AccountId: 011433970860
ContactId: a49fe2b9-7cf7-4aec-b318-d60a9b4097fe
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 323920 ms
Total Talk Time (AGENT): 188206 ms
Total Talk Time (CUSTOMER): 116301 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/a49fe2b9-7cf7-4aec-b318-d60a9b4097fe_20241230T18:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] over in customer care. How are you today?
[AGENT][NEUTRAL] I'm well. How are you?
[CUSTOMER][POSITIVE] I'm good thank you. I have an insured on the line. Her name is [PII] and she has a claim that she has some questions on. I was hoping you could help her with.
[AGENT][NEUTRAL] Sure, what's the policy number?
[CUSTOMER][NEUTRAL] Policy is 02270967.
[AGENT][NEUTRAL] And that's [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am, and I think there's just, it's just one claim in there um.
[CUSTOMER][NEUTRAL] So I did go into OnBase because she says that she submitted like the denial was for diagnosis codes and I did look at it. I'm not 100% if that was right what she submitted or not, so that's why I was hoping maybe you could help her.
[AGENT][NEUTRAL] Let's see. This is uh for cancer policy?
[CUSTOMER][NEUTRAL] Oh no, this was a hospital indemnity. Sorry.
[AGENT][NEUTRAL] Let's try.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Let me take a look if I can answer that because I don't process those that would be the HIQ but I can try to assist. Let's see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, did I call the wrong number? I'm sorry girl.
[AGENT][NEUTRAL] No, that's OK. Yeah. You came over to cancer uh disability.
[CUSTOMER][POSITIVE] Oh, I'm sorry.
[AGENT][POSITIVE] You. But no, that's OK. Send her over. I'll uh do my best to assist her.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Here she comes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], my name is [PII], and I was just calling um because I received a letter from APL stating that they received my claim.
[CUSTOMER][NEUTRAL] My claim forms and that they were reviewing it and I didn't, haven't heard anything else from you all, so I was and I just received a past due.
[CUSTOMER][NEUTRAL] Bill for $24,133 from [PII].
[CUSTOMER][NEUTRAL] And I was just wanting to know, should I go ahead and start paying or are y'all?
[CUSTOMER][NEUTRAL] You know, looking at my claim.
[AGENT][NEUTRAL] OK. Sure, Ms. [PII]. I can help you with that. And I do have your policy pulled up. Um, from what I can see, the most recent claim activity was [PII], where the claim was processed and we requested
[AGENT][NEUTRAL] Um, the diagnosis code. So we received the itemized bill, but nowhere on those documents does it have the diagnosis code.
[CUSTOMER][NEUTRAL] Where do I get that?
[AGENT][NEUTRAL] Which would be
[AGENT][NEUTRAL] Um, the hospital or doctor will have that information. It's basically, um, the diagnosis code is the reason for the visit or treatment. And, um,
[AGENT][NEUTRAL] In order to process the benefits we would need that code.
[CUSTOMER][NEUTRAL] OK, so if I call the hospital and get the diagnosis codes and they mail it to me or I mail it to you?
[AGENT][NEUTRAL] Yeah. Either way, you can um send it to us uh once you receive it, or if you wanna have them send it over to us. And anyway, we just need something for the date of service you're falling for that shows the diagnosis for that visit um and or treatment. So, yeah, you contact them and let them know that's what's needed, see if they can send that to you, um, mail, email, anyway.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And uh once you receive that you send that over to us and then the claim uh will pick up from um the process and it'll pick up from where it started right now it's it's not denied we're just requesting additional information.
[CUSTOMER][NEUTRAL] OK, alright, I'm gonna call them right now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. So be sure, uh, make sure you let them know it's the diagnosis code. Um,
[AGENT][NEUTRAL] And just they'll know what it is, but just uh for uh clarification for you is just the reason for the visit, the reason for the confinement.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So they can send it directly to you rather than sending it to me and then I'll send it to you?
[AGENT][NEUTRAL] They can. Um, I do know a lot of times, um, with, depending on the hospital, it may take a while before they send it. If you can get it directly to you, um, I feel like that would guarantee that we receive that because you'll send it to us. Um,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So yeah you can ask them to and also have them to send you a copy and then that way if um they take a while to get that over to us you can go ahead and send it to us as well.
[CUSTOMER][POSITIVE] OK, great. Alrighty, thank you very much.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No problem, Ms. [PII]. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Nope, I'm gonna call the hospital right now to get the diagnosis code.
[AGENT][POSITIVE] Alright, good deal. Well, uh thank you for calling APL and you have a great day.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thanks. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.