AccountId: 011433970860
ContactId: 38c2642d-f5ba-4c3d-9148-74f00625ceb1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 323920 ms
Total Talk Time (AGENT): 121784 ms
Total Talk Time (CUSTOMER): 103010 ms
Interruptions: 2
Overall Sentiment: AGENT=0, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/38c2642d-f5ba-4c3d-9148-74f00625ceb1_20250328T17:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, um, I just got a bill from, um, I had gone to the emergency room in November, um, and I, could you tell me if, um, APL, um, it was submitted to APL if I gave you the info?
[AGENT][NEUTRAL] Um, yes, ma'am. I could assist you with claim status. Um, first, could I get your name and a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure [PII] [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. Now, could I get your policy number, please?
[CUSTOMER][NEUTRAL] Sure, so I don't know if it would go under the group hospital indemnity or the Medin.
[CUSTOMER][POSITIVE] So, I'll give you both.
[AGENT][NEUTRAL] Um, what's the
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so the policy number.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's 02281581.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK, thank you. I found you in our system. Um, could you please verify your date of birth and your mailing address?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. And what's the date of service on the um hospital visit?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Let's see, it says.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let's see if there's some.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thanks for your patience. Um, I'm not showing a claim on file that they submitted. Um, I am showing claims on file where it looks like you submitted claims.
[CUSTOMER][NEUTRAL] OK, um, we just, my husband just did it over the weekend. Is that, um, would that cover?
[CUSTOMER][NEUTRAL] The the hospital or did we have to go through the other, the, the group hospital indemnity?
[AGENT][NEUTRAL] Well, um, who's
[CUSTOMER][NEUTRAL] Or is it the same?
[AGENT][NEUTRAL] Who's your primary insurance company?
[CUSTOMER][NEUTRAL] Uh, United Healthcare.
[AGENT][NEUTRAL] OK. Yes, ma'am. It'll go to United Healthcare first and then it looks like um your husband submitted the EOB and we covered, we covered the portion that goes towards the copay, the co-insurance, or the deductible. And the claim is denying because we need your diagnosis code.
[CUSTOMER][NEUTRAL] Right, yeah.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Uh, and where do I get the diagnosis code?
[AGENT][NEUTRAL] Um, you can get that from the hospital.
[AGENT][NEUTRAL] We needed um document. Mhm.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] So, uh, the, the claim that he sent in that, uh, [PII], do you see that?
[AGENT][NEUTRAL] Yes, ma'am, and I'm showing that it's denying again because we need that diagnosis code.
[CUSTOMER][NEUTRAL] OK, and where do I get that from?
[AGENT][NEUTRAL] Um, you'll get that from the hospital. Just let them know that um you need documentation showing what your diagnosis code is for the visit. The diagnosis code is um the code for the illness, and we need that because under your policy, we only cover charges that are related to an illness or an injury.
[AGENT][NEUTRAL] And once you get that information, um, you can submit that and we'll um add that to the additional information that we already have on file and we can get the claim processed and paid for you.
[CUSTOMER][POSITIVE] OK, very good so can um can I call you right back? I'm gonna call them right now.
[AGENT][NEUTRAL] Um, yeah, well, anyone in the claims department can assist you.
[CUSTOMER][NEUTRAL] Would you be able
[CUSTOMER][NEUTRAL] OK. All right, will do. And I called the, the number, right?
[AGENT][NEUTRAL] Yeah, but, but
[AGENT][NEUTRAL] Right, but we need documentation. If they, if they give, if they give you the diagnosis code by you calling and giving us that information over the phone because of HIPAA, we can't take it over the phone, we would need
[CUSTOMER][NEUTRAL] So what's the difference between uh
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, alright, I will call them and find out how to get that.
[AGENT][NEUTRAL] Documentation that you would have to submit from the hospital, the doctor.
[CUSTOMER][POSITIVE] All right, thank you so much.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Mm