AccountId: 011433970860
ContactId: e4599423-172f-4c3d-ab8d-c1d78ea51392
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 597710 ms
Total Talk Time (AGENT): 114879 ms
Total Talk Time (CUSTOMER): 129313 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/e4599423-172f-4c3d-ab8d-c1d78ea51392_20250214T17:09_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], it's [PII] in the care team. I have an insured on the phone. Her name is [PII]. Uh, her policy number is 2455059, and she has been verified and the number she's calling from is a good call back number. She is calling about claim number.
[CUSTOMER][NEUTRAL] 356-333-6. And I read her the remark that she needs to send in the diagnosis code. She has that, but she said that, yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] On this claim?
[CUSTOMER][NEUTRAL] But she needs further assistance.
[AGENT][NEUTRAL] She provided it
[CUSTOMER][NEUTRAL] Yeah, she needs further assistance though because she said that the facility is not giving her any paperwork for it.
[CUSTOMER][NEUTRAL] To send in, they just gave her the diagnosis code.
[AGENT][NEUTRAL] She didn't, I'll explain to her that's all she needs. All she had to do was write it on the EOB and resubmit it, but I'll let her know.
[CUSTOMER][POSITIVE] OK. All right. Thank you so much.
[AGENT][POSITIVE] Thank you, [PII]. Have a good day. [PII].
[CUSTOMER][POSITIVE] All right. You too. [PII]'s to you too. Thanks, [PII]. Bye-bye.
[AGENT][POSITIVE] You're welcome. Goodbye.
[AGENT][NEUTRAL] Hello, thanks for calling APL. My name is [PII]. I'll be assisting you today. You're calling in regards to claim 3563336. date of service [PII]. We're requesting the ELB.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Now we're requesting it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You, you requested the diagnostic code.
[AGENT][NEUTRAL] Oh gosh.
[AGENT][NEUTRAL] I want to know why they requested.
[AGENT][NEUTRAL] There's diagnosis code on here.
[AGENT][NEUTRAL] It's crazy. May I place you on a brief hold while I research this claim?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Because there's diagnosis codes listed there. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[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] Bear with me, I'm scanning through all the pages that you sent over to us for this claim, so give me a moment, I'll be back with you as soon as I'm done.
[CUSTOMER][NEUTRAL] Yeah, in.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome. Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, thank you for holding. So I sent that information back over to the adjuster and she's gonna reprocess your claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So is, is the, the diagnosis code on there?
[AGENT][NEGATIVE] The diagnosis code is listed on the claim itself. That's why I don't understand.
[AGENT][NEUTRAL] While she was requesting it.
[CUSTOMER][NEUTRAL] Yeah, she, she told me, she told me, and that's the one for $250 right? The claim for $250.
[AGENT][NEUTRAL] Um, no, this is the claim for the facility charge of the $46,562.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 46 5, yeah 46 5 66 to 85.
[AGENT][NEUTRAL] But the
[AGENT][NEUTRAL] Yeah, but the, um, but your co-pay amount is $250. Your copay amount is 250, yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, yeah, because I spoke to someone yesterday and she told me that the diagnostic code wasn't on there.
[AGENT][NEUTRAL] I'm not sure why she told you that cause I just scanned it and it is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so she's reprocessing it?
[AGENT][NEUTRAL] Yes, ma'am. She's reprocessing it now as we speak.
[CUSTOMER][POSITIVE] OK. I appreciate it. Thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Um, no, ma'am. I have a, have, 01 more question. You, you guys don't reimburse you don't reimburse for, um, um, pharmacy, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] No, we don't. Unfortunately, we don't cover any type of pharmaceutical.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] OK, no problem. Thank you so much.
[AGENT][POSITIVE] You're welcome and I apologize for the inconvenience, but glad you did call so we can review it and get it straight for you.
[CUSTOMER][POSITIVE] OK, I appreciate it. Have a great day and happy [PII].
[AGENT][POSITIVE] Same to you and have a great weekend. Thanks for calling APL. Have a good day. Bye.
[CUSTOMER][POSITIVE] OK. You too. Thanks. Bye.