AccountId: 011433970860
ContactId: 4c1b417a-32b6-4d42-a318-e16856961d0b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1797739 ms
Total Talk Time (AGENT): 1187374 ms
Total Talk Time (CUSTOMER): 368807 ms
Interruptions: 4
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/4c1b417a-32b6-4d42-a318-e16856961d0b_20250116T14:14_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEGATIVE] Uh, yes, ma'am. I got a text this morning saying my claim was completed and I don't know how to read that out. It doesn't tell me any info.
[AGENT][POSITIVE] Sure, I'd be happy to take a look at that claim for you. Can I have your name please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Ms. [PII], go ahead and provide me your call back number in case we should get disconnected, and I can call you back please.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you have your policy number handy or do you need me to look it up?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I have, uh, must be my claim number. I have. I don't have my policy number.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] That's fine. I can take the claim number and look it up that way.
[CUSTOMER][NEUTRAL] 355-0716
[AGENT][POSITIVE] Thank you and just give me one moment to pull that up please.
[AGENT][NEUTRAL] And can I please have you verify your date of birth?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, and your mailing address please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then the uh last piece of verification, your email address please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Great, thank you for verifying that information for me.
[AGENT][NEUTRAL] So let's take a look at your claim. I'm gonna pull the claim image, so just bear with me for one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So did you say it wouldn't allow you to open it or you don't?
[CUSTOMER][NEUTRAL] I just don't, I can go on to my app, but I don't know how to read where my claim status is.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like uh let's see.
[AGENT][NEUTRAL] Let me just pull up that claim documentation it looks like we're uh requesting some additional information so let me just take a look at what was submitted. So um let's see, I have your accident claim form.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And this claim is uh actually it would be for [PII], is that correct? your dependents?
[CUSTOMER][NEUTRAL] Um, no, no, this claim was for me 355-0716. It's, um, where I fell down my back steps.
[AGENT][POSITIVE] Oh, I'm sorry.
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] I'm sorry I pulled up the wrong I pull up I'm, I'm sorry to hear that. I pulled up the wrong number. My apologies.
[CUSTOMER][NEGATIVE] Mm, mess my ribs up.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, the one for
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, the one from [PII], um, I'm waiting on the bill to come in from the doctor, so I can submit that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, OK, so I do see yours and um it does look like though.
[AGENT][NEUTRAL] You fell down, uh, OK, so.
[AGENT][NEUTRAL] On the claim form, um, it does appear that the.
[AGENT][NEUTRAL] On the claim form itself, we have the accident date of [PII].
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEGATIVE] That's wrong. That's my son's birthday, or [PII]. It's his birthday.
[AGENT][NEUTRAL] Yeah, so it looks like we need you to complete probably.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] I would suggest
[CUSTOMER][NEUTRAL] I told that woman that day that that was wrong.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know if I put it down wrong or he got put in wrong, but.
[AGENT][NEUTRAL] Yeah, that's what's on the claim form um itself, so it looks like the, the information was filled in, um, and that's the date that was put in for the date of accident. So it does say on this particular claim, the 355-0716. I'm actually looking at the claim form and it has your information at the top about the insured on section B about the patient, it still lists [PII] as the patient.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, on that claim form and then in section C, the details of the accident that also lists the date of the accident as [PII] and it says two days after the Hurricane [PII], I was walking down my back steps and your feet came out from under and you landed on your ribs and uh you fractured ribs and bruised your uh body from.
[CUSTOMER][NEUTRAL] He left side
[AGENT][NEUTRAL] Yeah, OK, so, and then also for this particular claim we see that you did send a statement into us now that statement does say the um.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Let's, it has a statement date, the due date.
[AGENT][NEGATIVE] But it also doesn't have um.
[AGENT][NEUTRAL] Let's see on that next page I do see so it was [PII] that you went to.
[AGENT][NEUTRAL] The hospital, is that right?
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] You just take a look at this.
[CUSTOMER][NEUTRAL] Of 24.
[AGENT][NEUTRAL] Because it also, yeah, it also includes some information from [PII] that looks like it might have been, uh, just an office visit at Easley Family Medicine. OK, so it does show us the um kind of the balance forward and then the radiology. So this is what we're gonna need. First of all, we're gonna need that claim form to be corrected.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, and are you on the portal? Are you filling this out on the portal?
[AGENT][NEUTRAL] Or how did you get the claim forms?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, I think I did that one on the portal.
[AGENT][NEUTRAL] OK, so my suggestion would be to go ahead and complete a new claim form, and what we're gonna need is an itemized, uh, a detailed itemized statement from Prisma Health.
[CUSTOMER][NEUTRAL] I did that. I
[CUSTOMER][NEUTRAL] I did that. I, um.
[CUSTOMER][NEUTRAL] Um, faxed it in the day before yesterday, and they sent me a text and they got it.
[AGENT][NEUTRAL] OK, so you did send that in. OK, let me.
[CUSTOMER][NEUTRAL] And that's what I'm waiting on for my son on his claim.
[AGENT][NEUTRAL] OK, because that also looks like we're asking for that itemized bill, so this policy, um, because it is um it is accident only policy, however, it does um need to have that detailed itemized charge, a list of that because, um, this policy pays based on the charges.
[AGENT][NEUTRAL] So that's why we need that detailed itemization so let me take a look again at that um.
[AGENT][NEUTRAL] And that was the one that was sent on [PII], is that right?
[CUSTOMER][NEUTRAL] Uh, today is what, the [PII]?
[AGENT][NEUTRAL] Yeah, well, [PII], yeah.
[CUSTOMER][NEUTRAL] Yeah, so yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So this looks like again that um did he have to have uh.
[AGENT][NEUTRAL] Surgery, it looks like on his eye.
[CUSTOMER][NEUTRAL] That's not about him, that's me. Oh yeah, him, he did.
[AGENT][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Yes, he did. He had to have a 3.5 hour surgery.
[AGENT][NEUTRAL] OK, so what we were asking for is let's see.
[CUSTOMER][NEUTRAL] I know I have to send the itemized bill in for him, but for me I send it in on the [PII].
[AGENT][NEUTRAL] Right, for the initial.
[AGENT][NEUTRAL] Right, from the initial treatment. OK, and you said you were sending additional information for yourself cause I don't see that. The only information I've seen that we received was for um the uh claim for [PII] and it looks like it's from the uh anesthesia and then also the um surgery itself.
[AGENT][NEUTRAL] Uh, so let me look further in here is it.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Because what what we need is that itemization from the initial um visit.
[AGENT][NEUTRAL] From when from the accident occurred.
[CUSTOMER][NEUTRAL] Yes, on me, right?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Well, actually it looks like now we're gonna need it for both because the statement that you sent in, yeah, we, we need a detailed itemization.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And I know you need, I know you need his still. I'm waiting on her to come in from the hospital.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I have mine right here. Um,
[AGENT][NEUTRAL] And does it list the charges, the, the data service the charges, the procedure and diagnosis code?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, yes, as a mission date TM one discharge TM one.
[CUSTOMER][NEUTRAL] Uh, current hospital balance 10347.
[CUSTOMER][NEUTRAL] But um it says service date code.
[CUSTOMER][NEUTRAL] And description right there and then it says the dates.
[CUSTOMER][NEUTRAL] And then it says um.
[CUSTOMER][NEUTRAL] Adjustments, um, that's my payments. And then,
[CUSTOMER][NEUTRAL] It says hospital account diagnosis code and then it says intercoastal pain.
[AGENT][NEUTRAL] Intercostal pain, OK, so it does have the diagnosis code. OK, so if you wanna go ahead and upload that in the portal, my suggestion, um, go ahead also and update that claim form because we wanted to say your name and as the patient and you know, those details, um, we need the date of accident, your name in that section C, um instead of [PII]'s name.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Because on the claim form that was submitted, like I said, it shows [PII]'s uh name and his uh the date of service as [PII], let me go back to that.
[AGENT][NEUTRAL] [PII], I believe it's a [PII].
[AGENT][NEUTRAL] So we needed to have the correct patient information for you and the correct date of accident.
[AGENT][NEUTRAL] Um, and then also include that itemization that you're uh referring to that you have. I would go ahead and submit that through the portal for you and once you um.
[AGENT][NEUTRAL] Uh, you can just go ahead and upload it, you know, make sure when you're on that dashboard that you choose yourself. Um, now, a lot of times you'll have to download the form, you complete it, and then you'll have to reupload it to the portal. That's the easiest way to get it through to to us.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Does that make sense?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, yeah, because like I said this claim form doesn't have um the correct patient name or the correct date of accident, um.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] And then like I said we're asking for that detailed itemization of charges which it sounds like you have that so you can go ahead and uh submit that with the new claim form.
[CUSTOMER][NEUTRAL] Yeah, I fax that over.
[CUSTOMER][NEGATIVE] I faxed it over so I don't know why you don't have it cause she told me when I talked to her that I could fax it over.
[CUSTOMER][NEUTRAL] She said, how about you just fax it over to us. So I did that and cause I had a fax number right here.
[AGENT][NEUTRAL] I don't
[AGENT][NEUTRAL] The only
[AGENT][NEUTRAL] Yeah, the only um.
[AGENT][NEUTRAL] Documents I see are were submitted through the portal um but you said you did receive confirmation that we have it. I can try to search for it if you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, if you, let me see.
[AGENT][POSITIVE] But at any rate I would definitely um correct that claim form for us if you could.
[CUSTOMER][NEUTRAL] I am.
[AGENT][NEUTRAL] OK and then um.
[AGENT][NEUTRAL] Let me see if.
[AGENT][NEUTRAL] And you said you sent it on which date? on the the.
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] Uh, I sent it on the [PII], I think.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you know approximately what time do you have a copy of that confirmation?
[CUSTOMER][NEUTRAL] No, I did, but I turned around and used it. Let me see if I can.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I used it for a blank piece of paper because I needed it.
[CUSTOMER][NEUTRAL] But I can fax it in again, uh.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] You can fax it or if you wanna save it as a PDF and upload it with your claim form through the portal you can do that. Are you able to do that?
[CUSTOMER][NEUTRAL] If I need to.
[CUSTOMER][POSITIVE] Well, I can, I can do that. I'll just take me a few minutes.
[AGENT][NEUTRAL] Yeah, now you are using a desktop or laptop computer for that portal, is that correct? Yeah.
[CUSTOMER][NEUTRAL] Yes, I'm just using my work computer, so.
[AGENT][NEGATIVE] Yeah, because unfortunately it doesn't work well with the tablet or mobile device, so um.
[CUSTOMER][NEGATIVE] Yeah, no.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] I'm looking to see if I can locate that fax, but usually if we have it by now it would have been uploaded to your file.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Unless there wasn't any identifying information on it, then that would be um did you write your.
[AGENT][NEUTRAL] Do you know if you put your policy number on it?
[CUSTOMER][NEUTRAL] On what the, no, I wrote my claim number on it.
[AGENT][NEUTRAL] On the fact that.
[AGENT][NEUTRAL] And how um how many pages was it? Do you know?
[CUSTOMER][NEUTRAL] Um, 2.
[AGENT][NEUTRAL] 2, OK.
[AGENT][NEUTRAL] Because usually by this time we would have seen it in your file. So what happens when we receive these uh claim claims through the fax or the mail they're um they're put through our mail system and then they're sorted and then uploaded to the patient file usually that's done um re you know relatively.
[AGENT][NEUTRAL] Uh, soon after it's received unless, like I said, for some reason they can't identify the patient, then it would have to be, uh, researched a little bit further.
[AGENT][NEUTRAL] Um, so it might take a little bit more time that way, but I would think by now it should be uploaded to your file, so I would suggest that you're doing the claim form anyway to go ahead and, uh, include it with your claim form.
[AGENT][NEUTRAL] Um, and if you do it through the portal, you should be able to see it.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right. OK, so I don't, can you see my file my claim form that I filled out?
[AGENT][NEUTRAL] Um, I have to wait for it to go kind of go through the system. Did you already submit it?
[CUSTOMER][NEUTRAL] Uh, no, I'm working on it now, but I don't remember what day exactly it was the accident happened. I got all my paperwork at home. I'm at work, so.
[AGENT][NEUTRAL] OK, well, the, um, it does.
[AGENT][NEUTRAL] Let's see the information that you submitted, let's see if that can help us.
[CUSTOMER][NEUTRAL] I know it was the Saturday after the hurricane, so I'm thinking maybe the [PII].
[CUSTOMER][NEUTRAL] On the [PII] something like that.
[AGENT][NEUTRAL] OK, let's see, yeah.
[AGENT][NEUTRAL] Right, because it does look like the.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] The service, at least on the statement you sent in the it's just for radiology, which is why we need that complete statement from from uh Prisma Out. It says [PII], so that would have been um a few days after if you it hurt yourself on that weekend after.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, [PII] was on Tuesday.
[CUSTOMER][NEUTRAL] That's when I went to the doctor.
[AGENT][NEUTRAL] Yeah, OK, so then, uh, if that helps you, so that's Saturday, uh, before, um, the [PII] was the [PII].
[AGENT][NEUTRAL] I know I had, I had plans actually to travel to, to [PII] the day that it happened, so.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It was on that
[AGENT][NEGATIVE] Thursday and Friday that it was the worst I think.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm sorry you hurt yourself.
[CUSTOMER][NEUTRAL] My back porch was slippery because of the hurricane, all the trees blowing over it.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEGATIVE] It made it slippery.
[AGENT][POSITIVE] Wow.
[AGENT][NEUTRAL] Well, um,
[AGENT][POSITIVE] I hope that can help that information.
[AGENT][NEUTRAL] Um, and if you'd like, what I can do, Ms. [PII], if you wanna, um, take some time, go ahead, finish that claim form, and then try to upload that, um, file with your claim form, and if you'd like I can call you back in a little bit and just let you know it was received.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] See, that's my thing though, it's not letting me sign.
[CUSTOMER][NEUTRAL] That's why it happened to the last one, that's the reason why.
[CUSTOMER][NEGATIVE] I had such a hard time getting it to let me sign.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Well, um, it should allow.
[AGENT][NEUTRAL] Some of the documents should allow an electronic signature, but that might be one of those cases where you have to download it um add the information download it and maybe print it. Are you able to do that? And then just sign it and then go ahead and save it again um after it's signed, save it, upload it with your um with your additional file for the billing and then upload it through the portal that way.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, do you have my policy number?
[AGENT][NEUTRAL] Yes, 17.
[AGENT][NEUTRAL] 02
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 608.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, 17.
[AGENT][NEUTRAL] 02608 mhm.
[CUSTOMER][NEUTRAL] 02.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then like I said if you wanna give it some time uh once you upload it um I could call you back maybe like in a few hours possibly around lunch time would that be OK?
[CUSTOMER][NEUTRAL] OK, yeah.
[AGENT][POSITIVE] And then I could just like let you know it's received and it's what we, you know, everything that we need and uh I'll be happy to do that for you and that number that you provided me [PII] I can reach you at that number.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, and you are in [PII] you're, are you, um, in Eastern or Central time?
[AGENT][NEUTRAL] Eastern time.
[CUSTOMER][NEUTRAL] Um, uh, Eastern time.
[AGENT][NEUTRAL] OK, that's alright, so it's um it's about [PII] here, um, where I'm at too, so I'm in Eastern time. I'm actually up in [PII].
[CUSTOMER][NEUTRAL] Where are you at?
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, and you was going to [PII]?
[AGENT][NEUTRAL] Yeah, my son lives there. Yes. Well, he lives in [PII].
[CUSTOMER][NEUTRAL] For the hurricane?
[CUSTOMER][NEUTRAL] What part
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] So he's like kind of in the middle of uh middle of the state. Yeah, we were gonna travel down there for a golf outing where like uh it was a um.
[AGENT][NEUTRAL] It's a memorial kind of outing that they do um for someone that is my son's friend and uh so we were traveling for that but we ended up having to cancel due to.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Everything that was going on, we ended up not going. Although he didn't get very much rain from it um where he's at.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] But some other places.
[CUSTOMER][NEGATIVE] Oh, we got, we got it bad.
[AGENT][NEUTRAL] Around them or
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I know the lower end of [PII], which is close to us like [PII].
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEGATIVE] They got it bad.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So this is about all the um position statement, I don't have to fill that out, right?
[AGENT][NEUTRAL] We, we live in.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] You do not, no, you're just filling out the claimant statement that first page we do ask that you complete that um authorization, although I don't know if you I think you already included that so you don't have to worry about that page either. Basically you're just uh filling out that that first page of the claim form, uh, where it has the claimant statement information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The statement of insured is at the top. That's the only page we need. Like I said, we just need, um, and actually you, the, the claim form you have, you did sign it. I don't know if you, you said you had a hard time. It does, it does show a signature on it. That's when it was initially, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, eventually I got it.
[CUSTOMER][NEUTRAL] I had to download something on my computer at home to let me eSign.
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So like I said, that's the only place and really like I said just that section C is the most important, you know, where it has um I'm sorry, section B where it has the patient information and C where it has the date of the accident and then the details. But as long as we have that uh corrected, you know, information about the patient and then the date of the accident, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Just make sure that that is the correct date.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I got the data accident and I got B A B C filled out.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] So I'll sign them, download them and send them back to you.
[AGENT][NEUTRAL] OK, and I'll give it um I'll give it an hour or so and then I'll just um check it again and once it's received, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] You know, once I, I can see it actually and review it, I'll give you a call back and just let you know that it's what we needed.
[CUSTOMER][NEUTRAL] Now, can you, um, can you look at my son's and make sure his as well?
[AGENT][NEUTRAL] Yeah, let me just take a look. So it looks like they did uh process that information from the surgery, but what we're needing from that is like you said, you requested that uh that itemization of charges, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me just make sure his claim form is good, bear with me for one moment.
[AGENT][NEUTRAL] So that was reprocessed again on [PII] and we asked for that uh itemization of charges, and that would be the itemization from the initial uh visit to the doctor. And again, it's the same information that we just discussed and it has to show that it is um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] You know, from that initial visit to the either the doctor or hospital, wherever you sought treatment. Yeah. OK. So it does look like we, we requested a claim form for [PII]'s accident as well. And again, that same uh information on that statement of insured, it showed, this one does show uh [PII] as the patient, but it has the date of accident still [PII], and then the details of the accident is left blank.
[CUSTOMER][NEUTRAL] The hospital, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So are you
[CUSTOMER][NEUTRAL] It was [PII], [PII], [PII].
[CUSTOMER][NEGATIVE] So I just got the year wrong on that one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then it doesn't have the details of the accident, so my suggestion would be go ahead and complete that claim form for [PII] as well, correct that accident date, put the details of the accident, and um I know you said you've already requested that itemization you're waiting for it, um.
[AGENT][NEUTRAL] So what's gonna happen is if you just send in the claim form, it's just gonna um again be denied asking for that information from the initial visit to the hospital.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So, um, go ahead and, um, now you can.
[AGENT][NEUTRAL] There's also a form. Do you have major medical insurance as well, Ms. [PII]?
[CUSTOMER][NEUTRAL] I don't have medical insurance.
[AGENT][NEUTRAL] OK, because you can ask the hospital to provide you uh a copy of a UBO4 that would be um.
[AGENT][NEUTRAL] That would be the best uh option for requesting that information, you know, I know they said they're they're giving you the uh the detailed itemized bill. You can use an itemized bill or you can use that form. It's called a UBO4 and it's U for umbrella, B for boy.
[AGENT][NEUTRAL] 04.
[AGENT][NEUTRAL] And what that is is that is an I it's a universal billing form that the hospitals use to bill to insurance companies. So if you have a major medical insurance, they should have a copy of that UBO4 on file. You can request a copy of that UBO4 just let them know you're submitting a supplemental claim, um, that you have, uh, accident insurance and you need a UBO4 form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] To send to your insurance company a lot of times they can furnish that for you and it might be even quicker than asking for that itemization of charges, um, and that UBO4 will have the patient's name, the dates of treatment, and it will list all those procedure, diagnosis, uh, and diagnosis codes as well as the charges and for your policy it does require the charges, so that would be the best, uh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] The best form to get if you're able to if they'll furnish you that copy of the UBO4 and you could just send that and um and just so you know that's for future claims as well it just makes it a little bit easier because it gives us all that information and you're not having to go back and forth asking or waiting even for that itemization.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Of charges because sometimes it doesn't include that diagnosis code. So if, uh, and that's the reason for the visit. So, and, and for this policy because it is an accident policy, it does require that accidental bodily injury diagnosis. So that's what we're looking for on that diagnosis, just that we can verify that the injury was due to uh accident, whatever type of accident it might be.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I know that's a lot of information, so.
[CUSTOMER][POSITIVE] I think I got it.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] But like I said, if you can request that UBO4, it would make it a lot easier for for you and for um processing your claim.
[CUSTOMER][NEUTRAL] Um, um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty then and I'll get these downloaded and sent back over to you.
[AGENT][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] Do I need to put anything on this uh accidental claim form?
[AGENT][NEUTRAL] Um, like I said, you.
[CUSTOMER][NEUTRAL] Like a
[CUSTOMER][NEUTRAL] The um the the um claim number?
[AGENT][NEUTRAL] Well, if you're, no, because what we're gonna do is we've already have that claim on file so we know that information is um we've kind of pended it and we're waiting for that correct you know the the charges and then like I said in this case with that corrected uh um.
[AGENT][NEUTRAL] Uh, claim form and date of accident. So once you, uh, send that through the portal, it's gonna come through on your policy number and then we're gonna see that there is information already on file and we requested additional information so we'll pull that information that we already have on file and continue processing the claim once we get that uh information.
[AGENT][NEUTRAL] Oh, can you hear me?
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello?
[AGENT][NEGATIVE] I lost the call.
[AGENT][NEUTRAL] Hello?