats on page 21.
[CUSTOMER][NEUTRAL] that
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] You cut out.
[CUSTOMER][NEUTRAL] You, you
[CUSTOMER][NEUTRAL] You could, yeah, you had cut off. You were able to locate it?
[AGENT][POSITIVE] I was able to locate those. I do apologize for that being overlooked. I will send your claim back for reprocessing. It should be completed in 24 hours.
[CUSTOMER][NEUTRAL] OK, agree, and that'll be for both, correct? The 945.
[AGENT][NEUTRAL] Right, I I
[AGENT][NEGATIVE] I'm sorry, your phone is kinda cutting out.
[CUSTOMER][NEUTRAL] That'll be for both claims 947 and 006, right?
[AGENT][NEUTRAL] Yes, let me take a look here so collection date, so [PII].
[AGENT][NEUTRAL] Let's see if I can.
[AGENT][NEUTRAL] Yes, that will be for your dates of service [PII], and then you had dates of service of [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So those two claims will be sent back for reprocessing.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Perfect. Thank you very much.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's it. You have a nice day.
[AGENT][POSITIVE] You too, [PII]. Thank you for calling APL. You have a wonderful day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][NEUTRAL] Bye bye.