AccountId: 011433970860
ContactId: d9b98a12-6fb1-4ecc-99d7-6b46d23f5a19
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1086579 ms
Total Talk Time (AGENT): 398132 ms
Total Talk Time (CUSTOMER): 429832 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/d9b98a12-6fb1-4ecc-99d7-6b46d23f5a19_20250425T15:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII]. Could I give you my policy number or claim number?
[AGENT][NEUTRAL] May I have the policy number, please?
[CUSTOMER][NEUTRAL] Sure, policy number 2573221.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Could you verify your date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And I do need to verify the mailing address listed on file and the email address.
[CUSTOMER][NEUTRAL] Uh email [PII]. Uh maybe not. That's [PII] and
[CUSTOMER][NEUTRAL] Address you might have one of two either.
[CUSTOMER][NEUTRAL] Excuse me, either a PO box of [PII].
[CUSTOMER][NEUTRAL] [PII] or [PII].
[AGENT][NEUTRAL] OK, we do have the PO box listed and may I have a callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] And thank you so much [PII] for verifying the policy. How may I assist you?
[CUSTOMER][NEUTRAL] Um, well, I saw this morning that there was, um, a request for more information because I guess the documents I initially provided didn't have a diagnostic code when I called this morning. So, uh, between then and now I've uploaded additional documents and have they been reviewed?
[CUSTOMER][NEUTRAL] Or are they still pending?
[AGENT][NEUTRAL] If anything was submitted in today, you do have to allow a total to 7 to 10 business days before that claim is reviewed and or processed.
[CUSTOMER][NEUTRAL] OK, it's the same claim, but it's just uh additional documents.
[AGENT][NEUTRAL] Yes, we go within a date order of receipt.
[CUSTOMER][NEUTRAL] Oh, OK then, um, the reason why I'm calling is because I got a text message saying that my claim was complete.
[AGENT][NEUTRAL] There's a claim that we processed on.
[AGENT][NEUTRAL] [PII], which was yesterday.
[AGENT][NEUTRAL] That will be probably the information that you're receiving.
[CUSTOMER][POSITIVE] Correct. And that was
[CUSTOMER][NEUTRAL] Right, and that was not complete. I uploaded additional information for it.
[AGENT][NEUTRAL] Yes, the claim was completed because it was processed and it requested more information so that claim is complete.
[CUSTOMER][NEUTRAL] Wait, I was told that it wasn't complete and I just needed to upload additional docs.
[AGENT][NEUTRAL] OK, so when we process claims, if their claim has been processed and denied and requesting for more information that is considered a completed claim, when we receive that information, then that information.
[CUSTOMER][NEUTRAL] So do I need to submit a new claim form?
[AGENT][NEUTRAL] No, when we receive that information, then that is a whole different claim.
[CUSTOMER][NEUTRAL] But I don't need to upload a new claim form.
[AGENT][NEUTRAL] No, if we just requested that information and you did submit that in, we will review from the previous claim documentation that is received, if the EOB and everything is attached, and we would just enter the new document or information that was requested, but it will be reprocessed up on the different claim number.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Right, and you mentioned the EOB. I attached the EOB in my previous submission.
[AGENT][NEUTRAL] Yes, so if that was not requested, then we know we have the EOB on the previous claim, so that is where we will review that EOB.
[CUSTOMER][NEUTRAL] Got you. OK.
[CUSTOMER][NEUTRAL] So, could you look at the previous claim?
[AGENT][NEUTRAL] The first claim that came in?
[CUSTOMER][NEUTRAL] Yeah, and both documents pertain to the same claim both new uploads.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I did pull the claim up. It shows data of service of 216 and 224.
[CUSTOMER][NEUTRAL] No, it's just the service of 216. They, they share the same document, that's the only reason.
[CUSTOMER][NEUTRAL] My health insurance puts the EOB listed with
[CUSTOMER][NEUTRAL] You know, to save space, all documents, you know, together, so the 224 and the 216, it's the 216 that I highlighted for the claim that I submitted.
[AGENT][NEUTRAL] OK, so on the first claim, we received EOB showing dates of service of [PII] and dates of service [PII]. So any documentation that we receive in with a date, we're gonna enter that date on the claim. If that date is not what you want us to do, you will have to mark through that off the EOB for us not to enter that in. So that's the reason why I said we have date of service of [PII] and 224.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] OK. And for the previous
[CUSTOMER][NEUTRAL] So do I need to resubmit the EOB with a line through the 224 date?
[AGENT][NEUTRAL] No, I can go ahead and mark through it and put a note on there stating that the insured only wants date of service of [PII] to be reviewed and or processed.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK. And is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well, here's the thing. I, I was told that, could you read additional into that claim please? um, the claim notes.
[AGENT][NEUTRAL] You want me to read the notes?
[CUSTOMER][NEUTRAL] Yeah, well, can you read the additional as to uh what the, the denial was for?
[AGENT][NEUTRAL] So, for the date of service of [PII], it is showing that we were requesting the diagnosis code.
[CUSTOMER][NEUTRAL] OK, and.
[CUSTOMER][NEUTRAL] I was, so that's what, that's all you were requesting. OK. So I uploaded additional documents today for that diagnosis code. I sent them in two separate files.
[AGENT][NEUTRAL] OK, I'm pulling those images up.
[CUSTOMER][NEUTRAL] And I know you can't review them on the phone with me and that's not what I'm asking you to do, um, but
[CUSTOMER][NEUTRAL] like, can you stop [PII], please?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Is that I, I guess what I'm asking is the information I upload, does it look sufficient?
[AGENT][NEUTRAL] I'm reviewing it now.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] Let's go.
[CUSTOMER][NEGATIVE] Are you dressed, get your shoes on. We're running out of time.
[CUSTOMER][NEUTRAL] Um, today, can I be pick up? No.
[CUSTOMER][NEUTRAL] Can I be picked up early from daycare? Yes.
[CUSTOMER][NEUTRAL] I guess I, I don't know really.
[CUSTOMER][NEUTRAL] Can it be [PII]? I'll do my best, baby.
[AGENT][NEUTRAL] OK, so I'm looking at the images.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I just looked at the one that had 10 pages. Now I'm looking at the one that has
[AGENT][NEUTRAL] 33 pages.
[AGENT][NEUTRAL] So for the data service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So the one that had the lesser pages on here, I see that.
[AGENT][NEUTRAL] The mission diagnosis is
[AGENT][NEUTRAL] Occlusion and stenosis.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK. So I'm looking at that now this data of service is showing for 6:19.
[CUSTOMER][NEUTRAL] Well, here's the thing, I had the procedure on [PII] and then the follow up MR [PII] on.
[CUSTOMER][NEUTRAL] The, you know, it's like just to make sure everything's OK on [PII].
[CUSTOMER][NEUTRAL] I, I don't have.
[CUSTOMER][NEUTRAL] Go put it back on charge up. We're not talking video games.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And if you can see with the EOV, the even the insurance with Aetna paid a portion of it, approving the, if you need, I mean, I can send you the, the, the approval for the prior off from Aetna.
[AGENT][NEUTRAL] No, we don't need anything from Aetna. The only thing that we would get from Aetna would be the primary EOB showing the patient's responsibility.
[CUSTOMER][NEUTRAL] Which
[AGENT][NEUTRAL] So we already have that. Yes. So, I'm looking.
[CUSTOMER][NEUTRAL] Right, which you have.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] On the notes, which is showing exam date is [PII].
[AGENT][NEUTRAL] So, when we, when you look at that for that date of service, this information is gonna have to say the reason for this visit. I do see that there is a follow-up, but it doesn't have what you had a follow up for, like the diagnosis. It's not indicating any type of diagnosis. It's saying that you just had a headache.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] A headache.
[AGENT][NEUTRAL] Yes, it says follow-up sinus stent placement, and it said patient reports headache at the beginning of the procedure and that was on [PII]. So it doesn't say anything for [PII] for the date of service of [PII].
[CUSTOMER][NEUTRAL] Well, that was my discharge instructions from the hospital on
[CUSTOMER][NEUTRAL] Um, the [PII] date and which showed the uh procedure was the venous sinus stent. And then the follow-up MRI.
[CUSTOMER][NEUTRAL] Was the
[CUSTOMER][NEUTRAL] [PII] procedure and I think they asked me how I was doing and I just said I sometimes get a headache, but that was not the doctor. That was just the MRI outpatient place.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Now, the only thing that I can advise you of is it's a possibility that you will have to contact that provider and request that diagnosis because with this paper, it doesn't indicate the diagnosis with that date of service.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Because the data service is in [PII].
[CUSTOMER][NEUTRAL] OK, OK, so I would have to contact.
[CUSTOMER][NEUTRAL] Right, so I would have to contact the neurosurgeon who reviewed the, the, the MRI asking that they provide something with the diagnosis on.
[CUSTOMER][NEUTRAL] The for the MRI on the [PII] date, is that right?
[AGENT][NEUTRAL] Yes, when you contact them, just make sure that they do submit it in and show that you did have this is for services for data service of 216 and they do need to indicate the ICD 10 code.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, let me write that down. So that was the IDC 10 code?
[AGENT][NEUTRAL] It's I as in igloo, C as in Charles, D as in Delta, and the number 10.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] ICD 10. I asked you know video games. Um.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Get your backpack, make sure you're ready. Are your teeth brushed? So,
[CUSTOMER][NEUTRAL] Can I get a letter from the doctor stating that?
[AGENT][NEUTRAL] Yes, anything that has their letter.
[CUSTOMER][NEUTRAL] Because they've already submitted it to insurance.
[AGENT][NEUTRAL] Yes, but if they submitted it to insurance, then they will be able to submit it to us as well in order for us to have that diagnosis code with that data service.
[CUSTOMER][NEUTRAL] But see, they submitted it to the insurance, that's the EOB for the 216, hence the date of service of 216.
[AGENT][NEUTRAL] Correct. They submitted the document documentation to your primary insurance. So that same documentation should have came to us with the diagnosis code in order for the claim to be processed. But since we don't have that documentation, we're requesting that documentation which would either come from the provider or the provider can submit the same documentation to you and you can submit that to us.
[CUSTOMER][NEUTRAL] OK, so I need to request the information that was submitted.
[CUSTOMER][NEUTRAL] And that was the provider being inland imaging, is that right? Or the provider being the neurosurgeon?
[AGENT][NEUTRAL] Whoever rendered the services for the data service of 216, so let me see if that's listed on here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I submitted a bill, um, and that was on the second set of documents which had the claim form on my initial submission date I think of [PII].
[CUSTOMER][NEUTRAL] Which didn't have a diagnosis code on the bill. It was one of the last documents in that scan.
[AGENT][NEUTRAL] Let me pull that one up.
[AGENT][NEUTRAL] So the one that we received.
[AGENT][NEUTRAL] That was processed on [PII]. I'm seeing EOBs.
[CUSTOMER][NEUTRAL] Yeah, it was in the next section it was in the the the other set of documents.
[AGENT][NEUTRAL] Then I'm seeing claim form, and then the last page is showing.
[CUSTOMER][NEUTRAL] And it was behind the claim form.
[AGENT][NEUTRAL] Inland
[AGENT][NEUTRAL] Imaging
[CUSTOMER][NEUTRAL] Imaging.
[CUSTOMER][NEUTRAL] Yeah, they, they were the ones who did the scan.
[AGENT][NEUTRAL] OK. And this is your statement. So if you would like to contact them, they should have the information for the reason of that visit, or you can contact the provider that referred you to see them.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And get that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that was I as in India, C as in Charlie, D as in Delta 10 code.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And if they have, if they have the image that they submitted over which should be uh hick for 1500.
[CUSTOMER][NEUTRAL] OK, I'll work on that.
[AGENT][NEUTRAL] Then you can submit that over to us as well if they will submit it to you.
[CUSTOMER][NEUTRAL] OK, and what was the 1500 that you mentioned?
[AGENT][NEUTRAL] It is HCFA.
[AGENT][NEUTRAL] And 1500.
[CUSTOMER][NEUTRAL] HCFA 1500
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, hang on, I'm just gonna get I was looking here a paper, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] HCFA 1500 and that's the form?
[AGENT][NEUTRAL] Yes, that will be the claim form that they will submit in.
[CUSTOMER][NEUTRAL] OK, and that would have the, that would have that IDC, I as in India, D as in Delta, C as in Charlie. Did I get it?
[AGENT][NEUTRAL] To the providers.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Is ICD.
[CUSTOMER][NEUTRAL] OK, I got it confused. So it's I India, C Charlie, D Delta 104.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK. I'll get that and I'll submit that. Um, and I do thank you for talking with me.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome. Is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] Uh, I do, uh, again, I just do appreciate the information for what I need to get, and, uh, there's nothing else. Thank you.
[AGENT][POSITIVE] You're welcome. Thank you so much for calling American Public Life. Have a great rest of your day.
[CUSTOMER][POSITIVE] You too. Bye-bye. Happy Friday.
[AGENT][POSITIVE] Thank you. Same to you. Bye bye.