AccountId: 011433970860
ContactId: dea68bb5-c5cb-4b83-88cc-fc671e4b1b53
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 442880 ms
Total Talk Time (AGENT): 287775 ms
Total Talk Time (CUSTOMER): 95553 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/dea68bb5-c5cb-4b83-88cc-fc671e4b1b53_20250207T19:25_UTC.wav
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[AGENT][NEUTRAL] For contacting AP, my name is [PII]. How may I help you?
[CUSTOMER][POSITIVE] How you doing [PII]? This is [PII]. glad of best of luck if you can call me [PII].
[AGENT][POSITIVE] Yes, [PII], how can I help you?
[CUSTOMER][NEUTRAL] Um, I was actually calling about a claim that I put in like last year and then I resubmitted whatever else you guys asked for again this year because there was some code or something that I had to get from the diagnostic place.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what, what is your policy number? I can look that up and then we can check on your claim.
[CUSTOMER][NEUTRAL] It's um 0244.
[CUSTOMER][NEUTRAL] 3493.
[AGENT][NEUTRAL] Thank you. If I could verify your last name, uh date of birth, and a phone number, please, sir.
[CUSTOMER][NEUTRAL] Is [PII] is it's [PII] and phone number is that what you said?
[AGENT][NEUTRAL] Uh yes, sir.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] I do appreciate that. Thank you.
[AGENT][NEUTRAL] And what date is, is this is uh uh uh um
[AGENT][NEUTRAL] Claim for you, is that correct?
[CUSTOMER][NEUTRAL] It's the only one that I have in, yes ma'am, it's the only one I have in with you guys, it's like $880 or something.
[AGENT][NEUTRAL] Right. And what
[CUSTOMER][NEGATIVE] It wasn't so significant I wouldn't.
[AGENT][NEUTRAL] I see and what is the data service that we're looking for?
[CUSTOMER][NEUTRAL] I, I don't
[CUSTOMER][NEUTRAL] I know that maybe March of last year or something.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] March of last year. OK. So what I have is Baptist Outpatient services, um,
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. All right. Now, did you submit uh the diagnosis code for us, sir, because um I'm not seeing it on here. You did, OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] That was resent in the uh in the last one because I, I, I had her resend it.
[CUSTOMER][NEUTRAL] And when she resent it, she put the diagnostic code in there and said everything and that would have been within the last two weeks I wanna say.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm sorry, sir, when was it sent?
[CUSTOMER][NEUTRAL] Within the last few weeks.
[AGENT][NEUTRAL] The last few weeks, OK.
[CUSTOMER][NEUTRAL] The last yeah last month maybe.
[AGENT][NEUTRAL] Last month, OK, let me see if I can, I'm just pulling this up and, and, uh, so what we do, what we had was something that we received on [PII], um, this was for uh the um.
[AGENT][NEUTRAL] [PII] Chad, um, and outpatient and Baptist Outpatient services and you're saying that the diagnosis code is on here. So let me look that up, please, and uh.
[AGENT][NEUTRAL] OK, so it looks like there were 6 documents that were sent.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It looks like it was submitted by [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] On your behalf? OK, so we have.
[CUSTOMER][NEUTRAL] Yeah, she's one of my assistants at work.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we have what is the, the CPT code which is, is the uh uh what what was done, but I'm just looking now for the rest of the documents. Let's see.
[AGENT][POSITIVE] And thank you for your patience, sir. I'm just looking through here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So what we were looking for, it's, it, it's, it's always really confusing. There's, there's a thing called the CPT code. That, that is what the physician or, or the hospital has done. And then there's a diagnosis code and that's the reason that you, that you go in. So a diagnosis would be like, like if you broke a leg or or um a cough or, or having the, the flu or something like that. It's, it's actually
[CUSTOMER][NEUTRAL] But.
[AGENT][POSITIVE] So what it looks like she submitted to us was the CPT code and that's actually the um the service that was done and that's always helpful to have that but what we're what we're actually looking for is for the um is for uh the reason that you went and so it it's very easy to to fix this. I can give.
[CUSTOMER][NEUTRAL] OK then
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] It was [PII]. I mean that's why I went for the CT scan and, and when I went to the diagnostic place and went to the doctor's office and went to everybody to this CPT. I still have it in my wallet. 76775 is the only number they can give me. They say they don't have a diagnosis code. That's the only codes that they use.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] But you, you went for, for [PII]. Is that correct, sir? Is that what you're saying? OK, great. OK. Yes, I'm sorry to hear that. Um, so what we'll, we'll do, let me give you the, uh, if you are able to take this claim number and all you would need to do is just you just need to resubmit, um, she, she sent a fax, uh, a fax cover and what she can do is she can um
[CUSTOMER][NEUTRAL] Yes ma'am, yeah, yeah, I think a kidney surgery.
[AGENT][NEUTRAL] Uh, reference this claim and put that the, that the services were for kidney stones and we'll look up the diagnosis code and then we'll finish the claim. So are you, are you able to write down a, a claim number or?
[CUSTOMER][NEUTRAL] Well, I mean if she resubmits, what, what if she have that information for when she sent it or no is it something different.
[AGENT][NEUTRAL] Well, no, no, we didn't receive that information. We received the CPT code, which is what the doctor did. Now what we were asking for was, was basically what you just told me that you had kidney stones. So unfortunately, um, I can't take that information over the phone. We, we actually have to have it written because it then becomes a permanent part of, of the, of the claim record.
[AGENT][NEUTRAL] But um the only thing that that needs to happen is it looks like she faxed this to begin with, so she can re-fax the original or you know this this any fax cover sheet um and put APL uh claims department as she did before and she can put the name of this claim and say that all services were for kidney stones and then what we will do is we will look up the diagnosis code but that's um that is what we're looking for is that you went in for kidney stone so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, if you would like, I can give you the claim number so that you can reference that when, when she sends in that that uh fax cover sheet.
[CUSTOMER][NEUTRAL] OK and the same number.
[AGENT][NEUTRAL] That's the only thing that she needs to send in.
[AGENT][NEUTRAL] Yeah, the claim number is 35, yeah, sure, just let me know when you're ready.
[CUSTOMER][NEUTRAL] OK, just to, just a couple
[CUSTOMER][NEUTRAL] OK, 35, yes ma'am, 3 5s.
[AGENT][NEUTRAL] 354-7237. So just to repeat, that's 354-7237 and she all she has to do is we don't need any of the other documents. It's not necessary to send any of the other documents we have those.
[AGENT][NEUTRAL] And if she would just send that to us, please, on that, that fax cover sheet referencing this claim and saying that all services were for [PII], uh, then what we would do uh is we will go ahead and look up the diagnosis code ourselves and finish uh paying the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, is there anything else that I can help with, [PII]? Is it, or any other claims that we need to look at, uh, that, that might need paying?
[CUSTOMER][NEUTRAL] No, no, ma'am, that was the only one that was, no, ma'am, that was the only one.
[AGENT][NEUTRAL] OK, well, we'll be on the lookout for that and uh once we receive it, it usually takes 2 to 3 business days to process.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, well thank you for contacting UCL. You have a very good afternoon.
[CUSTOMER][POSITIVE] Perfect.