AccountId: 011433970860
ContactId: f04a90a8-2eff-453d-8cb1-7dfb050fe1d8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 314700 ms
Total Talk Time (AGENT): 108113 ms
Total Talk Time (CUSTOMER): 144793 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/f04a90a8-2eff-453d-8cb1-7dfb050fe1d8_20250612T20:50_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], how are you?
[AGENT][POSITIVE] Good how are you?
[CUSTOMER][NEUTRAL] Good, I just received a call back from the claims department and unfortunately my phone I have like a blocker on it for spam calls and it blocks it so it went to voicemail um but I was just calling back to speak on a claim if you can help with that.
[AGENT][NEUTRAL] Sure, um,
[AGENT][NEUTRAL] Can I get your name and
[CUSTOMER][NEUTRAL] Just
[AGENT][NEUTRAL] What is your name? I'm sorry.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]? No, it's OK.
[AGENT][NEUTRAL] OK, I spoke with you earlier.
[CUSTOMER][POSITIVE] Oh yes, possibly. I'm sorry.
[AGENT][NEUTRAL] Yeah, and, and I, and I apologize. I was, I was trying to figure out what I was, um, allotted to give you so that is my fault, um.
[AGENT][NEUTRAL] I am unable to see the documents though um but I do know that they need the primary EOB but let me go ahead and since I have all of your information still, uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They said in
[CUSTOMER][NEUTRAL] They said also that they needed um
[CUSTOMER][NEUTRAL] The diagnosis codes on the invoice, but I'm seeing that some of them do, so I just wanted to talk through it.
[AGENT][NEUTRAL] OK, yeah, and I'm not able to see those documents still, um, so let me go ahead and pull up the policy I'll see if I can get someone from claims, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Alright, give me just one moment.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], this is [PII] with the care team. I have a broker on the line. She was, uh, getting a call back from claims, and she missed the call, um, and I had spoke with her earlier. I had actually put in the ticket to get her a call back, um.
[CUSTOMER][NEUTRAL] The policy number.
[AGENT][NEUTRAL] The policy number is 17193999.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's in regards to part 4,
[AGENT][NEGATIVE] I read her the claim remarks on the documents that were needed, but she's saying that she thought that they were submitted and she needs help understanding um what's wrong with the documents that were submitted and what's missing because she she said that um everything that was submitted should have sufficed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you need her callback number?
[CUSTOMER][NEUTRAL] All right, one moment.
[CUSTOMER][NEUTRAL] Are, are you gonna put it in notes?
[AGENT][NEUTRAL] Uh, yeah, and they should be in the notes from earlier because she called about, 0, 20 minutes ago.
[CUSTOMER][NEUTRAL] Is it [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] All right, got it.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Uh, I will introduce you and I'll bring her right over.
[CUSTOMER][POSITIVE] Alright thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hi [PII], I have [PII] from uh claim support. She'll be able to talk you through those documents, OK?
[CUSTOMER][POSITIVE] Thank you so much. I appreciate all your help.
[AGENT][NEUTRAL] Right
[AGENT][POSITIVE] Alright thank you have a great day.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] Good afternoon, thanks for calling APO this is [PII]. How can I help you? Hi [PII], I'm calling on claim number 361-23000. OK, no, just 200, I apologize.
[CUSTOMER][POSITIVE] Got you and OK.
[CUSTOMER][NEUTRAL] I was advised that the EOB is missing fine, we can get that, but then also in the voicemail they expressed something about needing diagnosis codes. I do see that a few codes are included, so what are we looking for?
[CUSTOMER][NEUTRAL] OK. So the codes that are included in the information that was sent over, those are procedure codes. And the procedure code just tell us what uh what type of treatment they had. So the diagnosis code actually tells us why they went in for medical treatment.
[CUSTOMER][NEUTRAL] And so we just need something from the hospital, the, the discharge uh papers or the ER physician's notes that tells us why this person came into the emergency room.
[CUSTOMER][NEUTRAL] OK, and then.
[CUSTOMER][POSITIVE] I also I'm looking at a claim submitted and paid out for another employee because I help this group a lot and.
[CUSTOMER][NEUTRAL] They only have a billing code or a procedure code.
[CUSTOMER][NEUTRAL] And it was approved, so what's the difference between the two?
[CUSTOMER][NEUTRAL] Can I get the policy number so I can look.