AccountId: 011433970860
ContactId: 2980bfce-75b0-4d87-bb65-9af323a9b04a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 371730 ms
Total Talk Time (AGENT): 127384 ms
Total Talk Time (CUSTOMER): 164901 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/2980bfce-75b0-4d87-bb65-9af323a9b04a_20250418T16:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, sorry, was it [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], hi, hi [PII], sorry, um, I'm calling, uh, I filed a claim, um, let's see, I think last week sometime or maybe it was earlier this week and I was just calling to check the status. I checked online and it doesn't say anything. I was just wondering if you could give me some information on where it's at.
[AGENT][NEUTRAL] OK, may I have your name and a callback number?
[CUSTOMER][NEUTRAL] Sure, it's [PII] and uh callback number is [PII].
[AGENT][NEUTRAL] And may I please have your policy number?
[CUSTOMER][NEUTRAL] 244.
[CUSTOMER][NEUTRAL] 351 6
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And I do need to verify your date of birth.
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[AGENT][NEUTRAL] And is this claim for you or someone else listed on the policy?
[CUSTOMER][NEUTRAL] For me.
[AGENT][NEUTRAL] OK. And could you verify the mailing address listed on file?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] And thank you so much [PII] for verifying the policy you're calling in regards to a claim. Do you have that date of service?
[CUSTOMER][NEUTRAL] Uh, I have the claim number.
[AGENT][NEUTRAL] OK, may I have the claim number?
[CUSTOMER][NEUTRAL] 359-054-7
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So it looks like for the date of service of [PII], it is requesting the diagnosis code for that date of service.
[CUSTOMER][NEUTRAL] Uh, OK. Um, so how would, how do I submit that?
[AGENT][NEUTRAL] OK. The way that you will submitted, it will have to either be an autoized statement that's showing the diagnosis code from the provider.
[AGENT][NEUTRAL] Um, you will submitted
[CUSTOMER][NEUTRAL] Well, so I, I mean I sent you the, I sent you the explanation of benefits that has all of the.
[CUSTOMER][NEGATIVE] every, every single thing claim process code provider code and not save that like everything from the uh explanation of benefits.
[AGENT][NEUTRAL] Yes, but this will come from the provider. It's either going to be a the summit, the visit summary it's gonna be an itemized bill or you can just get the provider to submit it to you via email as long as it has the letterhead and that data service attached to it.
[CUSTOMER][NEUTRAL] OK. Um, hey, I, I do have something here, uh, but I wanna make sure it.
[CUSTOMER][NEUTRAL] Works so this is um.
[CUSTOMER][NEUTRAL] This is from the hospital, um.
[CUSTOMER][NEUTRAL] What are, what are you looking for? The remit code?
[AGENT][NEUTRAL] No, it's a diagnosis code. It's the reason of the visit. So it should be listed on your um the discharge paper if it's for the facility.
[CUSTOMER][NEUTRAL] Uh, OK, um.
[CUSTOMER][NEUTRAL] And it's not on the billing statement?
[AGENT][NEUTRAL] No, normally they don't put it on the explanation of benefit, but let me pull up your billing statement that was submitted in.
[CUSTOMER][NEUTRAL] No, I, the billing statement, yeah.
[AGENT][NEUTRAL] No, it's not listed on the billing statement.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So, I have something from the hospital here that is
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] They posted electronic payer, pay payment, payment invoice, total check amount, reference number, account, comment, electronic uh remittance run, posted to bucket invoice number, ICN number, payment amount billed, allowed, not allowed, denied write-offs, patient responsibility, non-covered co-pay, co-insurance deductible, remit code, um, any, is there any of those things?
[AGENT][NEUTRAL] No. It will say reason for visit or it's gonna say diagnosis.
[CUSTOMER][NEUTRAL] OK, uh, all right, I'll try to find that and, and so once I get that, how do I, how do I, um, submit that?
[AGENT][NEUTRAL] You can submit it either via the portal, fax or mail.
[CUSTOMER][NEUTRAL] OK, I'll, I'll do it. How do I do it on the portal?
[AGENT][NEUTRAL] You will upload it just like you submit any claim like this one was submitted in, you would just submit it on the portal.
[CUSTOMER][NEUTRAL] OK, but um,
[CUSTOMER][NEUTRAL] How do I know that it's attached to the correct?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Correct claim.
[AGENT][NEUTRAL] It comes in as a new claim.
[AGENT][NEUTRAL] So we would just go from the previous claim that was received in we will review that if we need anything else off of that original claim but as long as you submit in the document needed then we can go from there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right, thank you very much. I appreciate it.
[AGENT][POSITIVE] You're welcome. Is there anything else I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] No, Twe, I think that does it. Thank you.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day.
[CUSTOMER][NEUTRAL] Bye.