AccountId: 011433970860
ContactId: f55bead7-333a-4a74-ba4e-24d85d3fd0b9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 364859 ms
Total Talk Time (AGENT): 92147 ms
Total Talk Time (CUSTOMER): 117901 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/f55bead7-333a-4a74-ba4e-24d85d3fd0b9_20250410T18:47_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Yes, hi, good afternoon, [PII]. I was just calling to check the status on a claim that I submitted.
[AGENT][POSITIVE] I'd be happy to assist with claim status. May I have your first and last name please?
[CUSTOMER][NEUTRAL] My name is [PII]. The subscriber is [PII]. I'm his wife.
[AGENT][NEUTRAL] Is it OK for yourself?
[CUSTOMER][NEUTRAL] It's actually for our daughter.
[AGENT][NEUTRAL] OK. And Ms. [PII], what is your um
[AGENT][NEUTRAL] Callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Policy number is 2556453.
[AGENT][NEUTRAL] OK, and what's your date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what's the dependent's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And the data service for that claim.
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] Alright, and if you could verify your mailing mailing address for me.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you for that.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, I'm showing the claim was denied because we can't use receipts to process the claim. We need the um EOB along with the itemized bill that shows the um procedure codes, but but we mainly need the EOB because the EOB or explanation of benefits from your primary insurance will have the procedure codes on it.
[CUSTOMER][NEUTRAL] Yeah, I submitted the EOB with it.
[AGENT][NEUTRAL] Oh, you did? Um, let me take a look.
[CUSTOMER][NEUTRAL] I submitted the EOB mhm.
[AGENT][NEUTRAL] Alright, one moment.
[CUSTOMER][NEUTRAL] And the statement has the well you can check it out.
[AGENT][NEUTRAL] Oh, OK. Yeah, I do see the ELB. I don't know why they use that code. OK, so it looks like we just need um the diagnosis, but it can't be, it has to be on official medical documentation.
[CUSTOMER][NEUTRAL] Um, I've always, they've always told me to just put the diagnosis code on the.
[AGENT][NEUTRAL] We don't, yeah.
[AGENT][NEUTRAL] They stopped that. They stopped that a couple of months ago, they stopped that.
[AGENT][NEUTRAL] So now it has to be on official document, medical documentation.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I will look into that to submit it with it and then um I also had another question. Let me just make a note here.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So I actually see why she did use that code because this EOB doesn't have the procedure codes on it. Let me see.
[AGENT][NEUTRAL] 3187. It does have the procedure code.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Yeah, I got everything. I've submitted other ones like that before and I've never.
[AGENT][NEUTRAL] The EOB also, the receipt has, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] I've never had an issue before, but.
[AGENT][NEUTRAL] So it looks like we just need the uh an official diagnosis.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I needed to double check if I've submitted for myself for [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Any for a claim from [PII].
[AGENT][NEUTRAL] I don't see that on file.
[CUSTOMER][NEUTRAL] And [PII], so you don't show any claims for [PII]?
[CUSTOMER][NEUTRAL] Or [PII].
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] OK, perfect. That's what I needed to know. I didn't wanna repeat send something again.
[CUSTOMER][POSITIVE] OK then that's it for now thank you so much for your time.
[AGENT][POSITIVE] Thank you for calling APL you have a good day.
[CUSTOMER][NEUTRAL] You as well.