AccountId: 011433970860
ContactId: e3825ab6-48f7-4a87-b85d-687a2660a413
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1045910 ms
Total Talk Time (AGENT): 405247 ms
Total Talk Time (CUSTOMER): 334139 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/e3825ab6-48f7-4a87-b85d-687a2660a413_20250507T18:39_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I am calling because I had um submitted some um medical bills.
[CUSTOMER][NEUTRAL] In the portal and I got an explanation of benefits back that said it needed a diagnosis code but when I had submitted it, it has a diagnosis code so I'm just calling to see what else it needs.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, I can check and see if it's the diagnosis code. Um, may I have the policy number?
[CUSTOMER][NEUTRAL] 216-6570
[AGENT][NEUTRAL] OK. May I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] May I have your name and date of birth for security?
[CUSTOMER][NEUTRAL] My name is [PII] and my date of birth is [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And may I have a um not the call back. I already got that. The mailing address on file for verification.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect, thank you. All right, let's see.
[AGENT][NEUTRAL] And the cleaners for yourself?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Are you looking at claim 359-6838?
[CUSTOMER][NEUTRAL] Um, where would I find that number? I have like the confirmation number from when I sent it in. Oh wait, oh wait, wait, I have the click.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Go ahead with the confirmation.
[CUSTOMER][NEUTRAL] Oh, OK, it's OSC 96328. It's two bills from Quest Diagnostic Services whatever.
[AGENT][NEUTRAL] OK. Let me look at the paperwork and see if the diagnosis cos are listed, OK? Um, do you mind holding for me?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding and being patient for me, Miss. OK, so I went ahead and pull the documents that you send in, um, and it looks like it has a uh CPT code, which that is a procedure code, but it doesn't have the diagnosis code.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's on the very first page that I sent in. I'm, I'm looking at it in the portal right now. It says like Caroline Budro policy number and then it has 3 diagnosis codes.
[CUSTOMER][NEUTRAL] N 20 N 18.1 and N02. B.
[AGENT][NEUTRAL] Well,
[CUSTOMER][NEGATIVE] I can send it again. I've just already sent it twice so I'm just confused on why it's not showing up when I can see it in the portal myself.
[AGENT][NEUTRAL] You can
[AGENT][NEUTRAL] OK, when you send it in, what are you sending? Are you sending the bill or are you sending what you're looking at, um, because what we got is mhm.
[CUSTOMER][NEGATIVE] So the first page is the, the first page is the page I just read off to you, the page with the diagnosis codes, the 2nd page, 2 pages are the med link, the 3rd page is the bill, and then the 4th is the explanation of benefits from my primary insurance.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, the only thing I'm looking, and I'm just going by what I pulled when I pulled the documents on that uh claim, um, but what I see here is this laboratory bill, bill date, [PII], um, bill number, patient's name, responsible party, date of service, and it has the customer service phone number, the pay phone phone number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, most recent insurance information laboratory was requested by [PII], um, and then it has that, um,
[AGENT][NEUTRAL] They did the service on [PII] CPT code 82,570 8415636415 and 80069. And then after that I see the tax ID number. Uh it says Quest Diagnostic Houston Lab [PII], and then it says performed by Quest Diagnostic Coma Boulevard in [PII].
[AGENT][NEUTRAL] Um, and then it says the CPT codes provide information only based on MMA guideline without regarding a specific payer requirements and then it's like amount due, it has like a pay slip with $59.18 but it doesn't have the diagnosis code in this one that I'm looking at.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then after that,
[CUSTOMER][NEGATIVE] And it's more than one page because I, I don't know what that is, but this is like 8 pages long what I sent in so I guess what I'm asking is how do I get you to see what I have in the portal or how do I get it resent because I've already sent it twice and I can see it here when I click view files.
[AGENT][NEUTRAL] OK, can you
[AGENT][NEUTRAL] Can you print that out exactly that you're seeing it or um because I think that you probably, OK, yeah, if you can print out what you're looking at send us just a copy of that print because um uh we did receive the explanation of benefits for airline, but airline doesn't have the diagnosis codes listed in there. Um, so basically, mhm, yeah.
[CUSTOMER][NEUTRAL] Yeah, I have it printed.
[CUSTOMER][NEGATIVE] Right, no, it wouldn't have been coming from them, it would have been coming from me because they don't send it to y'all.
[AGENT][NEGATIVE] Yeah, um, yeah, but you send it all in one document, like you said 9 pages altogether. I'm looking at the all 9 pages that you send in, but in all the 9 pages that I'm looking at, I don't see the diagnosis code and I already checked 3 times. This is the 3rd time I'm going over it just to make sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So if you click on this, yeah, no, it's fine. If you click on the claim number of 3587926, there's like two tabs that have it in there twice. You don't, you can't see that on your end?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] I do. I see two batches of documents. One has 9 pages, the other one has 7 pages. I look at the 9 pages. I don't see it there and then I pulled the 7 pages, but I didn't see it there either. OK, let me go back to that on that.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] That very first page.
[CUSTOMER][NEUTRAL] OK, I'm sorry, the very first step it's the very first page is where the diagnostic codes are. It's not on the second one. It's on the very first tab when I click view files.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you tell me what you see in that page, like, um,
[AGENT][NEUTRAL] Like what other information besides that?
[CUSTOMER][NEUTRAL] It says file viewer and then the tab says Cudrow policy number 2,166,570 PDF and then the very first page patient [PII] policy 2,166,570 diagnosis codes list 32 quest bills with all the same diagnosis codes dates of service [PII] and 128 25. 2nd page is the meddling claim form. Third page is the second meddling claim form.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] 4th page is the quest bill. 5th page is my primary insurance um explanation of benefits. 6th page is on the next Quest bill. 7th page is the Allied.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Explanation of benefits for that bill.
[AGENT][NEUTRAL] Yeah, it's not, it's not gonna come like that to us, but, OK. So I do see here that one that has diagnosis that
[CUSTOMER][NEGATIVE] Can I ask a question then? Can I ask a question? I'm sorry, I've done this like 8 million times because I don't know why Quest cannot understand how to send this information to you all, so I constantly have to do it myself and I've never had a problem with it, but if you're not seeing what I'm seeing, how else can I get this sent into because it's like really a lot of work for it to not work. Do you know what I mean?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, and, and that's.
[CUSTOMER][NEGATIVE] It's a lot of work on my end for it to not even go through to you.
[AGENT][NEUTRAL] Mhm. OK. And then like I said, I'm looking at the 7 page, OK, and I see there's something from [PII], I think that's [PII] Health.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, yeah, I'm not talking about that bill. I'm just talking about the Quest one.
[AGENT][NEUTRAL] OK, that one does have the diagnosis code, yeah, that one has the diagnosis code, but yeah, the quest, the quest doesn't have the diagnosis.
[CUSTOMER][NEUTRAL] Wait, but does it because my ex because, wait, OK, I'm sorry, because while we're on that one then I, my explanation of benefits that I got from y'all about the about the Ossner bill says that you need a diagnosis code.
[AGENT][NEUTRAL] OK, so I can mark this one and send it back again because I do see this one, but I didn't see the ones for clients.
[CUSTOMER][NEUTRAL] It's, it's for the Ossner Health.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Because it says uh remarks number 2 next to Oshner Health which says that it's missing diagnosis codes but you just told me you saw them so now I'm so confused.
[AGENT][NEUTRAL] OK, let me check the date of service again.
[AGENT][NEUTRAL] Because the only thing, uh, the other only thing I can do is get an examiner to review again and give you a call back with her findings.
[CUSTOMER][NEUTRAL] Is there someone I can like email it to? Because if I mail it, I don't know that it's ever gonna get to you like I wanna make sure it gets to somebody and they actually see what's being sent since whatever um since the portal doesn't actually show what's being sent, I guess.
[AGENT][NEUTRAL] Let me try to get somebody on the line on that department on the claims department. Let me see if I can get an examiner, OK? You're welcome. One moment.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[AGENT][NEUTRAL] Hi [PII], how are you? This is [PII].
[CUSTOMER][POSITIVE] I'm doing good how about you?
[AGENT][NEUTRAL] I'm good, thank you. Um, I have a member on the line that she said that she's sent in the diagnosis code that they're listed. I, I went ahead and look at the paperwork, but I only found one, but she said that they're all supposed to be there. I'm not sure, but I went ahead and marked the one that I did find. Um, so can you help this member to see what else she needs to do to send this information because she said she already sent it 4 times and we're not seeing what she's seeing for some reason.
[CUSTOMER][NEUTRAL] OK, may I have the name and the callback number?
[AGENT][NEUTRAL] Uh yes. Her name is [PII]. Um, the callback number is [PII].
[CUSTOMER][NEUTRAL] And the policy number?
[AGENT][NEUTRAL] 216-657-02.
[CUSTOMER][NEUTRAL] OK, and is there a specific claim number or date of service?
[AGENT][NEUTRAL] Um, we're, yeah, we're looking at claim number 3587926.
[CUSTOMER][NEUTRAL] OK, we're not, we're not requesting.
[CUSTOMER][NEUTRAL] Oh, you said 7926. I'm looking at 7927.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] 926. It says uh Quest diagnostic and then in the back is stating that um
[AGENT][NEUTRAL] We need a fully itemized bill with the diagnosis code which I pull Quest and I didn't see the diagnosis code on their quest. Um.
[AGENT][NEGATIVE] And the only thing I found on the paperwork was a diagnosis code for [PII], which that's not Quest. I went ahead and highlighted it, but um that's definitely not Quest. Um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I try to put as much documents as I could, but I didn't find anything. OK, so here she comes and she just need help on how to send in what she's looking at because um she said that every time she said that we said we get something different, OK? So here she comes.
[CUSTOMER][NEUTRAL] You can go ahead and transfer.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK. Have a good day.
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you. Thank you for holding and being patient for me Miss [PII]. I got Ms [PII] on the line, she's in the claims department and she's gonna assist you from here.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Awesome thank you so much.
[AGENT][POSITIVE] You're welcome. Have a good afternoon, Miss [PII].
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Hi [PII], thank you for calling American Public Life. This is [PII], and how may I assist you?
[CUSTOMER][NEGATIVE] I'm just calling because I had uploaded 2 bills into the portal with the Medin form and the diagnosis codes and my primary insurance's explanation of benefits. I've actually sent it twice, but I got something in the mail from you guys.
[CUSTOMER][NEUTRAL] An explanation of benefits saying that you didn't, that you needed diagnosis code for it so I'm just calling to figure out, since I've already submitted those twice, how else I can get them to you.
[CUSTOMER][NEUTRAL] And like why it's not showing up on your end?
[CUSTOMER][NEUTRAL] OK.