AccountId: 011433970860
ContactId: 6c2d1ec0-faca-4484-9db6-d6ef90077205
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 344359 ms
Total Talk Time (AGENT): 126582 ms
Total Talk Time (CUSTOMER): 157448 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/6c2d1ec0-faca-4484-9db6-d6ef90077205_20250131T14:38_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling A. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, hi, my name is [PII], and, um, my husband, [PII] has a relatively new, um, policy with you, and he, um, has recently been hospitalized and received a new heart valve and, um, I have been tasked with negotiating the, uh, filing the claim, and I have been on the website and I have registered and
[CUSTOMER][NEUTRAL] Um, I've gotten to the point where it says upload forms and I know I'm giving you too much information, but I don't know what forms to upload. I, I'm so sorry, but I just need guidance.
[AGENT][NEUTRAL] OK, so you just need some help with getting the claim submitted?
[CUSTOMER][NEUTRAL] And knowing what to do, yes, and I can give you his information policy number. I, I don't know what you need.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I can help you with that, Ms. [PII] in case this call is disconnected, may I have your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And may I have the policy number, please?
[CUSTOMER][NEUTRAL] Yes, um.
[CUSTOMER][NEUTRAL] 18126
[AGENT][NEUTRAL] That wouldn't be the policy number. The policy number would be the policy er or certificate number.
[AGENT][NEGATIVE] That's not enough digits.
[CUSTOMER][NEUTRAL] OK, OK, well, it's, I mean, I'm looking at the cer certificate schedule and that number I gave you is listed across from policy number but under it it says certificate number and that number is 02342604.
[AGENT][NEUTRAL] Thank you. And that was 02342604?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And the name on the account?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. So for submitting a claim, there, what we will need is the itemized billing. If he was hospitalized, we would need the itemized billing with diagnosis code and procedure codes when you're filing the claim, and those would be the documents that you wanna upload.
[CUSTOMER][NEUTRAL] OK, I'm writing it all down like this.
[CUSTOMER][NEUTRAL] OK, I'm writing it down itemized billing with tell me that again please.
[AGENT][NEUTRAL] The, the, the itemized billing which includes the diagnosis codes.
[AGENT][NEUTRAL] And procedure codes?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and how now itemized billing that's different from, um, the EOB correct?
[AGENT][NEUTRAL] Yes, that is. That will be the actual itemized billing from the hospital. So you'll need to get the hospital itemized billing.
[CUSTOMER][NEUTRAL] So I would
[CUSTOMER][NEUTRAL] OK, OK, is there anything, is that all I need to upload?
[AGENT][NEUTRAL] Yes, that will be the only information we need. If you're not able to get the itemized billing, we can either, we can also use either the admin discharge summary that provides the day and time that they were admitted and the day and time they were discharged and provides that summary of what he was seen for as well.
[CUSTOMER][NEUTRAL] OK, I'm writing that down. We have that somewhere. I don't remember it had codes on it, but I could definitely be wrong so it OK.
[AGENT][NEUTRAL] As long as it provides the day and time that he was admitted and the day and time he was discharged and what he was seen for.
[CUSTOMER][NEUTRAL] Submitted
[CUSTOMER][NEUTRAL] Charge
[CUSTOMER][POSITIVE] Thank for.
[CUSTOMER][NEUTRAL] OK, well I will get started and if I have more questions I will call you back is that OK?
[AGENT][NEUTRAL] That's fine. Also I just wanna advise you this is individual coverage, so as far as any uh any information regarding his coverage, he'll need to contact us to give consent to speak with you moving forward in regards to actual claims information and details.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Well, uh, we have that printed off right here in front of us and we have talked to someone at his new firm who, um, confirmed that he is eligible so is that what you're asking?
[AGENT][NEUTRAL] No, I'm saying he has individual coverage so as far as speaking with you about his coverage and anything pertaining to claims, we will only need, we can only speak to him directly unless he contact us directly and give us consent to speak with you regarding his policy and coverage and claims questions.
[CUSTOMER][POSITIVE] Oh, I don't need to. I understand. I don't need to speak with anybody about that, so I'm good. Thank you very much.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You're welcome. Is there anything else I can help you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] Not today, but do I, if, if I have to call back, which is a possibility, do I need to ask for you?
[AGENT][NEUTRAL] No. Anyone can assist you in our in our claims area.
[CUSTOMER][POSITIVE] All right, that's all I need thank you have a good day.
[AGENT][POSITIVE] You too, thanks for calling APL bye.
[CUSTOMER][NEUTRAL] OK bye bye.