AccountId: 011433970860
ContactId: d90fb22f-420b-41ad-909d-7ff947bd2e12
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 754250 ms
Total Talk Time (AGENT): 337652 ms
Total Talk Time (CUSTOMER): 211367 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/d90fb22f-420b-41ad-909d-7ff947bd2e12_20250121T19:42_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] Hi, [PII]. My name is [PII]. I am calling to get a status on a claim I filed. I'm unable to open the document on OSC.
[AGENT][NEUTRAL] OK, [PII], so you're the insured and you're calling to check on a claim status for yourself, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes, I can help you with that. And [PII], what is your callback number please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And your policy number?
[CUSTOMER][NEUTRAL] 244-2603
[AGENT][NEUTRAL] Thank you, one moment while I get your information pulled up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and [PII], any information I do provide for you today will be a verification of benefits and not a guarantee of payment. Uh, first off, what is your date of birth, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And then also your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number we have for you is the same as the one you gave me, so that again is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, thank you. And lastly your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the date of service, [PII]?
[AGENT][NEUTRAL] And total bills amount?
[CUSTOMER][NEUTRAL] November.
[CUSTOMER][NEUTRAL] Um, the date of service was.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Um, well, I was admitted to the hospital, I guess.
[CUSTOMER][NEUTRAL] Either [PII] or [PII]. I'm not sure it was in the morning. I went in on the [PII] and I had my surgery on the [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there, OK, so are you logged into your portal?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, do you see the claim number that you're, does it end in a 67?
[CUSTOMER][NEUTRAL] So that one was when I uploaded all of the documentation itemized bill and I was told that I didn't have diagnosis code I have procedure codes on those documents, so on 115.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, the last three of the claim number 598 is me uploading the diagnosis code.
[AGENT][NEUTRAL] OK, so the remark on that claim.
[AGENT][NEUTRAL] It's the same as the one ending in 67.
[AGENT][NEUTRAL] It states in order to complete the processing of your claim, we need itemized statements of services provided listing the diagnosis codes.
[AGENT][NEUTRAL] And you're stating that, mhm, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] So on 173550367 is the claim number that is where I uploaded.
[CUSTOMER][NEGATIVE] All of the itemized.
[CUSTOMER][NEUTRAL] Um, the itemized descriptions and
[CUSTOMER][NEUTRAL] I went over it with a woman that I was on the phone with that APL. She said she was able to view those files, but I needed to get a diagnosis code that I could just write down on a piece of paper and sign, which is what I uploaded on the [PII]. So if it's saying the same thing, I don't know, I don't know what it is they're looking for at this point.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. All right. So let's see, so give me just a second. So let me.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you were in the hospital from the [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] This.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] If you
[AGENT][NEUTRAL] OK, so you said that on the information you submitted.
[AGENT][NEUTRAL] That's now assigned with the claim number ending in 98, that that included your diagnosis. Is that right?
[CUSTOMER][NEUTRAL] So that is only my diagnosis code. I didn't upload the itemized bill a second time.
[AGENT][NEUTRAL] OK, OK. Give me just a moment to see if I can look at that and I may have to get you connected with someone who can.
[AGENT][NEUTRAL] Look at this further with you, but bear with me just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thanks, [PII].
[AGENT][POSITIVE] Ah, you're welcome.
[AGENT][NEUTRAL] It just takes a moment, [PII], for this information to populate for me.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][POSITIVE] Pretty good.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You really figure it out?
[AGENT][NEUTRAL] OK. So I can see that diagnosis code on, uh written on that one document that you did upload. Now, what I'm gonna do though is I'm gonna connect you, since you have called, you know, a a couple of times over the last few weeks regarding this. And so all of the other medical documents.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] They were uploaded first. You're saying that the diagnosis code, which according to what I read was the only thing missing. Is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am, and I was told written should be OK, but I, I that they wouldn't know until everything got submitted, so that's what I have.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, sure, sure, yes ma'am, because we, we don't pay claims over the phone, we just have to receive everything, you know, for it to go through the review process. But what I'm going to do is, um, I'm gonna connect you over to one of the examiners who reviews this type of claim. Now when I do connect you thoug[PII], I'm gonna give them your policy number, let them know they're the reason for the call, you know, and you're not gonna have to re-verify any of your information, um, so that they can just verify that.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That we have everything now that we were missing, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, or if not, you know, exactly what you would need to present to us.
[AGENT][NEUTRAL] To upload for that. So is there anything else that [PII], I could help you with first?
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][POSITIVE] No, you've been a great help. I really appreciate it.
[AGENT][POSITIVE] Oh well you're certainly very welcome. It was my pleasure so thank you again for calling APL. I hope you have a very nice afternoon and if you will give me just a moment, I can get you connected, OK?
[CUSTOMER][POSITIVE] All right thank you ma'am you too have a good day.
[AGENT][POSITIVE] You're welcome. Thanks. Bye bye.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey, [PII], it's [PII]. How are you today?
[CUSTOMER][POSITIVE] I'm good how are you?
[AGENT][POSITIVE] I'm doing fine, thank you. I haven't talked to you in a while, so happy [PII].
[CUSTOMER][NEUTRAL] Happy [PII]. It's 9 degrees here. I'm freezing.
[AGENT][NEUTRAL] Yeah. Oh, it's, uh, uh, you know, I'm in [PII]. It's not 9 where I am, but it's plenty cold for around here, OK?
[CUSTOMER][NEUTRAL] I talked to [PII] this morning. It was 4 degrees where she was, where she is.
[AGENT][NEUTRAL] Yes. I mean, it feels like our real for right now is 19, and so that's cold enough. I mean, I'm good, you know, I'm good.
[CUSTOMER][NEGATIVE] Yeah, I can't handle it. My, my body's not built for this mess.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] Right. Mine either. I would like to look in the [PII] story when I take my fur baby outside. I'm steadily telling her to her.
[CUSTOMER][NEGATIVE] You should see me too. I'll be looking, my, my neighbors probably think, what is wrong with this lady and I don't care.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Me either. Well, I have an insured on the line. Um, her policy number, [PII], is 2442603. [PII].
[CUSTOMER][NEUTRAL] Mm, I have no clue who that is. What? OK, what's going on?
[AGENT][NEUTRAL] OK, so, on Amtrak, on the 2.
[AGENT][NEUTRAL] The last two claim numbers that are listed?
[AGENT][NEUTRAL] Claim number 355-0367.
[AGENT][NEUTRAL] She says it's all the medical information. We denied that needing a diagnosis code.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Then on the 3553598.
[AGENT][NEGATIVE] That's just like a one-page document that she wrote the diagnosis code on which she had been told by someone would be acceptable. But it's denied, they're denied the same reason.
[CUSTOMER][NEUTRAL] OK, yeah, we can't take written diagnosis codes we have to have it printed. I don't know who told her that, but we can't accept those.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Mm, can they not with Medli?
[CUSTOMER][NEUTRAL] Mm not with anybody.
[AGENT][NEUTRAL] Oh, see, we've been told that you could, yes, we've been told that uh written is fine. You just cannot take them verbally.
[CUSTOMER][NEUTRAL] Mm is it has to be from the provider, um.
[AGENT][NEUTRAL] Yeah, we've been told that you can write them on EOBs and send them in. Mhm.
[CUSTOMER][NEUTRAL] Oh yeah, I, when I process clients.
[AGENT][NEUTRAL] Yeah.
[AGENT][MIXED] As long as it's written, it's just, um, you, we cannot ver you know, used to the letter verbally give them over the phone, but that stopped, but yes, handwritten was fine.
[CUSTOMER][NEUTRAL] Um, OK, I'm looking at the 67 now. Give me just a second.
[AGENT][NEUTRAL] So just, yeah, that's why I'm transferring her there, but she's fully verified and the phone number in the system is the one she's calling me from or calling us from.
[CUSTOMER][NEUTRAL] Oh dear God.
[CUSTOMER][NEUTRAL] OK, yeah, you can transfer over. Let me see what's going on with this. I got a, I got the 67 pulled up now. Let me see what's going on.
[AGENT][NEUTRAL] OK. Um, you want, I mean, are you ready for it or you need a second?
[CUSTOMER][NEGATIVE] Yeah, you can send her through on base is just sticking so I have no clue what it's, it's been sticking all day.
[AGENT][NEGATIVE] It is slow. It is the slowest molasses.
[CUSTOMER][POSITIVE] Yeah you can send her through it's fine.
[AGENT][POSITIVE] OK, all right then. Well, thank you so very much and stay warm.
[CUSTOMER][POSITIVE] Yes, ma'am. You too.
[AGENT][NEUTRAL] OK. All right. Talk to you later. OK, bye-bye.
[CUSTOMER][NEUTRAL] All right, bye.
[AGENT][NEUTRAL] Well, just one second for me to release the call. OK, here we go.