AccountId: 011433970860
ContactId: 243aa336-c906-4aba-b27b-416828dadb98
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 401459 ms
Total Talk Time (AGENT): 176935 ms
Total Talk Time (CUSTOMER): 90320 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/243aa336-c906-4aba-b27b-416828dadb98_20250609T20:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh yes ma'am, Miss [PII], I received the.
[CUSTOMER][NEUTRAL] A letter about I mean um an email about my claim. I was just trying to see if maybe you could help me out. I don't really.
[AGENT][NEUTRAL] OK. Do you have your
[CUSTOMER][NEUTRAL] I guess I understand what I have to do.
[AGENT][NEUTRAL] Sure. Do you have your policy number?
[CUSTOMER][NEUTRAL] Uh, yes, 02.
[CUSTOMER][NEUTRAL] 317
[CUSTOMER][NEUTRAL] 886
[AGENT][NEUTRAL] OK. And could I get your first and last name and your date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And then do you have a good callback number, Mr. [PII], just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, just need 2 more pieces of information, your address and your email address.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] And my email address is [PII].
[AGENT][NEUTRAL] OK, thank you so much and then you said you were checking on a claim was it for yourself?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Mm, let's see.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] OK, it looks like we received a claim. Looks like we had denied it as inpatient surgery be um.
[AGENT][NEUTRAL] The benefit is payable for each day under the inpatient surgery benefit and um for which there's an inpatient surgery. The information we received didn't indicate that you had inpatient surgery.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Uh, I, I thought I, I emailed you guys. I can I find what I emailed you guys.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I emailed you guys all of the diagnos diagnostic codes uh.
[AGENT][NEGATIVE] Um, let me see what we received. Looks like we're missing.
[AGENT][NEUTRAL] Some of the documents are missing, diagnosis codes and um let me pull up what we got though, OK?
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, looks like, let's see.
[AGENT][NEUTRAL] Um, so we, we received a document from Oceanner Health.
[AGENT][NEUTRAL] Um, it looks like, yeah, uh, for itemized services.
[CUSTOMER][POSITIVE] Yes, from O help
[AGENT][NEUTRAL] It gave a description of the services rendered. It doesn't have, let me see.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And it says surgery to Jefferson Highway GI Center Atrium 44.
[AGENT][NEUTRAL] Yeah, we need to see the diagnosis code and then um was this due to an accident?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] No, illness.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, because it looks like, let me see.
[CUSTOMER][NEUTRAL] Oh I have the diagnosis because I was able to look it up. Oh look, the code, it has the code 46,020 and 46,050.
[AGENT][NEUTRAL] Right, we have the
[CUSTOMER][NEUTRAL] If you look on the 2nd.
[AGENT][NEUTRAL] Yeah, we have the procedure codes, but the policy that you're filing this under is an accident policy.
[AGENT][NEUTRAL] So, for services to be reimbursable, it has to be due to an accident.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, OK, I didn't really, I just, I didn't know which one covered it so I filed it under all of my policies.
[AGENT][NEUTRAL] Oh, OK. Um, let me see.
[AGENT][NEUTRAL] Yeah, we, we sent a form if it was due to an accident to complete that. Let me see if we got it filed under your other policies though. Let's see.
[AGENT][NEUTRAL] Um, you have, you have group term life, which that wouldn't apply. You have a short term disability policy that wouldn't apply. Let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, you had a group cancer that wouldn't apply.
[AGENT][NEUTRAL] And then there is a hospital indemnity. Let me see if that's.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Eligible, let's see 792.
[AGENT][NEUTRAL] I know what we received though, I don't see the diagnosis listed. So there's, there's two different codes. There's a code for what you had done, like the surgery itself, and then there's a code that tells us what was your diagnosis. And I don't see the diagnosis that we received that.
[CUSTOMER][NEUTRAL] OK, so I would need to get in touch with the hospital I guess to get the diagnosis codes.
[AGENT][NEUTRAL] Yes, that's correct. So we need to see what was the diagnosis on the claim, and then we could further look to see if we can process it under one of these policies.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And how would I
[CUSTOMER][NEUTRAL] I would I uploaded back to the same.
[AGENT][NEUTRAL] Um, so it looks like, let me see.
[AGENT][NEUTRAL] Let me give you a
[AGENT][NEUTRAL] Let me give you the policy number that it would potentially go under, um, and you can just, you can upload the document and then put that policy number on there.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That policy number is 231.
[AGENT][NEUTRAL] 7920.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] 231-792-0
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Alright thank you ma'am.
[AGENT][NEUTRAL] OK. Is there anything else I can help with today, Mr. [PII]?
[CUSTOMER][NEUTRAL] No ma'am.
[AGENT][POSITIVE] OK, well, thank you for calling APL. I hope you have a good rest of the day.
[CUSTOMER][POSITIVE] Hey, thank you.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah