AccountId: 011433970860
ContactId: d9b06ee9-da94-4c36-9f88-61e52d190881
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 677559 ms
Total Talk Time (AGENT): 201616 ms
Total Talk Time (CUSTOMER): 206850 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/d9b06ee9-da94-4c36-9f88-61e52d190881_20250418T19:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, good afternoon, uh, my name is [PII], and I received an EOB for a claim that I submitted, uh, this week or last week, I don't remember, and, uh, it says you need more information, and I don't really know what the heck you need, so, uh, the reference, the reference number is um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 02432937
[CUSTOMER][NEUTRAL] And it's for [PII] and [PII].
[AGENT][NEUTRAL] OK, are you calling from a provider's office?
[CUSTOMER][NEUTRAL] No, I am the patient. I am the insured.
[AGENT][NEUTRAL] Oh, you are. OK. Do you know your?
[CUSTOMER][NEUTRAL] I am [PII].
[AGENT][NEUTRAL] Oh, OK. I was like you, I could have swore you said your name was [PII]. OK, um, do you have the policy number?
[CUSTOMER][NEUTRAL] 02432937. I guess that's the reference number too.
[CUSTOMER][NEUTRAL] Alright, that's what it says the policy number is.
[AGENT][NEUTRAL] Oh, yeah, it is.
[AGENT][NEUTRAL] OK. And then what is your date of birth and the address we have on file?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the address is [PII].
[AGENT][NEUTRAL] OK, and your email?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then do you know the date of service?
[AGENT][NEUTRAL] This was for?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I've got the claim number if that would help.
[AGENT][NEUTRAL] Yes, it's the claim number 3588808?
[CUSTOMER][NEUTRAL] Yes, that's it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I did find that.
[CUSTOMER][NEUTRAL] 23, bill charges 23,000.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm gonna look up this remark code and see.
[AGENT][NEUTRAL] If it tells me exactly what you need.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So it says that you are needing itemized bills with a diagnosis code.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So did you send those in?
[CUSTOMER][NEUTRAL] I sent an itemized bill in at least I sent the itemized bill that they provided in.
[AGENT][NEUTRAL] OK. And then
[CUSTOMER][NEUTRAL] So I don't know if it didn't include a diagnosis code on it or what. I just sent what they provided.
[CUSTOMER][NEUTRAL] And it was an itemized bill.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And it also states hospital admission and discharge summaries and or diagnostic testing results.
[AGENT][NEUTRAL] Um, I'll have to look further into your policy to see exactly what it is. I think it's kind of
[CUSTOMER][NEUTRAL] Yeah, cause I mean I've had this policy for forever and there should not be any like preexisting conditions or anything like that.
[AGENT][NEUTRAL] Right, yeah. Um.
[CUSTOMER][NEGATIVE] So I don't, I don't know why they're asking for further information.
[AGENT][NEUTRAL] It doesn't say.
[CUSTOMER][NEUTRAL] I mean, I can, I can understand why they'd want a diagnosis code.
[CUSTOMER][NEUTRAL] If that wasn't on the itemized receipt, I can get that for sure.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Mm. Hm.
[AGENT][NEUTRAL] Yeah, I think this is a kind of a generic um code. Mm.
[CUSTOMER][NEUTRAL] I mean,
[AGENT][NEUTRAL] I'm gonna look further into your policy right now and see if I can.
[AGENT][NEUTRAL] Pinpoint
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I've submitted MRI claims before and never had much of an issue, never.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] I mean, I've, I've been asked for diagnosis codes before, but.
[CUSTOMER][NEUTRAL] That's usually been on the itemized statement and if they didn't provide that on their itemized statement then that's.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'll call them and have them provide that.
[CUSTOMER][NEUTRAL] But I thought it was on the itemized statement that a new one.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, um.
[AGENT][NEUTRAL] I'm seeing where there's codes on here.
[AGENT][NEUTRAL] Um, let me, I'm going to transfer you over to the claims department. They are the ones that deal with, um, like deeper into this paperwork.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's fine.
[AGENT][NEUTRAL] OK, just one second. I'm gonna put you on hold and get a hold of them really quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Thank you. You are on hold.
[CUSTOMER][NEGATIVE] Deferring.
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, [PII], this is [PII] from the care team.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Um, and I have an insured on the phone and
[AGENT][NEUTRAL] Um, on her policy, it says that they are needing more information, and she, so she sent in the EOB.
[AGENT][NEGATIVE] Um, but on the claim number she gave me, the, the code says that it's denied and it just states a list of like documentation that she needs, but I can't pinpoint exactly.
[AGENT][POSITIVE] Exactly what she needs to send in for this to be approved or denied.
[AGENT][NEUTRAL] Can, can you look further into her policy?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, sure, what's the policy number?
[AGENT][NEUTRAL] It is 243.
[AGENT][NEUTRAL] 2937 and then I have the claim number too.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim number is 358.
[AGENT][NEUTRAL] 8808.
[CUSTOMER][NEUTRAL] OK, let me take a look here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So looks like we're needing the diagnosis codes. Let me see what we received.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, it's just like such a generic code and it doesn't tell you exactly, so.
[AGENT][NEGATIVE] It's confusing on my end.
[CUSTOMER][NEUTRAL] Right, so cause it's on this med link, it's usually it needs to be like either like like the, if it was an injury or a sickness, it would need to be like the diagnosis code that depicts, you know, the injury or sickness for the claim that they're filing.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] OK. MRI due to joint hip pain.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Can I transfer her over really quick?
[CUSTOMER][NEUTRAL] Oh sure, sorry, I'll just take a look at the claim. That's, that's fine.
[AGENT][NEUTRAL] Sorry, she's, she's just been on the
[AGENT][NEUTRAL] Yeah, she's been on the phone for a little bit. OK.
[CUSTOMER][NEUTRAL] Uh, do you have the callback number?
[AGENT][NEUTRAL] Uh, I do. Let me see.
[AGENT][NEUTRAL] I guess not. I just could have swear I got a callback number. No, I don't.
[AGENT][POSITIVE] I'm so sorry. Um, but I can give you the number she called. OK. Thank you.
[CUSTOMER][POSITIVE] Oh, OK, well, I'm ready for.
[CUSTOMER][POSITIVE] Thank you for holding this is [PII].
[CUSTOMER][NEUTRAL] Hi, this is [PII].
[CUSTOMER][POSITIVE] Uh, yes, Miss [PII], how can I help you today?
[CUSTOMER][NEUTRAL] Right.