AccountId: 011433970860
ContactId: 00e8c9bd-2538-49bb-b1bf-ea4bdaae812f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 317440 ms
Total Talk Time (AGENT): 136198 ms
Total Talk Time (CUSTOMER): 140476 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/00e8c9bd-2538-49bb-b1bf-ea4bdaae812f_20250228T16:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. My name is [PII]. I'm an agent and I was following up regarding a claims that we had submitted for one of our members.
[AGENT][NEUTRAL] OK, all right, Mr. [PII], I can help you with the claim, sir. Can you please give me the group number um that you're calling for?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, yes, yeah.
[CUSTOMER][NEUTRAL] Yeah, the group number is 17,330, and that's under Total Marine Solutions.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me look that up real quick, sir.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And I've also got the policy ID number for the member as well as the claim number that's showing on file.
[AGENT][POSITIVE] Awesome. OK, I just need you to verify the group can you please give me your email address, sir?
[CUSTOMER][NEUTRAL] Alright, mine is [PII].
[AGENT][POSITIVE] Thank you and then the group's um street address.
[CUSTOMER][NEUTRAL] Uh, bear with me. Hold on one second. Uh, let me just verify.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Oh where is it Alex.
[CUSTOMER][NEUTRAL] To Lane they should be street address uh [PII].
[AGENT][POSITIVE] Yes, sir. That's great. Thank you very much.
[CUSTOMER][NEUTRAL] Swe
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] All right, Mr. [PII], um, what is, uh, the insured's name and policy number?
[CUSTOMER][NEUTRAL] Uh, first name is [PII], last name is [PII], and his policy number is showing as 1,566,010.
[CUSTOMER][NEUTRAL] And then the claim number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is 356-901-6.
[AGENT][NEUTRAL] OK, let me look him up real quick.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEUTRAL] It was uh
[CUSTOMER][NEUTRAL] Thank you. There was an ambulance claim with an EOB as well as an outpatient uh service that was done for him.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, I've got the claim pulled up right here.
[AGENT][NEUTRAL] And let me see what it says in the remarks.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] All right. It is giving me um two remarks. One is, um, the diagnosis code was not provided. Uh, it says the receipt of your claim was acknowledged. However, in order to provide further consideration of this loss,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, we need the supporting documentation to evidence that accident sickness is supporting documentation may include, but is not limited to itemized bills with diagnosis codes, super bills, office notes, hospital admission and discharge summaries.
[CUSTOMER][NEUTRAL] OK, so if I have them contact the facility, all we need is the diagnosis codes would that assist them?
[AGENT][NEUTRAL] It it right, it looks like we need the itemized statement with the diagnosis code on it.
[CUSTOMER][NEUTRAL] OK itemized uh statement.
[CUSTOMER][NEUTRAL] OK, would that justify for both the clients for the ambulance as well as the ER services there?
[AGENT][NEUTRAL] OK and so um.
[AGENT][NEUTRAL] Let me see what the EB says as far as the procedures. Um, we've got another.
[CUSTOMER][NEUTRAL] There was
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, we've got
[AGENT][NEUTRAL] We've got another remark that said insurance primary insurance provided full benefits there are no benefits payable.
[CUSTOMER][NEUTRAL] Um, but not on the, uh, no, because, uh, the, uh, on the EOD it shows the city of [PII]. The ambulance charge was 55948, so we're just trying to recuperate that portion of it, not all of it, of course, because the benefits 350.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And then for the outpatient uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The outpatient total is 12:40 uh for being in the hospital.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Yes, sir. It looks like for those codes, we just need the um itemized statement with the diagnosis code on it. That's what they're looking for.
[CUSTOMER][NEUTRAL] So, OK.
[CUSTOMER][POSITIVE] OK, I'll go ahead and request that information uh from the family member so we can go ahead and get this resolved. I greatly appreciate your thank you so much.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes sir.
[AGENT][POSITIVE] You're very welcome, Mr. [PII]. I hope you have a wonderful weekend and I'm glad I was able to assist you today. All right, thank you so much for calling APL, sir.
[CUSTOMER][NEUTRAL] You do the same.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][POSITIVE] Alright have a good one bye bye.
[AGENT][NEUTRAL] You too sir bye bye.