AccountId: 011433970860
ContactId: 8b422fac-ffef-4dfe-9862-fda7c6de3193
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 338959 ms
Total Talk Time (AGENT): 123061 ms
Total Talk Time (CUSTOMER): 147642 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/8b422fac-ffef-4dfe-9862-fda7c6de3193_20241231T15:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, I'm calling because I was getting ready to file a claim soon and so and they told me that I had to make sure that I put the um the the DX code on my claim.
[CUSTOMER][NEUTRAL] For my claim?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, and I spoke with someone yesterday. He told me it doesn't have to be a DS code. I can upload, I mean the like the, the reason for the visit from the discharge paper, and I'm calling to confirm is that true? Like is that good enough for me to upload the reason for me going cause he said that's equivalent to the DX code.
[CUSTOMER][NEUTRAL] It would be the description and the reason for why um I went to the hospital.
[AGENT][NEUTRAL] May I have your name and a callback number?
[CUSTOMER][NEUTRAL] Uh my name is [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] My policy is.
[CUSTOMER][NEUTRAL] One second is.
[CUSTOMER][NEUTRAL] 2252435
[AGENT][NEUTRAL] It's 225-243-5.
[CUSTOMER][NEUTRAL] Um, one second, I'm gonna confirm.
[CUSTOMER][NEUTRAL] Yes, it is um.
[CUSTOMER][NEUTRAL] 2552552435.
[AGENT][NEUTRAL] And is this claim for you or someone else listed on the policy?
[CUSTOMER][NEUTRAL] I'm sorry, can you repeat that?
[AGENT][NEUTRAL] Is this claim for you or someone else listed on the policy?
[CUSTOMER][NEUTRAL] Oh, so somewhere else listed, um, it should be [PII] from the date of service [PII].
[AGENT][NEUTRAL] And may I have her date of birth please?
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[AGENT][NEUTRAL] OK. So in regards to submitting the diagnosis code, if you do have the reason of the visit, you can either highlight that or you can put that description listed on there, or you can submit that page to the itemized bill that you have for the description and we will verify.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, so it just doesn't, um, it, it doesn't technically have to be cold. It has to be the reason for the visit.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes. If it's the reason, if you have the reason for the visit, that is fine. We will try to distinguish what the diagnosis code would be. But if you're able to get that diagnosis code from the facility or the physician, you can call them and you can get that diagnosis code and write it on there.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah, I wasn't able to get the call, so that's why I have the description for you, so I'll submit that with my EOB and my itemized bill.
[AGENT][NEUTRAL] Yes. As long as the description is the reason because sometimes the description could be the coding for the visit itself that was rendered, which would be like if she was in the emergency room, it would have the emergency room code and that's not the description.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh no, no, no, it's actual description, so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, just call, I was just calling to make sure so um.
[CUSTOMER][NEUTRAL] And another question I had was I have a claim for um [PII] and the claim that I just told you about from [PII] so but my EOB has both of those dates on it, so I will have to use that for both claims and file them separate, correct?
[AGENT][NEUTRAL] As long as that reason for that visit was done for that date of service of [PII] and also [PII] because if we end up receiving that claim for 89 from the provider and it's showing a different diagnosis code, then it could be an issue where we would have to request a refund because the claim was paid in error.
[CUSTOMER][NEUTRAL] So I have to get a separate diagnostics code or reason for the for both service dates, correct?
[AGENT][NEUTRAL] Yes, each, any time that you go to a provider, you have to have that diagnosis code, which is the reason for that visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that makes sense. OK.
[AGENT][NEUTRAL] Because
[CUSTOMER][NEUTRAL] And I have to file those separate though, right? Correct. I file them both separate for each service date.
[AGENT][NEUTRAL] If you're able to get that reason for the visit for 89, you do have the option to submit that in as well because on those paper it does, it does indicate the dates of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah. OK.
[CUSTOMER][NEGATIVE] So basically if I want to do it together, I have to have each um reason or dying not to go for both.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] And you do have the primary EOB as well?
[CUSTOMER][POSITIVE] Yes, yes, I do.
[AGENT][NEUTRAL] OK, yes.
[CUSTOMER][POSITIVE] Um, so I guess that's everything. Um, thank you. Uh, happy New Year and have a nice day.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Same to you and thank you so much for calling American Public Life, [PII]. Have a great day as well.
[CUSTOMER][NEUTRAL] All right.
[AGENT][POSITIVE] Thank you.