AccountId: 011433970860
ContactId: ed334f00-bffd-488f-9f48-8aa685296f96
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 658460 ms
Total Talk Time (AGENT): 238659 ms
Total Talk Time (CUSTOMER): 357400 ms
Interruptions: 7
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/ed334f00-bffd-488f-9f48-8aa685296f96_20250513T17:47_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII], and I have open claims to you, uh, with you, and I just received the mail where, uh, you, your facility asks me about the cos of the procedure, what to which the has done to me.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] But I send it twice to you twice. I sent it last week or 10 days ago to the paper with the quotes which each for each procedure. Why you send it to me again? Why you request it again? Because I send it to you twice by the mail.
[AGENT][NEUTRAL] I can
[AGENT][NEUTRAL] I can
[AGENT][NEUTRAL] OK, Ms. [PII], I can check and see if that is the diagnosis code. Make sure it's not a procedure code, OK, because those are two different codes. Uh, do you have the policy number?
[CUSTOMER][NEUTRAL] Um, I have a claim number, uh, but yeah, policy number it is 024.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 896
[CUSTOMER][NEUTRAL] 11
[AGENT][NEUTRAL] OK. And a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 9. Alright, and let's see.
[AGENT][NEUTRAL] OK, for security, may I have your date of birth, mailing address and email address on file for verification.
[CUSTOMER][NEUTRAL] Yes, it is [PII] and um my email address is [PII] oh my God, uh FX it's so long.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK. Thank you. Mhm.
[CUSTOMER][NEUTRAL] Who
[AGENT][NEUTRAL] OK, um, let's see. Miss [PII], give me just a few minutes. I'm just pulling the paperwork to see exactly what clothes are in this document, OK?
[CUSTOMER][NEUTRAL] Yes, OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, uh, let me look at the next one.
[AGENT][NEUTRAL] Mm OK. Ms. [PII], um, the codes that you, you are, you have, because I see you put a line beside one of the codes indicating that code, that code is not a medical code. That's just a code for uh Atlantic Health System is uh system codes, which is not a medical code.
[AGENT][NEUTRAL] Uh, the medical code is a little bit different. It's gonna be a diagnosis code which is um going to be letters and numbers altogether. It looks almost like the CPT code, but it's not a CPT code. The CPT code is a procedure code which let us know what they did, but the diagnosis code let us know why, why you had to have that service done. So it is a little bit different than what you're sending.
[CUSTOMER][NEUTRAL] So where do I need to get, uh, OK, where, where I need to get it, uh, this was diagnosed in my um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] In my gynecologist, uh, she did the, however, uh, my, my gynecologist diagnosed with what I had and, uh, uh, send me to the another doctor which should do this, uh, things to check these things and work with that and she, the another doctor told me that I need she did the all test what needed and I was diagnosed of pre cancer, uh.
[CUSTOMER][NEUTRAL] Uh, sales a week and, uh, she said that I need a procedure as soon as possible. It's almost emer almost emergency like so where I need to go and show this paper, uh, who.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK. You will have to contact Morrison Medical Center, Morristown, Morristown Medical Center. That, that is the visited location. That's the location you visited. So you need to contact Morristown Medical Center and let them know that you need a fully itemized bill with diagnosis code that you're trying to submit a claim.
[CUSTOMER][NEUTRAL] Mhm uh-huh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, I know what is it?
[CUSTOMER][POSITIVE] Oh [PII], so I need to go there, so I'm, I'm in and show this paper for them and they know what to do, yes.
[AGENT][NEUTRAL] You need to let them know if you want to write it down, and you need to ask them to give you a fully itemized bill with diagnosis codes.
[CUSTOMER][NEUTRAL] OK, so the paper what I have in my hand says just a moment, let me do my glasses say accident sickness surgery out surgery general anesthesia amount you need these 21.
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] No. No. Uh oh. OK. Do you have the copy of the explanation of benefits we send to you?
[CUSTOMER][NEUTRAL] OK, here it is.
[CUSTOMER][NEUTRAL] You send me uh oh, I don't have it right on my hands right now. Well, here is another one to the another, uh, page receipt of your claim is, uh, however, in order to provide for the account that the policy we need supporting documentation. Please provide diagnose quote for this date of service. This information may be obtained from your provider of service, this one.
[AGENT][NEUTRAL] Yes, you can yeah, take that. Yes, take that one with you and let them know that you're trying to get that information for your claim. So you can just take the copy of this information and benefits we sent you. Mhm. Yeah.
[CUSTOMER][NEUTRAL] I need to show them this paper and they know what to do.
[CUSTOMER][POSITIVE] Yes, I will, I will go there.
[CUSTOMER][NEUTRAL] I will, I will, uh, and I need to show the explanation of benefits.
[AGENT][POSITIVE] You can just show the back part, like the 2nd page, which it has the remarks description, so they know exactly what you need.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] OK, let me see. I will go there to go there tomorrow and, uh, I, I guess they can give it to me right away, yes.
[AGENT][NEUTRAL] Um, more than likely they can. If they can't, they will let you know how to get it, but, um, more than likely they probably can give you a copy right there.
[CUSTOMER][NEUTRAL] Oh, it's, it's, uh, it's, uh, keeps so long. I had it in last year October, and now it's coming another October.
[AGENT][NEUTRAL] Mm yeah.
[CUSTOMER][NEGATIVE] I had 2nd surgery because I needed it. I had 2nd surgery this year January, but I had another insurance which pay already for my for for that. I pay my deductible already and they pay all of the amount. Why is this time continues that long.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We just don't have all the, like the last time we did receive all the information, including diagnosis code, but this one doesn't have the diagnosis code.
[CUSTOMER][NEUTRAL] OK, why you don't, uh, uh, contact the M Memorial Medical by yourself?
[AGENT][NEUTRAL] Because due to security, they don't give that information to us.
[CUSTOMER][NEUTRAL] Oh, OK, maybe I will go there tomorrow, uh, if something I will call you again, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm, yeah, for privacy. Mhm. Mhm.
[CUSTOMER][NEUTRAL] Alright, so just to confirm, please provide the OK, just to provide confirm, uh, I need uh documentation supporting might include, but it's not limited to the, the, the bills with the diagnosis code super bills office notes, hospital admission and discharge summaries and diagnostic treating results, testing results.
[CUSTOMER][NEUTRAL] Uh, please provide the diagnose code for the state of service maybe applying from your provider for service. OK, I will show this paper to them tomorrow.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. No.
[CUSTOMER][NEUTRAL] I guess they can give me they, they have everything.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, almost done medical hold on let me pull that.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, thank you very much. So can you, can I ask you please, um, uh, do you have some extension number? Where is my, my pen? Jesus, do you have extension number so I call you directly?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Oh what? I'm sorry?
[AGENT][NEUTRAL] Oh, we don't have an extension, but you can ask for me. My name is [PII]
[CUSTOMER][NEUTRAL] You just uh, what is your name, excuse me?
[AGENT][NEUTRAL] [PII]. Yes. So.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, [PII], that's all.
[CUSTOMER][NEUTRAL] [PII] so.
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] Uh, so.
[CUSTOMER][NEUTRAL] OK, you're working every day?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Are you working everyday?
[CUSTOMER][NEUTRAL] I, so what, uh, what time, what?
[AGENT][NEUTRAL] Yes, from Monday, Monday to Friday from.
[AGENT][NEUTRAL] Yes, from [PII], Monday to Friday from [PII] Central time.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you, so, and I will, I will do it tomorrow, OK.
[AGENT][POSITIVE] OK, you're welcome and thank you for calling APL. You too, Ms. No yeah. Have a good day. Good afternoon. Bye-bye.
[CUSTOMER][POSITIVE] OK, thank you, have a nice day. OK, bye bye.
[CUSTOMER][NEUTRAL] That's.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You