AccountId: 011433970860
ContactId: a091f9fb-22fb-4383-abdb-b2e956500935
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 340279 ms
Total Talk Time (AGENT): 109103 ms
Total Talk Time (CUSTOMER): 206492 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/a091f9fb-22fb-4383-abdb-b2e956500935_20250102T17:16_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] funny.
[CUSTOMER][NEUTRAL] Hi, I have a question. Um, I had called previously and gotten the information and the form sent so that I could complete a claim. So as I was working on completing the claim.
[CUSTOMER][NEGATIVE] All right, so in this case, my husband cut his finger on a fence and like 4 days later he ended up having to go to the emergency room. The first emergency room that we took him to, we didn't have any bills from because that was included on his insurance. The charges that I paid that I'm submitting for reimbursement is from where they had to transfer him to for a specialist to look at his wound.
[CUSTOMER][NEUTRAL] So as I'm completing the form, there's the physician's form that I guess I need to get, I need to send to the hospital for them to complete, is that correct?
[AGENT][NEUTRAL] Um, let me pull up your policy. What is your first name?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Last name [PII]
[AGENT][NEUTRAL] OK [PII], what is a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and [PII], do you have your policy number?
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] 7671767121
[AGENT][NEUTRAL] Can I get
[AGENT][NEUTRAL] OK, let's see here.
[AGENT][NEUTRAL] And [PII], can you confirm your date of birth, your address, and your email address for me?
[CUSTOMER][NEUTRAL] [PII]. My address is [PII].
[AGENT][NEUTRAL] OK and the email address?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. Now you as far as the provider statement that's the one you're worried about, correct?
[CUSTOMER][NEUTRAL] Well, I'm not so, well, I guess I have two questions then. My first question is, I will have to send that to just an emergency room at the hospital because treatment was done, so it wasn't like it was our family care physician. So do I just get with the hospital for that? But as I was filling it out before I started seeing who to send that to.
[CUSTOMER][NEUTRAL] We went to one emergency room, and again, his insurance, because I guess that one was in network, I didn't get any bills from them, but they ended up having to transfer him to a separate facility, which was a separate owned hospital. That's the one that has the bills that I'm submitting for the reimbursement. So, but then I got to thinking about it. Do I need to have one for each one of the facilities or just the one that I'm seeking the reimbursement from that bill?
[AGENT][NEUTRAL] OK, let's start with the claim form um the provider statement on the claim form, it does not need to be completed that's gonna be extremely hard to get completed, especially with you going to the emergency room. um, you're never honestly you're never gonna locate that same provider or physician.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I, I
[CUSTOMER][POSITIVE] I, I thought so, but they told me they, she had to email me because the website it's really hard to find the claim form, so she ended up the first person I spoke to sent it to me and I'm like, um, this is probably gonna be super fun to try and get.
[AGENT][NEUTRAL] Um, so what you'll need to do is go to both hospitals and just obtain an itemized billing statement and make sure that it has the diagnosis code on there that will give us all the charges and the reason for the visit.
[CUSTOMER][NEUTRAL] OK, I have that what but do I need it for both where he started and where he transferred or just to the one that he got transferred to that I have the bill from that I that wasn't covered from both of them or just from one of them?
[AGENT][NEUTRAL] You're gonna need both of them because more than likely what's gonna happen is on the initial visit the one that was already paid it's gonna have the initial encounter diagnosis and then on the one that he was transferred to more than likely it may have a follow up diagnosis, not the initial encounter diagnosis.
[CUSTOMER][NEUTRAL] Yeah, because this
[CUSTOMER][NEUTRAL] OK, yeah, because and like I said it was all because of a cut from the accident he had on the fence, um, and then he actually ended up having to stay the night because they needed to make sure that it wasn't in the bone from I don't know, um, all right, so all I need to do is complete the top portion, everything but the physician's statement and then submit that with an itemized bill from each one of the facilities and our print out from his insurance company as well where it showed the charges because I have that.
[AGENT][NEUTRAL] You don't
[AGENT][POSITIVE] You don't even need um as long as the itemized bill from the hospital has all the charges and the diagnosis code you don't have to send anything from your insurance company.
[CUSTOMER][NEUTRAL] OK, they had just said on the first one that I need to send which we had because this happened back over the summer. I just got to thinking about it and I'm like, I think I have a policy that covers it, that covers accidents. So all right, OK, I will work on.
[AGENT][NEUTRAL] Yeah, as long as you have those itemized bills you don't have to send that insurance information as long as the charges are on those itemized bills.
[CUSTOMER][NEUTRAL] OK, and then where am I gonna scan that to once I get that?
[AGENT][NEUTRAL] Um, if you have access to the portal, you can upload your claims through the portal or you can, um, you can fax it or you can mail it. You have three options.
[CUSTOMER][POSITIVE] OK all right thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] No, ma'am, that's it.
[AGENT][POSITIVE] OK, well thank you for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] his
[CUSTOMER][POSITIVE] Thanks bye bye.