AccountId: 011433970860
ContactId: 032f5b61-f4c3-44c5-bf51-87b4386777de
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 577369 ms
Total Talk Time (AGENT): 224637 ms
Total Talk Time (CUSTOMER): 231344 ms
Interruptions: 6
Overall Sentiment: AGENT=0.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/032f5b61-f4c3-44c5-bf51-87b4386777de_20250422T16:06_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, [PII]. My name is [PII]. I'm an agent and I'm following up regarding a claim, um, a med gap claim that we had submitted online. Uh, the original request we did was back on [PII], and we needed an itemized invoice or bill.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And which we submitted on [PII] and the member received a notification saying that there was a double claim so I just wanted to make sure that it was processed correctly.
[AGENT][NEUTRAL] OK, let me take a look at that for you. Could I get your name one more time? I'm sorry.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, sure. The first name is [PII], last name is [PII].
[AGENT][NEUTRAL] OK, and are you the broker or the benefit rep? OK.
[CUSTOMER][NEUTRAL] And yes I am yeah I'm the uh broker.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I've got the group number as well as the policy number for the member.
[AGENT][NEUTRAL] OK. [PII], if I could get a callback number for you for my records.
[CUSTOMER][NEUTRAL] Sure, yeah, absolutely, area code [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And the policy number for the member.
[CUSTOMER][NEUTRAL] Uh, the policy number is showing as 1,566,010.
[CUSTOMER][NEUTRAL] His first name is [PII], last name is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I do have the claim numbers that are showing online here.
[AGENT][NEUTRAL] OK, so let's see, and this is for a few days of service, um.
[CUSTOMER][NEUTRAL] Yeah, it was actually.
[AGENT][NEUTRAL] Ranging from [PII].
[CUSTOMER][NEUTRAL] [PII], yeah, exactly, for one day being hospitalized.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK, so it looks like for the day of service [PII] we did request um the ICD 10 code um.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, and you're saying with the resubmit, that information was provided?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, let me go pull the, the uh most recent image.
[CUSTOMER][NEUTRAL] And then it looks like then they yeah and then they received the EOB stating that uh there that nothing was paid yeah as a duplicate so that's why I wasn't sure because online it shows that they both have processed.
[AGENT][NEUTRAL] It was a depot, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me
[CUSTOMER][NEUTRAL] I was thinking maybe one canceled out the other.
[AGENT][NEUTRAL] No, so it looks, what happened is when it was reviewed, it appeared to um still need that same information and so um it's gonna deny as a duplicate.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEGATIVE] Hold one moment sorry it's not a good time.
[AGENT][NEUTRAL] Sorry my systems.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Sorry, it looks like.
[AGENT][NEGATIVE] My system is giving me an error. Hold one moment for me please.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding, [PII]. I apologize for the wait. So, I did, uh, take a look at what we received. It is the itemized statement, however, we still do not have the ICD pin code, which is the diagnosis code.
[CUSTOMER][POSITIVE] Yeah, no, no, no problem.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK, and then how would he go about getting the diagnosis code from?
[AGENT][NEUTRAL] Oh, OK. So this was an inpatient stay?
[CUSTOMER][NEUTRAL] Is that
[CUSTOMER][NEUTRAL] Yeah well it was in an ER service.
[AGENT][NEUTRAL] ER, OK. So normally when you, the easiest way, um, he can, he can request it documentation from the hospital, uh, but he should have received a uh discharge summary when he was let out of the hospital. Uh, that summary of information is going to tell us why he was being treated.
[CUSTOMER][NEUTRAL] Yeah, it was in
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so on the, OK, so in other words, uh, the itemized bill does not, uh, show.
[CUSTOMER][NEUTRAL] There, OK, yeah, it shows what happened, but now you need to know the diagnosis code.
[AGENT][NEUTRAL] Right, so the ICD 10 code tells us what the treatment was for. The itemized statement tells us what they did.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah,
[AGENT][NEUTRAL] Uh, but the ICD 10 code tells us why, like what was the sickness or the injury that brought him into the emergency room.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, yeah.
[CUSTOMER][NEUTRAL] Yeah, apparently it was a it was a heart attack so I can have, yeah, so I can have the.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so would they just contact the, what the hospital to to request diagnosis code? Is that the best way to do it?
[AGENT][NEUTRAL] Yes, yes. So, um, what they can request from the hospital if he does not still have it, but he would have received an admit and discharge summary when he was let go of the, uh, let go out of the emergency room. If he does not have that, that is what he wants to request from the hospital, his admin and discharge summary.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and with the, uh, just so if they provide, do we need that form or is it with the diagnosis code would be sufficient so if he call, you know, gets it verbally sends it to me via email.
[AGENT][NEUTRAL] As long as it's documented, right, we cannot accept it verbally. It does have to come from something from the, you know, a letterhead from the hospital or the admin and discharge summary that he received from the hospital.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, perfect then I will go ahead and, you know, request the information. It's just it's kind of a touchy subject unfortunately Mr. [PII] passed away at the hospital, so right now, yeah, so right now we're dealing with the spouse, um, you know, obviously she's grieving with the.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I'm just trying to get the claim processed so that's why I'm asking uh I've got a contact uh with the hospital facility where this occurred and I could probably reach out to her directly asking her for a copy of the diagnosis code which would be.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Given by the entry and discharge forms.
[AGENT][NEUTRAL] The admin, admin and discharge summary or if she has the code. As long as it comes on like the letterhead of the hospital, she maybe can send you an email, um, you know, Mr. uh, [PII] was admitted due to this diagnosis code and, you know, she can email that to you and that would be sufficient also.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, I'll go ahead and do this then. OK, I'll request it and I'll get it. I'll go ahead and upload it again and then we'll go ahead and hopefully it'll get processed at that point, OK.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] Yes, that is all we need at this point. You are welcome. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Thank you so much. OK, perfect. OK.
[CUSTOMER][POSITIVE] No, no, no, that should be it for right now thank you.
[AGENT][POSITIVE] OK. You're welcome. You have a wonderful day and thank you for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Alrighty you too.
[CUSTOMER][POSITIVE] Absolutely thank you bye bye.