AccountId: 011433970860
ContactId: f73ca69c-dec9-4ae6-b2ff-5bccf61316c7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 525390 ms
Total Talk Time (AGENT): 171137 ms
Total Talk Time (CUSTOMER): 273496 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/f73ca69c-dec9-4ae6-b2ff-5bccf61316c7_20250121T21:45_UTC.wav
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[AGENT][NEUTRAL] We wanna say this because I.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Can you hear me?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yeah, I can hear you ma'am.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] Yeah, it's very difficult. I almost cannot hear you because it's cutting off. Well, the reason of my call is because I submitted a claim for ambulance service. My insurance paid for part of it, but there is a $251 that should have been covered by your insurance, which is basically my secondary insurance.
[CUSTOMER][NEGATIVE] So I don't know why it was not paid.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I need to understand the reason.
[AGENT][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What is your policy number, ma'am?
[CUSTOMER][NEUTRAL] Well, let me see if I find it here. I have a
[CUSTOMER][NEUTRAL] I have policy number is 02473297.
[AGENT][NEUTRAL] I'm sorry, I can barely hear you. 247.
[CUSTOMER][NEUTRAL] 0247.
[CUSTOMER][NEUTRAL] 329 7.
[AGENT][NEUTRAL] You said 3297?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Give me 1 2nd, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. I need to verify some information, ma'am. Could you please tell me your full name, date of birth, address, and phone number, please?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]
[CUSTOMER][NEUTRAL] My phone number is [PII].
[AGENT][NEUTRAL] OK. Could you verify your date of birth and address?
[CUSTOMER][NEUTRAL] Oh yeah, my date of birth is [PII].
[AGENT][NEUTRAL] And what is your address, ma'am? And I need to verify also your email, please.
[CUSTOMER][NEUTRAL] Oh yes, OK, um, my address is, I changed it, so I don't know if I gave you the new one, but let me give you the new one for now, which is [PII].
[CUSTOMER][NEUTRAL] [PII], well, [PII].
[AGENT][NEUTRAL] OK, thank you for that. And could you verify your email, please?
[CUSTOMER][NEUTRAL] I couldn't tell you which one I have. I may have, let me see.
[CUSTOMER][NEUTRAL] I don't know. I have two emails, so let's try this one first. [PII].
[AGENT][NEUTRAL] That's the one we have in the system.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] That's the one, and the address that you have is the one that I gave you?
[AGENT][NEUTRAL] That is correct, ma'am. That's the address that we have in the system.
[CUSTOMER][POSITIVE] Perfect. OK, so.
[AGENT][NEUTRAL] OK, you, you're calling in regards of a claim that we process and has been denied, you wanna know the reason, correct?
[CUSTOMER][NEGATIVE] Yes, because you're supposed to pay for any exit that my insurance does not cover.
[AGENT][NEUTRAL] Mhm. Yes, I understand that, Ms. [PII]. I just need to verify something. Could you please tell me what is the claim number associated with the, with those charges?
[CUSTOMER][NEUTRAL] the claim number, yes, it's 354-894-0.
[AGENT][POSITIVE] OK. Thank you very much. Give me one sec.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It seems like you were taken by ambulance back on [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Correct. That's the date.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] In this situation, Ms. [PII], what we requesting is the diagnosis code, the reason why you were transferred by ambulance to the hospital.
[AGENT][NEGATIVE] Um, we reviewed the documents that you submitted to us and I'm afraid those documents do not reflect that information. That's why we, we denied the claim. It's not that we don't wanna cover, it's just that the information was incomplete.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We sent you a document letting you know that um.
[CUSTOMER][NEUTRAL] Oh, OK. And how?
[AGENT][NEUTRAL] Go ahead, please.
[CUSTOMER][NEUTRAL] Yeah, I have it here, but I don't know what the diagnosis called. How do I get a hold of that?
[AGENT][NEUTRAL] You can ask your doctor. You can ask the doctor who will attend you back in August. Ask them or, or tell them that you're submitting a claim with your insurance and you need um
[CUSTOMER][NEUTRAL] Can you help
[AGENT][NEUTRAL] The diagnosis because they can provide you with that in writing or they can give it to you um over the phone. You write it down and then you submit that information to us again through the portal.
[CUSTOMER][NEUTRAL] Yeah, the thing is that when you go to the emergency room.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Anyone takes care of you, so I have no, I have no idea who my provider is. I mean, I was at the emergency room.
[AGENT][NEUTRAL] Oh, you had
[AGENT][NEUTRAL] All you have to do is call the emergency room and let them know that, that you are submitting a claim and you were asked for the
[AGENT][NEUTRAL] For the diagnosis code, they can give you that information.
[CUSTOMER][NEUTRAL] Oh, OK. And I also submitted a claim, not only for, no, let me think, let me take a look at this, Medicare ambulance, ambulance.
[CUSTOMER][NEUTRAL] I don't know why the ambulance is like.
[CUSTOMER][NEUTRAL] And you think is the diagnosis called A0425?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] No, ma'am. That's not the diagnosis code. That is the procedure code. That is the that is the procedures that they follow when they pick you up.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Mm, OK. And I also submitted another claim which came in the same explanation of benefits that you sent me, something I was hospitalized on the [PII] and [PII], and I submitted everything.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh it was the night too, but you know, I don't know how you work.
[CUSTOMER][NEGATIVE] I, I don't know what to do because it's such a mess the billing process in the, in the [PII]. It's such a mess. So I don't know what else to provide to you.
[AGENT][NEUTRAL] We also requested that the, the diagnosis code for uh [PII], ma'am. For the hospitalization that you had on [PII]. We also requested the diagnosis code.
[CUSTOMER][NEUTRAL] So I need that.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We got everything. We only need to know the reason why you were in the hospital.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEGATIVE] Oh, OK, OK. So, I mean, with all the things that I submitted, the diagnosis code is not there. I don't know why they do that, you know what I mean? I don't know why the hospitals do not put it in the, in the bill. I don't get it.
[CUSTOMER][POSITIVE] Well, that's fine. Um, I will try to get that. Thank you very much for your help. I appreciate it.
[AGENT][POSITIVE] You're welcome. Anything else I can do for you today?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] That's all thank you very much bye bye.
[AGENT][POSITIVE] Thank you for calling APL. You have a great day, ma'am.
[CUSTOMER][NEUTRAL] You are.