AccountId: 011433970860
ContactId: 11ca9e81-c413-41d6-ba13-eb9353d46339
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 846840 ms
Total Talk Time (AGENT): 206993 ms
Total Talk Time (CUSTOMER): 154943 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=-1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/11ca9e81-c413-41d6-ba13-eb9353d46339_20250219T16:09_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, yes, good morning. My name is [PII] and I'm calling in regards to a claim that I filed. The policy is under my husband's name, but the claim is under me.
[AGENT][NEUTRAL] OK, um, may I have a callback number just in case we get disconnected, Ms. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, it's 211-0350.
[AGENT][NEUTRAL] And may I have your date of birth for security and the mailing address?
[CUSTOMER][NEUTRAL] Mine is [PII] and the mailing address is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. All right, let me check on that um.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Let me check on that claim. One moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull the documents and see what's going on. Um, do you mind holding for me while I read you?
[CUSTOMER][POSITIVE] No, no problem, thank you.
[AGENT][POSITIVE] Thank you. You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding and being patient for Ms. [PII]. OK, um, yeah, you have several claims I have to go through all of them. I'm sorry. Um, so the most recent one was denied because there is not a surgical benefit on the policy, but it looks like the, um, you have two more that you submitted and it has um.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] No, and actually there should only be one from February of last year, and that one, it's the same thing that was done now in December.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] What is the date of service? Is it for [PII] or
[CUSTOMER][NEUTRAL] [PII] and [PII].
[CUSTOMER][NEUTRAL] I was in the hospital on [PII] and [PII]. I did have surgery, but I was in the hospital overnight.
[AGENT][NEUTRAL] And so you're trying to get the admission and the confinement benefit, correct? Um, let me see exactly what they're needing.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And it's the exact same surgery I had back that was reported in August, but I had my other knee done.
[AGENT][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] Mm, got you.
[CUSTOMER][NEUTRAL] But it's just the hospital doesn't always know what to.
[CUSTOMER][NEUTRAL] What you give me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, it looks like we need the itemized bill with the diagnosis code. It looks like the diagnosis codes are not on this paperwork and that's what we're needing for that payment.
[CUSTOMER][NEGATIVE] Not even on the 2nd 1 that I sent on uh.
[CUSTOMER][NEUTRAL] Let me see when I sent that one.
[CUSTOMER][NEUTRAL] Because I sent one on [PII] when I filed it.
[CUSTOMER][NEGATIVE] And they said that wasn't the right one and on [PII] I sent another one.
[CUSTOMER][NEUTRAL] Which they sent to me and.
[CUSTOMER][NEUTRAL] And I told him I need to diagnose diagnostic codes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So this is an.
[CUSTOMER][NEUTRAL] The first one I said had the AR date service date type transaction code.
[CUSTOMER][NEUTRAL] Change record number, quantity description, the charge.
[CUSTOMER][NEUTRAL] And it showed the.
[CUSTOMER][NEUTRAL] The admission date, the discharge date.
[CUSTOMER][NEUTRAL] That one is with 9 pages because it included the claim form.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, that one didn't have the diagnosis code and then uh I'm looking at the second one. It looks like you send in um some explanation of benefits from Blue Cross, but that one doesn't have um let me see. It looks like you haven't.
[CUSTOMER][NEUTRAL] Yeah, so the one for Blue Cross Blue Shield, I mean that's it.
[AGENT][NEUTRAL] OK, and this one is um the.
[CUSTOMER][NEUTRAL] But the one I sent on the [PII] is.
[AGENT][NEUTRAL] And that's the one I'm looking at, um, and there's a page that says, um, like diagnosis cost and stuff, but it doesn't have anything. It's just have your, your information like a record of admission.
[AGENT][NEUTRAL] Um, like in the middle of it, it says a diagnosis code, but it doesn't have the code. It just has uh and the directive and the code and there's nothing there and there's no, there's nothing under the coding.
[CUSTOMER][NEUTRAL] I don't know. I mean, I've called the hospital so many times and.
[CUSTOMER][NEUTRAL] They're like, well, what is it that they're needing? I said, something with a diagnostic code.
[AGENT][NEUTRAL] Yes, and I say fully itemized bill with the diagnosis code. If they can send you a copy of the UBO4 form that will have everything we need um.
[CUSTOMER][NEUTRAL] What is that? UV?
[AGENT][NEUTRAL] UVO4.
[CUSTOMER][NEUTRAL] UVO4 form, like umbrella Victor 04.
[AGENT][NEUTRAL] Yes. Mhm. Mhm.
[AGENT][NEUTRAL] Umbrella Ball 04.
[CUSTOMER][NEUTRAL] OK, let me see if they will send that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, because yeah, the, the only patient.
[CUSTOMER][NEGATIVE] Cause even for the one I submitted in August, it took forever to get.
[AGENT][NEUTRAL] Yeah, and it does have a very same diagnosis, but there's nothing on the diagnosis code, so yeah, it's just missing that little part. OK.
[CUSTOMER][POSITIVE] OK, alrighty.
[AGENT][NEUTRAL] OK, is there anything else I may help you with today, Ms. [PII]?
[CUSTOMER][NEGATIVE] No, I just wish they would make it simpler for us to be able to collect on our insurance claims.
[AGENT][NEUTRAL] Mm, yeah, and I, I do apologize. Yeah, usually if they send in the claim directly from the provider's office or the facility, um, they do send in the uh the information that we ask or that we need, um, but yeah, um whenever you send in the claim and you have to gather all the documents, sometimes it's a little bit harder to do.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Um, but yeah, if you let them know that what you're looking for is like a UVO4 or something similar to that that has all the codings in diagnosis codes, procedure codes, charge amount of the detailed itemized bill, um, that will help you with your claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Already thank you very much appreciate your help.
[AGENT][POSITIVE] You're welcome, Ms. [PII], and thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you, bye bye.
[CUSTOMER][NEUTRAL] Bye.