AccountId: 011433970860
ContactId: 0f33e0fd-478f-465b-b395-a7f51f8c068d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 588119 ms
Total Talk Time (AGENT): 251996 ms
Total Talk Time (CUSTOMER): 276872 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/0f33e0fd-478f-465b-b395-a7f51f8c068d_20250421T18:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Um, I'm calling today because I submitted some documents for, um, I have hospital indemnity insurance, and I see here that it didn't get accepted. So I was wondering the reason behind that and if you guys need any supporting documents.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah, let's.
[CUSTOMER][NEUTRAL] So that it does get accepted.
[AGENT][NEUTRAL] Yeah, let's take a look. Do you have the claim number or policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number is 02581222.
[AGENT][NEUTRAL] OK, let me take a look here.
[AGENT][NEUTRAL] And then I need to verify please your first and last name and date of birth.
[CUSTOMER][NEUTRAL] Yeah, so mine is [PII], and I was born [PII]. It is under my husband's, uh, insurance though, so if you need me to give you his birthday, I can do that as well.
[AGENT][NEUTRAL] No totally fine and then let me just verify lastly please the physical address and email address on file.
[CUSTOMER][NEUTRAL] Yeah, [PII] and then um the, I would assume the email is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you. Alright, let's.
[AGENT][NEGATIVE] What's the denial.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it looks like the receipt of the claim is acknowledged. It says, however, in order to provide further consideration, uh, we need supporting documentation for evidence of accident or sickness. Documentation may include an itemized bill with diagnosis codes.
[AGENT][NEUTRAL] Or you could um give us like a hospital admission or discharge summary with the diagnostic results on it if you were admitted to a hospital.
[CUSTOMER][NEUTRAL] The hospital admission summary.
[CUSTOMER][NEUTRAL] With diagnostic codes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, what, um, and I apologize because this was a week ago and I probably should have checked, but what, because I know I uploaded some documents.
[AGENT][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] Um, when I did this.
[CUSTOMER][NEUTRAL] I uploaded an itemized bill.
[AGENT][NEUTRAL] Let me see what.
[CUSTOMER][NEUTRAL] Um, yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I do remember, uh, and I'm waiting to get back, I think.
[CUSTOMER][NEUTRAL] Because I, I spoke with one of your customer representatives about 2 weeks ago, 1 week ago, and she was mentioning something about a specific form that shows like the hospital charges, uh, or the, um, I'm sorry, the room charges, so like for room and board getting that specific bill. So I'm waiting on that. Would that help to cover me for this indemnity insurance once I get that?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, so, yeah, you definitely would, um,
[AGENT][NEUTRAL] You want to submit that, but as far as diagnosis codes, so I see the itemized receipt that you um submitted to us and it has all these codes on it.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So, what those are, are procedure codes. That's what the code is for what they actually gave you or did in the, in the facility.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, if you contact the hospital and let them know that you need an itemized receipt with a diagnosis code, that's basically what you were being treated for. Um, it's confusing, all these codes and stuff like that, but they should know exactly what you're talking about.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so itemized seat with diagnosis codes versus what did you say these codes were that I have on here.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You have procedure procedure codes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So she asking for ID code.
[CUSTOMER][NEUTRAL] Uh yeah, it would that be like an ICD code that I would want for the diagnosis code?
[AGENT][POSITIVE] Exactly, exactly, yes, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, so get an itemized receipt with that code and then I'm waiting for freighter to send me the codes with the room and board and everything, but so you think this might have just been because I, I didn't have the ICD code hopefully but.
[AGENT][NEUTRAL] Right. And some of them will give you like an ICD 10 form with the diagnosis on it. Um, that's a common form that they will give to you, uh, with the diagnosis on it. So, yeah, that was the only thing that was, was needed. And honestly, it's, like I said, if you don't do this on a regular basis, it's really confusing. Most of us don't know the difference, you know, between the codes.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The admin because I I remember something on my policy about like you can have up to $1200 for your admin date. So yeah, so I guess the question is, is, is it being rejected just because we don't have all the components of this ICD code um my husband was just
[CUSTOMER][NEUTRAL] Speaking about how with his policy there's something for like the admission date and that we get up to $1200 I believe on admission date. So is there anything else I would need to submit for that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Um, I don't believe so. Yeah, I mean, the only denial that I'm seeing, um, is just as far as like needing more documentation, and they'll, and it, the, so like the no diagnosis code is multiple lines on your claim. So yeah, that would probably lend to the admission also. They're not gonna approve any of it without that, unfortunately.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. All right. But they don't explicitly deny permission so I, I would wanna see, you know, the fact they just haven't. Sorry, it's [PII]'s husband, um, I'm the policy owner, so I guess my question then is it looks like the denial reason was because of the diagnostic codes but does it say anything specifically about the admin date because I like I see what you're saying, but.
[AGENT][NEUTRAL] And, and
[CUSTOMER][NEUTRAL] If this isn't being grouped together and nothing about the admission is being addressed and that seems to me like either it's gonna have to be something separate that's being reviewed or it's just something that APL is not really disclosing, uh, that's something that's available to us for reimbursement so um I'm just, I'm trying to understand, you know, and making, making the most of the coverage that I paid for.
[AGENT][NEUTRAL] Um, so, surgical, surgical, surgical. Let's see, what was this?
[CUSTOMER][NEUTRAL] And honestly, if you have a PDF of the policy that you could send to me um just so I have plans.
[AGENT][NEUTRAL] How
[AGENT][POSITIVE] Yeah, absolutely.
[AGENT][NEUTRAL] So it says right here.
[CUSTOMER][NEUTRAL] Yeah, and not a, not as a full version.
[AGENT][NEUTRAL] It says right here hospital admission benefit, and then it has the denial code next to it, and the denial code is reading for diagnostic.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, so it is being addressed. OK, so I just missed that.
[AGENT][NEUTRAL] Yeah, so, but if you would like me to, yeah, if you want me to.
[CUSTOMER][NEUTRAL] Mhm. OK, I just wanted to make sure that they had to bring it up this be covered.
[AGENT][NEUTRAL] Yeah, so it looks like the hospital admission benefits on there, uh, surgical facility, surgical facility, and all of the action codes like denial reasons next to it or for the diagnostic code. Um, is the Gmail a good email to send the policy certificate to?
[CUSTOMER][POSITIVE] Yeah, that'd be great and again this is a a full policy not a reduced version correct?
[AGENT][NEUTRAL] Yeah, mhm, yeah, it's gonna be all 37 pages.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Lovely thank you.
[AGENT][POSITIVE] Yeah, no problem.
[AGENT][POSITIVE] Alright, that's on its way to you guys. Is there anything else I can help with or check on today?
[CUSTOMER][POSITIVE] I think I'm good. Yeah, no, I'm great thank you so much for your help and explaining everything. I, I appreciate it.
[AGENT][POSITIVE] Yeah, no worries, we're here to help, so if you guys have any other questions or concerns please feel free to reach out, OK?
[CUSTOMER][POSITIVE] Awesome thank you have a great day.
[AGENT][POSITIVE] You too. Take care.
[CUSTOMER][NEUTRAL] Bye.