AccountId: 011433970860
ContactId: 04a2dd37-9615-49fa-a3f5-b38951280aa1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 465450 ms
Total Talk Time (AGENT): 251280 ms
Total Talk Time (CUSTOMER): 127989 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/04a2dd37-9615-49fa-a3f5-b38951280aa1_20250310T12:57_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. Um, my name is [PII]. My policy number is 00971288.
[AGENT][NEUTRAL] OK, Mr. [PII] and how can I help you today?
[CUSTOMER][NEUTRAL] I'm calling regarding um a claim that I made, but um.
[CUSTOMER][NEUTRAL] It, I wasn't paid out. Um, would you like the claim number or?
[AGENT][NEUTRAL] Uh, no, sir, not yet. What, first off, what is a good callback number for you, please, Mr. [PII]?
[CUSTOMER][NEUTRAL] Um, phone number would be [PII].
[AGENT][NEUTRAL] OK, thank you. So give me a moment to get your policy information up and then I will have to verify several things first for security purposes, Mr. [PII], and also any information that I do provide would be a verification of benefits and not a guarantee of payment. So just one moment, please.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so first off, Mr. [PII], again, as I stated before, any information that I provide would be a verification of benefits and not a guarantee of payment. So if you could first please verify your date of birth.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you. Also your home mailing address, please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that is on file for you is the same as the one you gave me, so that is your best contact number. Is that correct?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][POSITIVE] Thank you. And lastly your email address, please?
[CUSTOMER][NEUTRAL] Email is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you very much.
[AGENT][NEUTRAL] And you said that you do have the claim number is that correct that you're calling in regards to?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, you can give me that now.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] The claim number is 356-5195.
[AGENT][NEUTRAL] OK, thank you. So yes, sir, I can see that that claim was just processed on [PII].
[AGENT][NEUTRAL] OK. And this is for outpatient, this was for the two dates of service, [PII] and [PII]. Is that correct?
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] And yes, sir, I
[CUSTOMER][NEUTRAL] Well, it's actually the same, it, it was the same day, but I don't know why it's just two different dates.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] OK, so I can say that it was denied because in order to provide further consideration of the claim, please submit the following items. Your explanation of benefits from the primary insurance carrier.
[AGENT][NEUTRAL] And also the diagnosis for which treatment was provided on this state of service. Once we have received this information, we will resume processing your claim.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, I sent the, I sent the bills, um.
[CUSTOMER][NEGATIVE] I guess from the hospital. That's not good enough. I need actual.
[AGENT][NEUTRAL] Yes, sir. We're gonna, uh, yes, sir, we have to, because of this being a supplemental policy to your primary insurance, we will always have to have a copy of your explanation of benefits from your primary insurance carrier so that we can see the amounts, any amounts applied to your deductible, co-pay or co-insurance. And then on the bills, they don't usually.
[CUSTOMER][NEUTRAL] Explanation
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Have the diagnosis code, they'll have treatment codes but not the diagnosis. So we, you would just need to contact the facility for an itemized bill including diagnosis code.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So let me see the um
[CUSTOMER][NEUTRAL] Let's see the bills I sent, uh.
[CUSTOMER][NEUTRAL] I guess it doesn't have a diagnosis code or it's not itemized.
[AGENT][NEUTRAL] I can look at the documents you sent.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But it
[AGENT][NEUTRAL] It's your hospital bill that they sent to you, and it would not have that information on there.
[CUSTOMER][NEUTRAL] I see.
[AGENT][NEUTRAL] Let me, it's, it's still, it's still loading, Mr. [PII]. Give me just a moment.
[CUSTOMER][NEUTRAL] So, how would I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, so this is just a, this is just their billing statement. So we need an, an itemized bill including diagnosis code. Yes, sir, this doesn't have on there, this just tells how much you owe.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I would, I would get that from the hospital, I believe, I guess.
[AGENT][NEUTRAL] Yes, sir that is correct. Uh-huh. You would contact uh their billing and it may be depend different facilities, different departments handle different things, but you would just explain it for your insurance company, you're needing an itemized bill that includes your diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I would ask the hospital that question, right?
[AGENT][NEUTRAL] Yes, sir. Uh-huh.
[CUSTOMER][NEUTRAL] Or, or would my, or would my insurance, no, my, my primary insurance, would they know?
[AGENT][NEUTRAL] That would not be on, no, sir, that's going to need to come from, it's not going to be on your explanation of benefits.
[CUSTOMER][NEUTRAL] I see. OK.
[AGENT][NEUTRAL] Yes, sir. That's not a piece of information that's included on a, it'll give you the, what they did, the procedure codes, but it's not gonna give you the diagnosis code, the why you were there.
[CUSTOMER][NEUTRAL] I see. OK.
[CUSTOMER][POSITIVE] Alright, thank you for your help, [PII].
[AGENT][NEUTRAL] Well, you are certainly very welcome and then once you do have that information you are set up on the online service center portal with APO correct?
[CUSTOMER][NEUTRAL] Correct. Do I submit a new claim?
[AGENT][NEUTRAL] No, sir, you don't actually have to submit the claim, you would just upload that information once you get it, and then our system will know that that was the information we were missing to review this.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] All right, thank you for your help, [PII]. Have a nice day.
[AGENT][POSITIVE] Well, you are so, oh, I hope you have a nice day too, Mr. [PII]. And so if that is all I can help you with this morning, then thank you again for calling APL.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, thank you very much, [PII].
[AGENT][POSITIVE] You're welcome. Absolutely. My pleasure. You too.
[CUSTOMER][POSITIVE] Take care. OK, thank you. Bye bye.
[AGENT][NEUTRAL] Bye bye.