AccountId: 011433970860
ContactId: 592438b0-02c7-4f47-8dfa-c36dd25c0b59
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 401029 ms
Total Talk Time (AGENT): 243623 ms
Total Talk Time (CUSTOMER): 113021 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/592438b0-02c7-4f47-8dfa-c36dd25c0b59_20250213T19:29_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I would like to know in regards to a claim that I submitted.
[AGENT][NEUTRAL] OK, just so you're wanting to check on a claim status for yourself?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that and I'm so sorry. What was your last name again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your policy number, please?
[CUSTOMER][NEUTRAL] 2473403
[AGENT][NEUTRAL] Thank you. One moment while I get your information pulled up and once I do do so, I will need to verify several things with you first for security and also any information that is provided would be a verification of benefits and not a guarantee of payment. So one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] It will be [PII].
[AGENT][NEUTRAL] Thank you. And your home mailing address, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have for you is the same as the one you gave to me, so that is your best contact number that we should have, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you and lastly your email address and this does appear to be your work email.
[CUSTOMER][NEUTRAL] Yes, [PII]. No, or you have uh [PII].
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK, thank you very much for verifying your information. And do you have a specific claim number? I just say that you would like for me to look at, OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 3561903
[AGENT][NEUTRAL] 3561903. OK, thank you.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] This is for data service of [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I can see yes ma'am that that claim was processed on the [PII]. It has been denied and give me just one moment to see the reason.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so the denial remark states please provide excuse me, please provide a diagnosis code for this state of service. This information may be obtained from your provider of service.
[AGENT][NEUTRAL] So once you have gotten and requested the diagnosis code from your provider and you received that, you can upload that into your portal like you did the, this initial claims information.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] They don't give the reason why they are, what, what do you need like the, the, the release? Like when you get out of the hospital, it states the, the reason why.
[AGENT][NEUTRAL] If that is on your discharge summary, the diagnosis, but if, if it, it depends on the facility, um, Ms. [PII] as to whether it's on that document or not.
[CUSTOMER][NEUTRAL] Right. Mhm.
[AGENT][NEUTRAL] You would have to just ask the facility if that's included on their discharge number, but they need, you just need to let them know that you need your diagnosis code for your supplemental insurance.
[CUSTOMER][NEUTRAL] Because the thing is, um,
[CUSTOMER][NEUTRAL] Yeah, this is the emergency room, so.
[AGENT][NEUTRAL] Mhm. So you would have to contact, I believe, uh, this claim is for HCA Florida University Hospital.
[CUSTOMER][NEUTRAL] Mhm, mhm, mhm.
[AGENT][NEUTRAL] Yes, ma'am. So what you can do is you can contact them and ask them for an itemized bill including your diagnosis code.
[CUSTOMER][NEGATIVE] I am out of my bill.
[AGENT][NEUTRAL] Mhm. That includes the.
[CUSTOMER][NEUTRAL] Well, I did provide it.
[AGENT][NEUTRAL] OK, but it, what we received does not have your diagnosis code. It only has procedure information.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I'm, I'm assuming they don't have a diagnosis probably.
[AGENT][NEUTRAL] Yes, ma'am, they would have to. Yes, ma'am. They would have to have a diagnosis code.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Code.
[AGENT][NEUTRAL] Mhm and and since you are set up on the online service center, you do have access to that explanation of benefits that has that remark on there that I just read to you.
[CUSTOMER][NEUTRAL] It does because I don't see it. I don't see it on the.
[AGENT][NEUTRAL] Uh-huh. On page 2. Uh-huh, it's on page 2.
[CUSTOMER][NEUTRAL] Uh, it's on page 2.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] On page 2 of the attachment.
[AGENT][NEUTRAL] On page 2 of our explanation of benefits that's in your portal in the online service center.
[CUSTOMER][NEUTRAL] Oh, because I'm in the um, I'm in the um
[CUSTOMER][NEUTRAL] What do you call this? or do I have to go in the claim number? Like I press the claim number and, and, OK, I didn't know that.
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh. Right, yeah, yeah, if you click on the claim number, then you should be able to um have that explanation of benefits for APL with that remark on the second page.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. I really appreciate it.
[AGENT][POSITIVE] Oh, yes, ma'am. Well, you're very welcome. So is there anything else that I can help you with at the moment?
[CUSTOMER][NEUTRAL] So I just upload the, the diagnose, correct?
[AGENT][NEUTRAL] Once you receive, yes ma'am, once you have the diagnosis code and it does, yes ma'am, you would just upload it now you will not be able to attach it to this claim number, OK? For this explanation of benefits you'll just upload it on the like if you were uploading a new claim, but our system will know that that was a missing piece of information tied to this data service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. I really appreciate it.
[AGENT][POSITIVE] Oh, yes, ma'am. You're very welcome. It was my pleasure in helping you today. And if that is all that I can help you with at this time, then thank you again for calling APL and I hope you have a very nice afternoon.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye bye.