AccountId: 011433970860
ContactId: e4bc36dd-45e0-46e1-8f8f-9303d8415c55
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 577479 ms
Total Talk Time (AGENT): 229195 ms
Total Talk Time (CUSTOMER): 228844 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/e4bc36dd-45e0-46e1-8f8f-9303d8415c55_20250203T15:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Yes, good morning.
[CUSTOMER][NEUTRAL] Uh, can I, I have a claim, uh, that I've been waiting to get refund. Can I give you policy number or reference number?
[AGENT][NEUTRAL] Uh, the policy number and the claim number.
[CUSTOMER][NEUTRAL] 025
[CUSTOMER][NEUTRAL] 03862.
[AGENT][NEUTRAL] You gave me 02523862?
[CUSTOMER][NEUTRAL] No, 025.
[CUSTOMER][NEUTRAL] 03862.
[AGENT][NEUTRAL] 00. OK. And the claim number?
[CUSTOMER][NEUTRAL] 025038 0, that's the missing number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I was looking at on the, I was looking at on the uh the, the, the, the, on the receipt reference. Doesn't have claim number. Oh, OK, here we go. 3553626.
[AGENT][NEUTRAL] What's your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Spell your first name for me.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] M E S E R E T.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I'm the policy holder.
[CUSTOMER][NEUTRAL] Yes, last name [PII] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you spell the can you verify the patient's name and date of birth for me?
[CUSTOMER][NEUTRAL] It's [PII], [PII].
[AGENT][NEUTRAL] OK, so you're the policy holder?
[CUSTOMER][NEUTRAL] Yes, that's my son.
[AGENT][NEUTRAL] OK, what's your date of birth and your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And my address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your email address on file?
[CUSTOMER][NEUTRAL] Uh, I believe it [PII] [PII], um, my [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that information. And you said, so it's for your dependent. And you said regarding a refund?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yeah, it was a clean.
[CUSTOMER][NEUTRAL] So, so we can get reimbursed.
[AGENT][NEUTRAL] OK, so are you checking the claims status measure?
[CUSTOMER][NEUTRAL] Well, I'm, yeah, I'm just checking the claim, uh, yeah, sorry.
[AGENT][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] So the claim was processed on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it looks like we're requesting some additional information. Let me see what that is.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, we did provided the details from the clinic.
[CUSTOMER][NEUTRAL] The detail.
[AGENT][NEUTRAL] A fully itemized bill?
[CUSTOMER][NEUTRAL] Um, yes, I, yes, we did, I did provide this.
[AGENT][NEUTRAL] OK, when did you send that in?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, I have to check my email. It's uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] I'm just trying to talk on my computer, sorry, but it was, uh, been at least a couple of weeks.
[AGENT][NEUTRAL] Did you send it in January?
[CUSTOMER][NEUTRAL] Uh yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I'll just put you on a speaker.
[AGENT][NEUTRAL] OK, what I'm looking at is a copy of the balance due statement.
[CUSTOMER][NEUTRAL] No, I, I send the.
[CUSTOMER][NEUTRAL] The, the, the details, uh, just give me a minute. I'm just downloading my.
[CUSTOMER][NEUTRAL] I mean, I, I just have no information.
[CUSTOMER][NEUTRAL] My computer.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So while I still have you online, can, can I have all these on a paperless?
[AGENT][NEUTRAL] What, what do you mean?
[CUSTOMER][NEUTRAL] Can you change my, uh, like on, uh, I, I see we still receive uh uh paper invoices.
[CUSTOMER][NEUTRAL] All, all, all the communication to be on email.
[AGENT][NEUTRAL] OK, I'm not quite sure that I understand what you're asking.
[CUSTOMER][NEUTRAL] So I wanted to change our, uh, uh.
[CUSTOMER][NEUTRAL] In uh bills that we get from the insurance or any uh communication we get from the insurance to be by email only.
[AGENT][NEUTRAL] Yeah, whenever we process a claim it has to be sent to you via mail.
[AGENT][NEUTRAL] We do not send uh an EOB.
[CUSTOMER][NEUTRAL] Oh, that's one of the requirements. OK, so I sent, I sent all the supporting documents on the, the email on the [PII].
[AGENT][NEUTRAL] Yes. Yeah.
[AGENT][NEUTRAL] Yeah, I'm looking at what you.
[CUSTOMER][POSITIVE] The item is good.
[AGENT][NEUTRAL] Right, um, and I'm looking at it and it's, it's not what is required to process the claim because I don't, there are no procedure codes or diagnosis codes on this document that you sent. I see the total charges.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] I see the
[AGENT][NEUTRAL] Day of service.
[AGENT][NEUTRAL] But it doesn't provide any uh procedure codes or, or diagnosis codes on this document. So what I can do, is this a hospital claim or was it a service in a doctor's office?
[CUSTOMER][NEUTRAL] The service in the, it's, it's a college clinic.
[AGENT][NEUTRAL] OK. So, what I can do is give you, give you the.
[CUSTOMER][NEUTRAL] Wait a minute, but that we ask for like my.
[CUSTOMER][NEUTRAL] Hm, let me just open because there was
[AGENT][NEUTRAL] What I can
[CUSTOMER][NEGATIVE] It was 22 itemized bill that they sent.
[AGENT][NEUTRAL] It is a form of an itemization.
[AGENT][NEUTRAL] Meet, but it's not the one that that we need to process the claim.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So I can give you the name of the form.
[AGENT][NEUTRAL] And you can request this from the doctor's office?
[AGENT][NEUTRAL] And this will capture
[AGENT][NEUTRAL] The date of service, the procedure codes and diagnosis codes, the doctor's name, billing address, and so on and so forth on the document that I'm fixing to give you to ask for.
[AGENT][NEUTRAL] You ready?
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] So it's an acronym, um, it's an itemized bill and it's a C as in Charlie, Elm Mary S Sam.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] 1500.
[AGENT][NEUTRAL] So you'll request the itemized bill CMS 1500 form.
[CUSTOMER][NEUTRAL] CMF 1504.
[AGENT][NEUTRAL] Right. Now, now, when we process the claim, it says the Sarasota Hospital. So is it in a hospital or in a physician's office?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Good question. I don't know. Whatever the name came from.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So let's, let's do this. The form name of the, the form name that I just gave you.
[CUSTOMER][NEUTRAL] So that is I mean.
[AGENT][NEUTRAL] That's for any service done in like a, a physician's office setting.
[AGENT][NEUTRAL] If it turns out to be a hospital, then let me give you another form to request. So you'll have both depending on, you know, if they say the location is a hospital or a doctor's office, you'll know which form to request, OK?
[CUSTOMER][NEUTRAL] OK. It is the WA 005?
[AGENT][NEUTRAL] So if they
[AGENT][NEUTRAL] It's UBO4 is a hospital bill.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the first one that I gave you, the CMS 1500, that's for service in a physician's office.
[CUSTOMER][NEUTRAL] OK, can you give me the, the number, the phone number for the hospital?
[AGENT][NEUTRAL] Uh, we do not have that information. It should be on the bill that you that you have.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] No, no, no, I said the, the phone num number or what is the name of the form for the hospital.
[AGENT][NEUTRAL] Oh, the itemized bill for the hospital got you it's U as in university.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] B as in Bobby.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] See what?
[AGENT][NEUTRAL] 0 B as in Bob, B.
[AGENT][NEUTRAL] B as in Bob.
[CUSTOMER][NEUTRAL] Be like, OK.
[AGENT][NEUTRAL] Number 04.
[CUSTOMER][NEUTRAL] OK. UB 04.
[AGENT][NEUTRAL] Correct. That's an itemized bill for the hospital.
[CUSTOMER][NEUTRAL] That's it.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] That makes sense?
[CUSTOMER][POSITIVE] Yes, thank you.
[AGENT][NEUTRAL] Once you get that you can upload it and then we get review.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right. Anything else I can assist with today, Ms. [PII]?
[CUSTOMER][POSITIVE] Uh, that's all. Thank you very much.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] OK, bye.