AccountId: 011433970860
ContactId: e22c24f4-22bd-4f2f-8bbd-0cb37ab121ff
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1221040 ms
Total Talk Time (AGENT): 449389 ms
Total Talk Time (CUSTOMER): 366649 ms
Interruptions: 7
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/e22c24f4-22bd-4f2f-8bbd-0cb37ab121ff_20250409T12:45_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm trying to um get information on a claim that I filed.
[AGENT][NEUTRAL] OK, Ms. [PII], you're needing to check claim status for yourself, is that correct?
[CUSTOMER][NEUTRAL] Uh, for my son.
[AGENT][POSITIVE] OK, yes ma'am, I can help you and what is your callback number please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And the policy number, please?
[CUSTOMER][NEUTRAL] 026.
[CUSTOMER][NEUTRAL] 04219 M as in Mary L as in Larry 8.
[AGENT][NEUTRAL] OK, thank you. Give me a couple of moments please to get the uh policy information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and Miss [PII], any information that I do provide for you?
[AGENT][NEUTRAL] Today would be a verification of benefits and not a car payment. If you could, I will need to verify several things with you first for security. So first off, if you could please uh verify your date of birth and then your son's name and date of birth.
[CUSTOMER][NEUTRAL] Hello? Oh.
[CUSTOMER][NEUTRAL] My date of birth is [PII] and my son is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And also your home mailing address, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you provided for me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. And there is also another phone number on file for, do you have another phone number as well?
[CUSTOMER][NEUTRAL] Um, maybe.
[AGENT][NEUTRAL] With a different area, well.
[CUSTOMER][NEUTRAL] A different area code? No.
[AGENT][NEUTRAL] Uh, no, I think this is just a typo. So give me just one moment please to get this corrected.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and the last thing to verify would be your email address please.
[AGENT][NEUTRAL] And this does appear to be your work email.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Oh, work, OK, [PII].
[AGENT][POSITIVE] OK, thank you very much.
[AGENT][NEUTRAL] And for your son, what is the data service?
[AGENT][NEUTRAL] In total build amount?
[CUSTOMER][NEUTRAL] 131
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, 131 it's 3500 I believe.
[AGENT][NEUTRAL] 3500 even.
[CUSTOMER][NEUTRAL] I have a claim number.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, just one, OK, if uh.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For that date of service, it should be.
[CUSTOMER][NEUTRAL] Oh, they have.
[CUSTOMER][NEUTRAL] The total bill amount is 1,354,480.
[AGENT][NEUTRAL] OK, thank you. All right. So let me look.
[CUSTOMER][NEUTRAL] But what I
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I can see that the most recently processed claim was on 48 and that claim number ends in 80.
[AGENT][NEUTRAL] That claim was
[CUSTOMER][NEUTRAL] Yeah, so, let me explain.
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] Let me explain, so it should be the first claim.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 720
[CUSTOMER][NEUTRAL] That one
[CUSTOMER][NEUTRAL] Says that you guys needed explanation of benefits or or itemized bill.
[AGENT][POSITIVE] Well, that's, I'm so sorry, your voice went out.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Hold on, let me get off the.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] OK, you can hear me better?
[AGENT][NEUTRAL] Uh, yes ma'am. Now, what was the first claim number? Because I didn't hear that, that your voice.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh, OK. It ends, it ends in 720?
[AGENT][NEUTRAL] I cut out on that part.
[CUSTOMER][NEGATIVE] Yeah, you keep cutting out too.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] And it says date completed 325, so that was the first one.
[AGENT][NEUTRAL] Alright, let me look at the remark on that one because I do see it was tonight.
[AGENT][NEUTRAL] OK, so yes, this one.
[AGENT][NEUTRAL] Uh.
[AGENT][POSITIVE] This one will be that explanation benefits for the full with the full description of the remark.
[CUSTOMER][NEUTRAL] Yeah, I have that, so.
[CUSTOMER][NEUTRAL] It says you need supporting documentation, so I provided all of that on that last claim.
[CUSTOMER][NEUTRAL] I don't know how else to submit it. I, I did it online.
[CUSTOMER][NEUTRAL] Um, and then it says on the last claim that it looks like a duplicate, so I don't know.
[CUSTOMER][NEUTRAL] How to provide that.
[AGENT][NEUTRAL] OK, so we were again I'm so sorry. I don't know we do, we don't have a very good connection and I'm so sorry. I don't know if it's on my end or your end. So on the first claim because I didn't hear again anything you just said to me, um, until uh until you get to the part about didn't know how to submit it. So, um, that's all I heard. So I'm looking at the notes for the very first one that was sent in, it does state that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We were needing.
[AGENT][NEUTRAL] Supporting documentation.
[AGENT][NEUTRAL] Um, this, this may include it's not limited to the itemized bills with the diagnosis codes, super bills, office notes, hospital admission and discharge summaries and or diagnostic testing results.
[AGENT][NEUTRAL] That is what we needed for that claim.
[CUSTOMER][NEUTRAL] OK, I submitted.
[CUSTOMER][NEUTRAL] On that, on the last claim.
[CUSTOMER][NEUTRAL] Because again, I don't know how, how else to submit the paperwork. Um, I submitted the itemized bill.
[CUSTOMER][NEUTRAL] The EOB.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What's what I submit.
[CUSTOMER][NEUTRAL] 3 things on the claim form. So
[CUSTOMER][NEUTRAL] What else?
[CUSTOMER][NEUTRAL] But it just says that it's a, it's a duplicate, I mean, or, or.
[CUSTOMER][NEUTRAL] Uh, is the paperwork
[CUSTOMER][NEUTRAL] Sufficient or?
[AGENT][NEUTRAL] No, it appears it's still missing. But, let me look at one additional thing on this another claim.
[AGENT][NEUTRAL] For the same date of service.
[CUSTOMER][NEUTRAL] There's 3, the 3 claims are for the same thing.
[AGENT][NEUTRAL] Right, there's a total, yes, there's a total of 4 claims on that data service.
[AGENT][NEUTRAL] There's one claim that ends in number 3, 30. I'm so sorry, yes. OK, so let me look at the remarks on that because that's a different billed amount.
[CUSTOMER][NEUTRAL] Oh, there's 3.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] That one has
[CUSTOMER][NEUTRAL] Yeah, that one has all the paperwork I have for that, for that 131 visit.
[CUSTOMER][NEUTRAL] Uh, I could send the report of the MRI, but that's, that's.
[CUSTOMER][NEUTRAL] Neither here or there, I mean.
[CUSTOMER][NEUTRAL] The money was spent on, on the deductible for that MRI so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look.
[AGENT][NEUTRAL] Now what I can do is I can have I can send a request to have someone to.
[AGENT][NEUTRAL] You look at this and to give you a call back to research on the documents because you're saying that you did submit the itemized bill EOB and claim form, is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK. So I will be happy to do that. Now, uh-huh. No, go ahead.
[CUSTOMER][NEUTRAL] Yeah, that, that last.
[CUSTOMER][NEUTRAL] Sorry. That last claim has the a claim form?
[CUSTOMER][NEUTRAL] An itemized bill and the EOB from the, from the insurance company.
[AGENT][NEUTRAL] Primary.
[AGENT][NEUTRAL] OK. And on that itemized bill, does it include your diagnosis code?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Or his diagnosis code, I should say.
[CUSTOMER][NEUTRAL] It should, yeah.
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] So not the procedure codes, but the diagnosis code. That's what
[CUSTOMER][NEUTRAL] I believe it does, yeah.
[AGENT][NEGATIVE] A lot of them will have the procedure codes as to what they did, but not the why they did it.
[CUSTOMER][NEUTRAL] Oh wait.
[CUSTOMER][NEUTRAL] You know what?
[CUSTOMER][NEGATIVE] I did not upload the right thing.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] That's my fault.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How do I submit
[CUSTOMER][NEUTRAL] How do I submit the the itemized bill without opening?
[AGENT][NEUTRAL] You can just upload that into your portal.
[CUSTOMER][NEUTRAL] But it'll do a whole other claim.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] Actually, it's going to.
[AGENT][NEUTRAL] Yeah, the way the system is you cannot add to an existing claim that has already.
[AGENT][NEUTRAL] Gone through review so you would just upload the it does appear like it's a file a new claim, but the system will know.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So, to tie those two together that that was a decision for that data service.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK, hold on.
[CUSTOMER][POSITIVE] I'm gonna do it right now.
[CUSTOMER][NEGATIVE] Because it, the problem is it has the same name as the other document and I uploaded the wrong one.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Let, let me rename.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, so I'm gonna upload.
[CUSTOMER][POSITIVE] It looks fast.
[CUSTOMER][NEUTRAL] Ma
[CUSTOMER][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] Where did it go?
[CUSTOMER][NEGATIVE] I hate when it, it, it'll save.
[CUSTOMER][NEUTRAL] With a different date.
[CUSTOMER][NEUTRAL] I don't know if you ever had that happen. It it says what the date is created.
[AGENT][NEUTRAL] Yeah, well, it's going.
[CUSTOMER][NEUTRAL] There it is, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know if you wanna make a note of the confirmation number or anything that you need to do that or is you don't know.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] I will
[AGENT][NEUTRAL] Once I can see, I can't see it yet. Just a moment to refresh. OK, so there we go. So yes, I do see that we have got something.
[AGENT][NEUTRAL] Now that has just been uploaded for so it is in line for review.
[CUSTOMER][NEUTRAL] Yeah, it has
[CUSTOMER][NEUTRAL] It has a HCPC CPT code.
[CUSTOMER][NEUTRAL] That should be enough, right? That's all they gave me. I, I requested an itemized bill and that's what they gave me.
[AGENT][NEUTRAL] OK, so on the CPT code, that is going to be the
[AGENT][NEUTRAL] That's gonna describe the procedures done.
[AGENT][NEUTRAL] You, uh, if you don't have the diagnosis, which is an ICD code.
[AGENT][NEUTRAL] You'll need to request that from them.
[CUSTOMER][NEUTRAL] Should I send the
[CUSTOMER][NEUTRAL] Can I send the order that has
[CUSTOMER][NEUTRAL] The code?
[AGENT][NEUTRAL] Uh, you can upload that if you have what his diagnosis code is.
[AGENT][NEUTRAL] And they will, one of the examiners will review it. But the CPT, yes, ma'am, that's not what we're needing. We're needing to know why they did it.
[CUSTOMER][NEUTRAL] Um, it should
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] According to what I can see.
[CUSTOMER][NEUTRAL] Hold on, is it on the EOB?
[AGENT][NEUTRAL] No, it would not be on your EOB.
[CUSTOMER][NEUTRAL] Yeah, OK, so let me.
[CUSTOMER][NEUTRAL] Let me find the original.
[CUSTOMER][NEUTRAL] Order form.
[CUSTOMER][NEUTRAL] Hold on because I have that um.
[CUSTOMER][NEUTRAL] On my phone.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] I wish I could have just had them process that.
[CUSTOMER][NEUTRAL] When I went, but
[AGENT][NEUTRAL] I am.
[CUSTOMER][NEUTRAL] It was a a mix up with my enrollment and then
[AGENT][NEUTRAL] Next up.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yeah, there was um.
[CUSTOMER][NEUTRAL] Hold on, let me make sure this is that date and time for MRI. Yeah, I actually didn't get confirmation of enrollment so like February.
[AGENT][NEUTRAL] OK. Well, the good thing with APL is that we do not have a timely filing limit, so you, you know.
[AGENT][NEUTRAL] It just, it does make it, just a little more, yeah, it just, it does make it a little more challenging when you were the one.
[CUSTOMER][NEUTRAL] Yeah, I've used you guys before.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Having to get all of the information together to submit.
[CUSTOMER][NEUTRAL] OK, I'm gonna email this for myself.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] I wanna say I had you, had covered with you guys when I had my son.
[CUSTOMER][NEUTRAL] That do Sasco to email it to myself so I can upload it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then again, you know, it will just it will have to be reviewed by one of the examiners, Ms. [PII], and if that is not sufficient, then obviously, you know, you still have the opportunity to reach back out to the facility or the prescribing provider that's.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That ordered the test, um,
[AGENT][NEUTRAL] And, you know, just then just did the same thing.
[CUSTOMER][NEUTRAL] Uh, this has the ICD code, so.
[AGENT][NEUTRAL] If it does have ICD codes, yes, and that, I mean, that should be, that should be fine, but again, I just cannot 100%.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Confirm that for you.
[CUSTOMER][NEUTRAL] Oh, so how do you know?
[CUSTOMER][NEUTRAL] I guess I can name it with the claim number.
[CUSTOMER][NEUTRAL] Should I do that?
[AGENT][POSITIVE] Uh, you can, you can, you can, you can do that.
[CUSTOMER][NEUTRAL] Or the data service on there?
[CUSTOMER][NEUTRAL] OK, let me do that because.
[AGENT][NEUTRAL] And that's on like your notes or something from the doctor that ordered the test?
[CUSTOMER][NEUTRAL] This is the actual order.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, it's just uploaded it.
[AGENT][NEUTRAL] And give it just a second and then I'll.
[AGENT][NEUTRAL] I'll refresh it to verify that I can see that one as well.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yeah, if you look all the way to the right on the 2nd page, it has the ICD code.
[CUSTOMER][NEUTRAL] Well, 2 and 2nd page of the um.
[AGENT][NEUTRAL] So I do see that there has been a 2nd upload. Mhm uh yes ma'am. So now there's two separate uploads in line for review.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And again, once it has been reviewed, I believe that you did opt in, yes, it looks like you've opted in for text notification alerts so you should get a notification now.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] be able to log into your portal, Ms. [PII] just because of the processing, how it's processed, but you, if you don't see the status once you received your text, you can call us and we'll be happy to look at it for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK, well, is there anything else this morning I can help you with?
[CUSTOMER][POSITIVE] No, that was it. Thank you so much.
[AGENT][POSITIVE] Well, you are certainly very welcome. So thank you for calling APL and I hope that you have a wonderful day.
[CUSTOMER][POSITIVE] Thanks you too.
[AGENT][POSITIVE] Yes, ma'am. Thank you so much. Uh-huh. Bye-bye and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] Thank you. Bye.