AccountId: 011433970860
ContactId: 64cccd84-b3ca-4173-84b5-e9fed314ca11
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 355910 ms
Total Talk Time (AGENT): 142122 ms
Total Talk Time (CUSTOMER): 94972 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/64cccd84-b3ca-4173-84b5-e9fed314ca11_20250415T14:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, I have a question about a um a claim I put in.
[AGENT][NEUTRAL] OK. Do you have your policy number?
[CUSTOMER][NEUTRAL] Uh, yes, let's see, uh, 224-4449.
[AGENT][NEUTRAL] OK, could I get your name and your date of birth?
[CUSTOMER][NEUTRAL] Name is [PII].
[AGENT][NEUTRAL] His name
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and do you have a good callback number, [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Uh, just need to verify a few more pieces of information. What is your address?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And lastly your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you and what data service are we checking on today?
[CUSTOMER][NEUTRAL] Uh, the date of service was, uh, they received, um, and I sent it was [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have a claim number.
[AGENT][NEUTRAL] OK, what's that?
[CUSTOMER][NEUTRAL] 358-896-1
[AGENT][NEUTRAL] OK, uh, looking at the, uh, looks like it was denied, but let me see what's going on.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, it looks like we were missing a diagnosis code. Let me pull up what we received.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm looking through this, let me, give me one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it looks like we've got a.
[AGENT][NEUTRAL] Looks like you've submitted a uh.
[AGENT][NEUTRAL] Itemization from AdventHealth.
[CUSTOMER][NEUTRAL] Yes, um, the reason for that was for the hospital stays because.
[CUSTOMER][NEUTRAL] I spent 5 days in the hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] So it doesn't look like there is a diagnosis code listed anywhere.
[AGENT][NEUTRAL] So it's got an itemization of what
[AGENT][NEUTRAL] Procedures they did.
[AGENT][NEUTRAL] But we have to have an actual diagnosis code.
[AGENT][NEUTRAL] Um, to determine if it's a illness or injury. Um, so typically, you can either call the hospital, see if they'll provide that with you through documentation, or you can ask them for the actual claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, which is called a UBO4. So that, that's the, the claim that they submit and it has everything that we need. So it'll have your diagnosis codes and then the procedures what you're seeing for, um, but this, the, the piece that's missing is the diagnosis.
[CUSTOMER][NEUTRAL] OK, so diagnosis code and uh UBO4.
[AGENT][NEUTRAL] Yeah, so the UBO4 will have that on it, um, and that's usually probably the easiest, easiest thing to get, um, that will allow us to process the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I will look into that um now I have another question I guess pertaining to this, but um.
[CUSTOMER][NEUTRAL] As far as hospitalization, um, that, that is paid for, right? for hospital stay?
[AGENT][NEUTRAL] Um, let me see what your benefit is. Hold on one moment.
[AGENT][NEUTRAL] Um, and this is not a guarantee of payment. It's a basic outline of the policy. Uh, so it looks like for your hospital plan that you're on,
[AGENT][NEUTRAL] Were you admitted to the hospital?
[CUSTOMER][NEUTRAL] Yes, I was, uh, there from [PII].
[CUSTOMER][NEUTRAL] Through, oh God, now I.
[CUSTOMER][NEUTRAL] I don't recall, but I was 5 days in the hospital.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's all in that paperwork.
[AGENT][NEUTRAL] OK, so for your plan, there's a $2000 per day hospital admission benefit. It's a max of 1 day per calendar year.
[AGENT][NEUTRAL] And then your hospital confinement benefit pays out $100 per day, a max of 30 days per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So how do I submit that then?
[AGENT][NEUTRAL] That that's what we're needing is the diagnosis code in order to process the claim under these, yeah, under these benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, I will see if I can obtain that.
[AGENT][NEUTRAL] OK. Anything else I can help with today?
[CUSTOMER][NEUTRAL] That should do it for me.
[AGENT][POSITIVE] OK, well, thank you for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] Thank you, ma'am you too.
[AGENT][POSITIVE] All right, thank you. Bye.
[CUSTOMER][NEUTRAL] Bye bye.