AccountId: 011433970860
ContactId: 3a0053c9-788d-4e90-871f-ea0f7d2a801a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 486660 ms
Total Talk Time (AGENT): 191560 ms
Total Talk Time (CUSTOMER): 244544 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/3a0053c9-788d-4e90-871f-ea0f7d2a801a_20250224T14:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I have a question about a claim that was apparently denied and I'm not sure what maybe I need to do differently to file that.
[AGENT][NEUTRAL] OK, who am I speaking with?
[CUSTOMER][NEUTRAL] This is [PII].
[AGENT][NEUTRAL] And [PII], do you have your policy number?
[CUSTOMER][NEUTRAL] I do. It is 247.
[CUSTOMER][NEUTRAL] 921 7
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is your date of birth and mailing address?
[CUSTOMER][NEUTRAL] My, I'm sorry, say that again? [PII].
[AGENT][NEUTRAL] Date of birth. Date of birth and your
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what's your email address?
[CUSTOMER][NEUTRAL] Oh sorry, um, [PII].
[AGENT][NEUTRAL] I have a Gmail account for you.
[CUSTOMER][NEUTRAL] OK, yeah, [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that information. OK, so have you received notification of a claim being processed and you have a question about it?
[CUSTOMER][NEUTRAL] Yeah, I'm, I'm not understanding that it's, um, I submitted it for my son, which my understanding should be covered, but, um, and I got an, I just got a notice about what needs to be done differently but I'm not understanding it and I wonder if I could get this quick.
[AGENT][NEUTRAL] OK. What's your son's
[AGENT][NEUTRAL] OK, what's your son's name?
[CUSTOMER][NEUTRAL] His name is [PII].
[AGENT][NEUTRAL] And [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have a claim number?
[CUSTOMER][NEUTRAL] Yes, the claim number is 356-683-1.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And did you go online to verify that claim status or do you have the explanation of benefits in your hand?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Well, I, I went online and submitted everything and now it's come back and it has given me a um.
[CUSTOMER][NEUTRAL] And yeah an explanation of benefits as to what what I need to submit to get it fixed.
[AGENT][NEUTRAL] OK, so receipt of your claim is acknowledged. However, in order to provide further consideration of this loss under this policy, we will need supporting documentation to evidence the accident or sickness. Supporting documentation may include but not limited to, um, an itemized bill with, with the diagnosis codes.
[AGENT][NEUTRAL] Um, a Supervi, and office notes, hospital admission and discharge summaries and or diagnostic testing. Did you send us like a re, uh, what did you send in?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I, I sent all of that. So my son has like a, I mean he's been getting treatment for this condition for um months now, so it's um.
[CUSTOMER][NEUTRAL] Trying to think here, let me pull it up, uh, files, sorry, one second, the files. OK, so I submitted the Blue Cross explanation of benefits, an itemized bill from the hospital, and then I filled out the claim form.
[AGENT][NEUTRAL] OK, the itemized bill, does it include the diagnosis code?
[CUSTOMER][NEUTRAL] Let me see, I'm trying to open that up.
[AGENT][NEUTRAL] I think that may be what, that may be what's missing. Let me take a peek.
[CUSTOMER][NEUTRAL] OK, so diagnosis code, no, I don't see the codes on there.
[AGENT][NEUTRAL] So I see the claim form that you completed.
[CUSTOMER][NEUTRAL] OK, so the
[AGENT][NEUTRAL] I see the.
[CUSTOMER][NEUTRAL] Uh, it says code, yeah, I have some codes on there.
[AGENT][NEUTRAL] It's probably the procedure codes.
[CUSTOMER][NEUTRAL] It says service date and then code for each one of the charges.
[CUSTOMER][NEUTRAL] Is there a different type of code they need?
[AGENT][NEUTRAL] Yeah, so what you may see is the, what page are you on that shows the codes?
[AGENT][NEUTRAL] Oh, those are procedure codes like comprehensive metabolic panel.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, that's what I'm looking at, yeah.
[AGENT][NEUTRAL] OK, those are, yeah, those are procedure codes, not diagnosis codes. We need those as well. So I'm gonna give you the I'm gonna give you a form name to request.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So this is a hospital bill.
[AGENT][NEUTRAL] Um, it's an acronym. Let me know when you're ready.
[CUSTOMER][NEUTRAL] Um, sorry, one second here.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] Um, it's U as in university, B as in boy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Number 04.
[AGENT][NEUTRAL] That's an itemized bill for hospital charges, so when you contact the billing team, let them know that you need the UB 04.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that should include the diagnosis codes on there as well with the other information.
[CUSTOMER][POSITIVE] OK, great, that makes sense. Yeah, typically I, I have, we just didn't give them the APL card and they, so I've never done this on my own. So, OK, so that's great. So once I get that, um, then I just resubmit everything correct?
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Yeah, it looks like you uploaded it. You can go online and upload the itemized bill.
[CUSTOMER][NEUTRAL] Or you can add to it.
[AGENT][NEUTRAL] Yeah, so it'll be a new entry so you can't add it to an existing.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Upload, so treat it as a new entry.
[AGENT][NEUTRAL] And then when
[CUSTOMER][NEUTRAL] Yeah, so just upload, sorry I missed you, you cut out there.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, so just upload as if it's a new entry.
[CUSTOMER][NEUTRAL] OK, OK, great, and then um I've already set up my automatic deposit so that would just go right to my account then?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Once it's approved? OK, excellent. Right, OK, um, well, I, since you have those forms up, can I ask you another question?
[AGENT][NEUTRAL] And even if it's payable would, yes.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, on those, uh, forms there, um, I noticed that what Blue Cross, um.
[CUSTOMER][NEUTRAL] Said, uh, I would probably owe versus what the hospital said I owe is slightly different like off by $100. That's not gonna be an issue, right? You guys would just pay the correct amount of the bill.
[AGENT][NEUTRAL] Yeah, so we're looking at the deductible column, the copay amount column, and then the co-insurance columns.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and that would be the amount.
[AGENT][NEUTRAL] That we would reimburse uh for this service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So there's not gonna be a discrepancy there between the two numbers being different, you guys will just pay out the correct amount.
[AGENT][NEUTRAL] Right, so are you, what figures are you looking at under the deductible column?
[CUSTOMER][NEUTRAL] Um, so on the, um.
[CUSTOMER][NEUTRAL] On the the EOB it says 1372 and then um on the itemized bill it says 1494.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, so
[CUSTOMER][NEGATIVE] So the the hospital is charging me more than what Blue Cross said I would owe.
[AGENT][NEUTRAL] Yeah, so any dollar amounts that that's reflected in the three categories that I just named is what we will reimburse.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, great. I just wanna make sure that wasn't gonna hold it up like because there were two different numbers there. OK, great. OK, well thank you so much for your help.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Oh, you're welcome. Any other questions I could help out with today, [PII]?
[CUSTOMER][POSITIVE] Uh, no, I'll go ahead and get that bill and get it up there as soon as I can. Thank you.
[AGENT][POSITIVE] OK, uh, you're welcome, [PII]. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Alright you too bye bye.