AccountId: 011433970860
ContactId: 8e8bf1e6-a604-4b1e-9054-a83c347e4348
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 363760 ms
Total Talk Time (AGENT): 173474 ms
Total Talk Time (CUSTOMER): 123351 ms
Interruptions: 1
Overall Sentiment: AGENT=2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/8e8bf1e6-a604-4b1e-9054-a83c347e4348_20250110T15:39_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling A. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey how you doing? Um, I saw a claim and they got denied because the, um, the I guess the hospital put it as uh.
[CUSTOMER][NEUTRAL] As a health visit, but it was an emergency room visit.
[CUSTOMER][NEUTRAL] And they're still sending me a bill for it. Like it was 3:36. It's on my records, but.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] I'll be happy to check that for you, sir. Do you happen to have your policy number available?
[CUSTOMER][NEUTRAL] Can I give you my social?
[AGENT][POSITIVE] Absolutely, let me get to that screen and I am ready for your social.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what is your name, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you, Mr. [PII].
[AGENT][NEUTRAL] And what is your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you. And do you mind verifying your current mailing address, email, and phone number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And my email is [PII].
[AGENT][NEUTRAL] Is it just and then your phone number?
[CUSTOMER][NEUTRAL] Oh, phone number [PII].
[AGENT][POSITIVE] All right, thank you, sir. I appreciate that verification. I'm just getting your information pulled up and.
[AGENT][NEUTRAL] On your active policy.
[AGENT][NEUTRAL] Um, do you know what that date of service?
[CUSTOMER][NEUTRAL] And it was under my spouse.
[AGENT][NEUTRAL] Oh, it's your spouse, is it for [PII]?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, I did it on hers.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Was this for [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] um, West Side Hospital.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] OK, let me take a look at this for you real quick, bear with me just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now what I'm going to do, Mr. [PII] is I'm pulling up the claim to look at the diagnosis that was listed at the hospital.
[CUSTOMER][NEGATIVE] Yeah, they gave me a code, but I don't think it was the correct one.
[CUSTOMER][NEUTRAL] Cause um they're not trying to give me any codes. Like they told us, oh, we'll have to mail it to you guys. And then when they mail it, they only send me an itemized. I'm like, I don't need to itemize. I just need the, the agno's code, and they keep sending us the itemized mail.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] And that's the reason that it was denied um because of the diagnosis.
[AGENT][NEUTRAL] And I tell you what you can request from them. If you can request a it's a form called a U as umbrella, B as in Bravo.
[CUSTOMER][NEUTRAL] UB 4
[AGENT][NEUTRAL] Yep, that's it.
[AGENT][POSITIVE] You got it.
[CUSTOMER][NEUTRAL] Yeah, I think we did that. I'm not sure.
[AGENT][NEUTRAL] And that should give us the information, the diagnosis.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They, they always include the diagnosis on those EOBs, I mean, on the UBO4. Let me check one other thing.
[CUSTOMER][NEUTRAL] So I'm
[AGENT][NEUTRAL] Bear with me just one second, I'm checking this other one.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] I'm gonna check this other information.
[AGENT][NEUTRAL] See if that UVO4 is might happen to be there or any information.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] So I even went on health one and I don't even see that. Like I see an old ID number, that's it.
[AGENT][NEUTRAL] Yeah, I don't see a UBO4. If you can request that UBO4 from them, you shouldn't have any problems getting that and then just uploaded on your policy the same way you loaded these documents.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So I'm gonna have them call and make sure that's what they send us because they keep sending itemized bill. I don't understand why they keep doing that.
[AGENT][NEUTRAL] Yeah, and it shouldn't be a problem to get that UBO4. Have you requested that from them?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, and they keep saying it's like 15 to 30 days or something like that.
[AGENT][NEUTRAL] Well there is no time frame, so if, if they could provide that UBO4, I know you probably need your money.
[AGENT][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah, it's 336 I had to pay but.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] We're working on it.
[AGENT][NEUTRAL] And you know, for the future, you can always show your APL ID along with your primary insurance and the hospital or the provider should file a claim for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, you know what's so funny? They said that we didn't even have medical insurance.
[AGENT][NEUTRAL] Instead of making it what's that.
[CUSTOMER][NEUTRAL] And I'm showing them that is there and they said that we didn't have any.
[AGENT][NEUTRAL] What did they think you had? Did they say?
[CUSTOMER][NEUTRAL] I don't know. I said I work for a government, you know, we, they pay for our insurance.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] But they couldn't apparently it says inactive and I'm showing them that we're active so we we had that problem too.
[AGENT][POSITIVE] Absolutely.
[AGENT][POSITIVE] Oh my goodness.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] That is crazy.
[CUSTOMER][POSITIVE] Well I'm gonna call them and then get that out to you guys hopefully.
[AGENT][POSITIVE] Yes, sir, if you can do that, hopefully we'll be able to continue the process and and get that taken care of for you.
[CUSTOMER][POSITIVE] Oh thank you so much for your time.
[AGENT][POSITIVE] It's been such a pleasure to assist you, Mr. [PII]. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's all. Thank you.
[AGENT][POSITIVE] And thank you for calling APL. I hope you have a wonderful weekend.
[CUSTOMER][POSITIVE] You too, thank you.
[AGENT][POSITIVE] Thank you bye bye.
[CUSTOMER][NEUTRAL] Yes