AccountId: 011433970860
ContactId: e45792aa-4645-4516-b868-77a58797f39d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 448070 ms
Total Talk Time (AGENT): 150718 ms
Total Talk Time (CUSTOMER): 184491 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/e45792aa-4645-4516-b868-77a58797f39d_20250402T17:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. Hey, I filed a claim on my insurance for a surgery that I had and
[CUSTOMER][NEUTRAL] I got a letter back. It says this is from American Public Life Insurance Company.
[CUSTOMER][NEGATIVE] And it states that they're unable to use.
[CUSTOMER][NEUTRAL] Balance forward statements please fully or please submit fully itemized bill for consideration of the policy benefits and I sent in uh itemized um.
[CUSTOMER][NEUTRAL] Portion so I don't know exactly what um.
[CUSTOMER][NEUTRAL] They're looking for it's the first time I ever filed a claim, but
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I can help you looking at that claim. Um, do you have a policy number, [PII]?
[CUSTOMER][NEUTRAL] Uh, so yes, I do. It is 02471346.
[AGENT][NEUTRAL] OK, thank you. And what is your telephone number?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And I just need to verify a few pieces of information. Um, what's your birth date?
[CUSTOMER][NEUTRAL] Birthday would be [PII].
[AGENT][NEUTRAL] OK, thank you and your address?
[CUSTOMER][NEUTRAL] Address would be [PII]. Zip code would be [PII].
[AGENT][NEUTRAL] And lastly, email address.
[CUSTOMER][NEUTRAL] Email address would be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let's see what we received pulling that up, just give me a moment.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, and that was that for 9-18-2024?
[CUSTOMER][NEUTRAL] Mm, let's see here.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah, 9-182024 um 72 2024 925 of 2024, so it's the whole breakdown of everything on there.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] OK, so it looks like, so with this statement,
[AGENT][NEUTRAL] The one thing that it doesn't have is like a diagnosis code.
[AGENT][NEUTRAL] And then procedure codes, so we don't know, although we can see some of the hospital.
[AGENT][NEUTRAL] Services spelled out we we need an actual um diagnosis code in order to process the claim.
[AGENT][NEUTRAL] Um, probably the easiest thing would be to give your provider a call, see if they can provide you with the actual claims for these dates of service, and then if you can get those submitted to us, then we can get this processed according to your policy.
[CUSTOMER][NEUTRAL] OK, so the reference numbers in there don't mean anything?
[AGENT][NEUTRAL] No, um, there's specific, it's called an ICD 10, um, so it's specific, that's the diagnosis, it's ICD 10 and then there's CPT codes, um, which basically tell us exactly what procedures were performed, um, and that's, that's what we need in order to process and the easiest way what encompasses all of that is usually the actual claim form from the healthcare provider.
[CUSTOMER][NEUTRAL] OK, because this is what they sent me, so I'll call them and, and I'll ask them for the what what did you say it was the IPD code?
[AGENT][NEUTRAL] Um, it's ICD 10. Those are the diagnosis codes.
[AGENT][NEUTRAL] And then CPT codes are the other things. So, the ICD 10 tells your diagnosis, the CPT tells exactly what services were performed at the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, well, I will, uh, can I just get that when I get it then I will attach it back to this, um.
[CUSTOMER][NEUTRAL] First claim that I started here?
[AGENT][POSITIVE] Yeah, that'd be just fine.
[CUSTOMER][NEUTRAL] And then resend it?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh, OK, well if I have any other issues then um you've been very helpful and if I have to I'll get us on a three way call with the provider because sometimes they don't understand either the same way I don't, you know what's needed, especially this is different, different type of insurance, so.
[AGENT][NEUTRAL] I know.
[AGENT][NEUTRAL] Sure, yeah, I understand. Yeah, well, absolutely we can do a three way call but definitely give that verbiage to them because they should know exactly what that that means and what we need so.
[CUSTOMER][NEUTRAL] OK, while I have you on the phone here, I am going to exit my recliner and grab a pen and write that information down so I don't have to feel old and call you back and say well I forgot.
[AGENT][POSITIVE] No, that's fine, totally understand.
[CUSTOMER][NEUTRAL] OK, let's see pen pen pen pen.
[CUSTOMER][NEUTRAL] OK, I'm gonna throw you on speaker because I'm, I'm left handed and I can't hold the phone to my ear and write at the same time.
[AGENT][POSITIVE] Yeah, absolutely, no problem.
[CUSTOMER][NEUTRAL] OK, now could you repeat, could you repeat the code definition for me so I can let them know.
[AGENT][NEUTRAL] Yes, so for each date of service you were seeing, you're gonna need the ICD as in dog, 10 codes. That's gonna be your diagnosis codes.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] You'll need your CPT code. That's gonna be for the procedures that were performed for each day of service.
[CUSTOMER][NEUTRAL] OK, and let me read that back to you so the first code would be.
[CUSTOMER][NEUTRAL] Ida Charlie dog.
[CUSTOMER][NEUTRAL] And the second code would be.
[CUSTOMER][NEUTRAL] Charlie
[CUSTOMER][NEUTRAL] People
[CUSTOMER][NEUTRAL] Um, tangle
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Alright, got it. Alright, thank you very much.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you for calling [PII]. I hope you have a great day. Bye.
[CUSTOMER][NEUTRAL] All right bye bye.
[CUSTOMER][NEUTRAL] Alright bye.