AccountId: 011433970860
ContactId: 0e7d8d9e-2a4f-4a8d-8e2f-5afaf674b5ad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 578200 ms
Total Talk Time (AGENT): 339432 ms
Total Talk Time (CUSTOMER): 184085 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/0e7d8d9e-2a4f-4a8d-8e2f-5afaf674b5ad_20250303T19:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] this is over on the care team. How are you today?
[AGENT][POSITIVE] I'm doing well thank you how are you?
[CUSTOMER][NEUTRAL] Doing good thank you. I've got a member on the line calling regarding an HI claim that she made um and it's stating that we're missing some information like diagnosis codes, um, and she's pretty adamant that she sent us what she should have. She said she was with her agent when they got it all together, so she was just wanting to review uh what was submitted to us.
[AGENT][POSITIVE] Certainly I'd be happy to take a look at that. Go ahead and put the policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, that is 01768249.
[AGENT][NEUTRAL] OK, just give me one second to pull that up please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And is that her number listed there?
[CUSTOMER][NEUTRAL] Uh, let's see. Yes, so 0210, yes.
[AGENT][NEUTRAL] On the screen.
[AGENT][POSITIVE] Yeah, OK, great. OK.
[CUSTOMER][NEUTRAL] And she's just calling about the most recently submitted claim.
[AGENT][NEUTRAL] OK, just give me one second, sorry, I was stuck in a screen. I, I couldn't get out.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, you're fine.
[AGENT][NEUTRAL] For [PII]?
[CUSTOMER][NEUTRAL] Uh, [PII], yes.
[AGENT][NEUTRAL] [PII], and it's uh her under her, that 356-8497?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, I'll pull up that mail number and she's been verified.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and you can go ahead and send her over when you're ready.
[CUSTOMER][POSITIVE] Alright thanks [PII] have a great rest of your day.
[AGENT][POSITIVE] You too thank you.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Hi, good afternoon, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Did I say that correctly?
[CUSTOMER][NEUTRAL] [PII], but you're OK.
[AGENT][NEUTRAL] [PII], sorry about that. My name's [PII]. I'm in the claims department, so I'm just taking a look at the information that you sent over to us. It looks like we were asking for a diagnosis code and I'm going to go ahead and verify that that information was missing from the documents that you sent over, um, but let me just, uh, give me just one moment to take a look at that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, cause I, I had the hospital send me the whole rundown.
[CUSTOMER][NEUTRAL] You know, and I was in the hospital for 5 days. I was in the hospital for [PII].
[AGENT][POSITIVE] Oh I'm sorry to hear that.
[CUSTOMER][NEUTRAL] You know, so
[CUSTOMER][NEUTRAL] Well, you know, I had to have a new hip.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Well, are you feeling better now?
[CUSTOMER][POSITIVE] Um, yeah, I'm actually able to walk up and down stairs right now.
[CUSTOMER][NEGATIVE] But I'm not allowed to go back to work without.
[CUSTOMER][NEUTRAL] A note saying no restrictions and I'm still restricted so.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You know this $1500 is needed.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, I, I can.
[CUSTOMER][NEUTRAL] You know, plus I don't, it could be like 30 bucks a day for 5 days or something like that.
[AGENT][NEUTRAL] I can understand that, yes, yes ma'am. OK, so I am looking at the documents that were sent over. I do not see the diagnosis code so what they gave you was that itemized bill and that just kind of gives us uh uh the information that's needed for that the charges, the dates of service, the charges incurred, um, however, I don't have a diagnosis code.
[CUSTOMER][NEUTRAL] Yeah, that's a mortgage payment.
[AGENT][NEUTRAL] So, and we do see, of course, it was surgery, but we do require that diagnosis code um and it can be just a description as well. So when you were discharged from the hospital, did they give you any kind of documents, uh, like a discharge summary or aftercare summary?
[AGENT][NEUTRAL] Perhaps
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Yeah, but I was so out of it. I, I don't know because they put me on so many drugs, it's ridiculous. Um, I have to go with my husband, but I can contact the hospital.
[CUSTOMER][NEUTRAL] If you can if if I can call them and get the surgical code and call you back, would that be OK?
[AGENT][NEUTRAL] Well, it's, it's actually we're gonna have to, we have to have documentation of it, meaning that we have to have it in, in writing. So um it can, it doesn't necessarily have to be the code, it can be a description of the code, but what we're looking for is the diagnosis like the reason for it sounds like you said you had your hip.
[AGENT][NEUTRAL] Replaced, so more than likely it's gonna have some sort of uh diagnosis. And like I said, that is the procedure code is like actually what the doctor did while you were in the um surgical area. That's like your procedure code, the actual um what he did to fix and repair your hip.
[CUSTOMER][NEUTRAL] OK, yeah, I was trying I
[CUSTOMER][NEUTRAL] Yeah, I was diagnosed with osteonecrosis.
[AGENT][NEUTRAL] OK, and, and, and that um like I said that is fine if we have just a description it doesn't need to be the code if you can look through your paperwork, possibly if they gave you an aftercare summary, a lot of times it'll say it'll have your name at the top it'll either be discharged or aftercare summary, and it'll kind of have your information at the top, the facility information, that hospital information and then sometimes it'll give us those dates that you were confined from what date to what date and.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Then it'll give you like the reason why you were there and like you said it's osteonecrosis so that would be, you know, something along those lines would be on that paper and then usually it's um you your follow up like if you're following up with your PCP if you're following up with the specialist or you know if you've got outpatient physical therapy, it's got those orders on there so that's kind of what.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I've, I've already been through, I've already been through physical therapy, um.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] You know, I just, it's, hang on, let me see if I got a pen.
[AGENT][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] In my right now, do you have a fax number?
[AGENT][NEUTRAL] I do, and I was just gonna say if you can, you can even um uh fax that information over to us or if you can get the provider, you know, the facility or even the, the surgeon that did your surgery, perhaps they could just give us that diagnosis information. And like I said, what it really just needs to say is your name, the facility, the dates, and then that description or that diagnosis code.
[AGENT][NEUTRAL] And our fax number let me know when you're ready and I'll provide you that.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] It's 877.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 942-3 and do I put this in attention to you?
[AGENT][NEUTRAL] Um, you could just put attention claims and then, um, be sure to include your if you're able to include your policy number.
[CUSTOMER][NEUTRAL] And policy number.
[AGENT][NEUTRAL] And do you have your policy number?
[CUSTOMER][NEUTRAL] Uh yes, ma'am. It is 01768249.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, so once I get this done and I have them fax this to you, what is the turnaround time gonna be?
[AGENT][NEUTRAL] Um, usually, you know, we have a, uh, we have a standard 7 to 10 day, uh, processing window. However, we're processing ahead of of schedule right now. It really depends on the volume of claims. However, um, if you can get that information, you know, I'd be happy to, um, try to get it expedited as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] You're awesome. So once I get it, get it faxed, I will, your name is [PII]?
[AGENT][NEUTRAL] Yeah, [PII]. I go by [PII]
[CUSTOMER][NEUTRAL] OK, um, sorry.
[AGENT][NEUTRAL] And I'm in the claims department. Would you like me to give you my uh direct number?
[AGENT][POSITIVE] This, I can give you that and then you could just call me if you get it, you submit it and like I said, I'd be happy to take a look at it and see if I can get it expedited. You can call me directly. Um, I'll give you my direct line it's [PII].
[CUSTOMER][NEUTRAL] Uh, yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then if you did have to call that [PII] number again you just put in my extension [PII] or ask uh to be transferred over to me. Either one will be will work.
[CUSTOMER][NEUTRAL] OK, very good. Are you in [PII]?
[AGENT][NEUTRAL] I am not. I'm actually remote. I'm in I'm actually in [PII].
[CUSTOMER][NEGATIVE] Oh Lord, it's gonna be cold up there.
[AGENT][POSITIVE] It is, it's a little bit better today. We're supposed to be, we're supposed to hit 50 on Wednesday, believe it or not, that's like a record for us.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] In March
[CUSTOMER][NEUTRAL] Mm yeah our our guy today is 73.
[AGENT][POSITIVE] Oh wow, good for you.
[CUSTOMER][NEUTRAL] But [PII] and, you know what, I'm not waiting. I mean, you gotta figure we've got humidity from hell coming from the Gulf of [PII] to the Atlantic Ocean.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] And it's, it's ridiculous. I, you know, I'm a [PII] girl.
[AGENT][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] And this is where my husband's from, and I told him, I said, when you die, I'm going back to [PII] where I belong.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] A little drier, huh?
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, [PII] is my home.
[AGENT][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] All right, well, Ms. [PII], thank you so much, honey for your time and just please do not close out this claim.
[AGENT][NEUTRAL] No, and, and I was just gonna let you know it's kind of like right now it's in a pending staff so it's kind of waiting so once we get that information like I said they'll just pull that information from the claim that's it's that's essentially pending waiting for that diagnosis code and then we'll get it processed for you.
[CUSTOMER][POSITIVE] All right you're awesome, honey thank you so much I really appreciate your time.
[AGENT][POSITIVE] You're so welcome, thank you for your patience and have a great day. Thank you for calling APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, ma'am. Bye bye.
[AGENT][NEUTRAL] All right bye bye.