AccountId: 011433970860
ContactId: 73fd8e23-91a7-45a2-aabd-c7683d96cbbe
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1391300 ms
Total Talk Time (AGENT): 230790 ms
Total Talk Time (CUSTOMER): 196621 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=-1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/73fd8e23-91a7-45a2-aabd-c7683d96cbbe_20250312T20:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], uh, I just got a letter saying they wanted they wanted to, uh, you need more information for my claim?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, but all the yeah, all the information I've already sent, so I don't know what you guys, what else you guys need besides what I've already sent.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Alright, let's take a look at the claim. Do you have your policy number, claim number?
[CUSTOMER][NEUTRAL] Yeah, uh, the policy number is 02297152.
[AGENT][NEUTRAL] OK, thank you. Let me just pull this up here.
[AGENT][NEUTRAL] Can I get your first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh, [PII] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And then if you could please verify the address on file and the email address.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And what was the other day?
[AGENT][NEUTRAL] Uh, the email address please.
[CUSTOMER][NEUTRAL] Oh, [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Alright, let me pull this claim up and see what it says here.
[AGENT][NEUTRAL] All right, bear with me here just one moment. I'm just pulling up all the pages that were submitted so I can take a look at it.
[CUSTOMER][NEUTRAL] It was an itemized hospital services bill that was uploaded.
[AGENT][NEUTRAL] Yeah, cause it looks like they're, it says itemized statement with diagnosis and procedure codes. So let me see here.
[CUSTOMER][POSITIVE] Exactly, that's exactly what I uploaded.
[AGENT][NEUTRAL] OK, I see.
[AGENT][NEUTRAL] OK, so yeah, I see all the 14 pages here [PII] that were uploaded so let me reach out to somebody in claims and um that processes these and see if there's something that we're not seeing that's missing um bear with me just a moment if you don't mind.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, [PII], this is [PII] in customer care. How are you today?
[CUSTOMER][POSITIVE] Oh, I'm good how are you?
[AGENT][POSITIVE] I'm good, thank you for asking. Um, I have an insured on the line who has a question about an HI claim, and I was wondering if that was something you could help me with.
[CUSTOMER][NEUTRAL] OK. Uh, let's see.
[CUSTOMER][NEUTRAL] And what is the policy number?
[AGENT][NEUTRAL] 02297152 for a [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] He only has one claim in there and I read the the denial and then I pulled up what he sent in. And so from what I can see, it is an itemized bill with diagnosis and procedure codes, so I'm just not sure to tell him exactly what he's missing here.
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK, I don't see a diagnosis code.
[AGENT][NEUTRAL] So we just need the diagnosis code. Everything else is good, right?
[CUSTOMER][NEUTRAL] Mhm. Yup, looks like we have an itemized bill, but I don't see the diagnosis as to why he was uh inpatient. Uh, he would need to get something from the uh hospital with the diagnosis code on it.
[AGENT][POSITIVE] OK, gotcha. That was the only thing missing. OK. I appreciate you looking at that with me and helping me out. I will let him know that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thanks.
[CUSTOMER][POSITIVE] No problem bye bye.
[AGENT][NEUTRAL] Thank you so much for your patience and waiting on that, [PII]. So, um, they looked at all the information that was submitted. It looks like the only thing that they need is something from the hospital with a diagnosis code. That's what's missing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Diagnosis code. What do you mean by that? I mean, all the diagnosis there are there, the codes.
[AGENT][NEUTRAL] Those are treatment and procedure codes for what was actually administered. So they need something from the hospital stating the diagnosis, what you were being seen for.
[CUSTOMER][NEGATIVE] You guys are ridiculous, uh, uh, hold on, let me see if I can.
[CUSTOMER][NEUTRAL] I had a feeling this was gonna happen.
[CUSTOMER][NEUTRAL] No deny, deny, deny. Let's see here, hold on.
[CUSTOMER][NEGATIVE] And when you say the diagnosis code, are you seeing what the procedure they did on me or what? I don't understand what that what.
[AGENT][NEUTRAL] What the diagnosis was, which you were being treated for in the hospital.
[CUSTOMER][NEUTRAL] Tells you right there.
[CUSTOMER][NEUTRAL] Uh, hold on.
[CUSTOMER][NEUTRAL] Let me see if I can find it on this form.
[CUSTOMER][NEGATIVE] Ridiculous, you know.
[CUSTOMER][NEUTRAL] Uh, let me get out of this.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Well, this, this, uh.
[CUSTOMER][NEUTRAL] This benefit is a hospitalization benefit, so you can see I was hospitalized, you see the dates there.
[AGENT][NEUTRAL] Mhm. Yeah, I do see the dates, yeah.
[CUSTOMER][NEUTRAL] So it's a hospital, a hospitalization benefit so you could see I was hospitalized, OK?
[CUSTOMER][NEGATIVE] This this isn't a, you know, something made up here this is what this is what they sent me.
[AGENT][NEUTRAL] I apologize for the frustration.
[CUSTOMER][NEUTRAL] Who, who else can I talk to? Who else can I talk to besides you? Can I talk to supervisor?
[AGENT][NEUTRAL] Yeah, if you'd like to speak with a supervisor, I can get somebody on the line.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yeah, just one moment please.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for your patience and waiting, [PII]. I'm waiting for a supervisor to reach back out to me. Is the [PII] a good call back number?
[CUSTOMER][NEUTRAL] Yes it is.
[AGENT][NEUTRAL] OK. Do you um prefer a call back or did you prefer to hold? Totally up to you.
[CUSTOMER][NEUTRAL] Uh, I'll hold for a little bit longer.
[AGENT][NEUTRAL] OK, I'll wait a few more minutes and then check back in with you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Thanks.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for your patience, [PII]. I have my supervisor [PII] that I'm getting on the other line and I'm gonna transfer you through, OK?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] This is [PII] speaking. How may I help you?
[AGENT][NEUTRAL] Hey [PII], it's [PII]. I was gonna warm transfer him. I gave him your name before I send him over.
[CUSTOMER][NEUTRAL] Alright, let's see what, OK, let me get my me find my check supervisor. OK, policy number. Let me get him pulled up. I was in a one on one with a I see I tagged. I tried to get Deb in don't know that. So let's see 229-7152.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Calling on claim number 3.
[CUSTOMER][NEUTRAL] 692-95 insured upset regarding denied claim advice and we need DX. oh, so we don't have the DX code.
[AGENT][NEUTRAL] Just
[AGENT][NEUTRAL] Yeah, we just need the diagnosis code. I looked at what he uploaded. He uploaded a bunch of stuff and um we have like procedure codes, all this stuff, the hospital itemized statement. We just need the diagnosis code, but he was upset by that, saying he, you know, he didn't want to have to submit anything else and, you know, he's like, you can see I was in the hospital and then he asked for a soup, so.
[CUSTOMER][NEUTRAL] OK, got you. I will take him.
[AGENT][POSITIVE] All right, here he comes, thanks.
[CUSTOMER][NEUTRAL] Right. Uh-huh.
[CUSTOMER][NEUTRAL] Hello, this is [PII] in care in the care team. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, uh, I'm just trying to get a a claim paid, uh, uh.
[CUSTOMER][NEUTRAL] Already uploaded the hospital bill with the uh diagnosis, I mean the uh.
[CUSTOMER][NEUTRAL] Uh