AccountId: 011433970860
ContactId: a9addbae-6ca9-42c6-a7a0-4911437e8301
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 579570 ms
Total Talk Time (AGENT): 196859 ms
Total Talk Time (CUSTOMER): 248180 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/a9addbae-6ca9-42c6-a7a0-4911437e8301_20250527T15:25_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][POSITIVE] Yes ma'am. How are you doing?
[AGENT][NEUTRAL] I'm fine and yourself?
[CUSTOMER][POSITIVE] Good good um.
[CUSTOMER][NEUTRAL] I'm just following up the claim I make for the.
[CUSTOMER][NEUTRAL] One bill I get from the hospital?
[AGENT][NEUTRAL] OK, I can verify the claim status for you and your name is?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the policy number, please?
[CUSTOMER][NEUTRAL] The member, the member ID?
[AGENT][NEUTRAL] Policy number or policy certificate number?
[AGENT][NEUTRAL] Should start with 01 or 02?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Alright, give me one second here we go.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Let me get the card.
[CUSTOMER][NEUTRAL] All right. So, the number [PII].
[CUSTOMER][NEUTRAL] 99829
[AGENT][NEUTRAL] Uh, it's not one of our policy numbers. Are you looking at a car from APL?
[CUSTOMER][NEUTRAL] Uh, I'm looking from the card, yeah.
[AGENT][NEUTRAL] And it shows AL.
[CUSTOMER][NEUTRAL] You know the the the insurance card.
[CUSTOMER][NEUTRAL] Group ID and the member number.
[AGENT][NEUTRAL] No, sir. Um, spell your first and last name for me, please.
[CUSTOMER][NEUTRAL] His first name is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Last name [PII]. Last name [PII], [PII]
[AGENT][POSITIVE] OK, thank you so much, give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And Mr. [PII], verify your date of birth, mailing address, and the email address for me, please.
[CUSTOMER][NEUTRAL] So [PII] email [PII].
[CUSTOMER][NEUTRAL] Address [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And you said you're calling about a claim status, correct?
[CUSTOMER][NEUTRAL] Yes no.
[CUSTOMER][NEUTRAL] About the I went to the ER, the hospital bill.
[AGENT][NEUTRAL] OK, what was the date of service?
[CUSTOMER][NEUTRAL] Alright, let me see the.
[CUSTOMER][NEUTRAL] Give me 1 2nd
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] I show we received a claim on the [PII] of this year, this month and it's in line for processing.
[AGENT][NEUTRAL] And looking at the claim information, we will need billing or um.
[AGENT][NEUTRAL] Walkout statement showing the diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] Yeah, I mean, my question, yeah, I went to the ER that was weekend.
[CUSTOMER][NEGATIVE] And um I say like 2 hours, you know, just AKG whatever the bill say but this is what not uh what I um I was promising to get because when I signed it was like they cover 70% of the bill.
[CUSTOMER][NEGATIVE] And 30, 30% from my pocket. That's what I signed for and they asked too many times and this is the answer they gave me. Now I'm surprised they cover only $1000 from $4000 or whatever the bill.
[CUSTOMER][NEUTRAL] You know what I mean?
[AGENT][NEUTRAL] I hear you, but the type of policy you have with us is a limited medical indemnity plan. But I'm just saying, looking at the information you submitted, uh, we will need the billing, showing diagnosis and procedure codes or itemized bill with those, especially diagnosis codes, cause it's not listed on the bill that you submitted.
[CUSTOMER][NEUTRAL] What do you mean?
[AGENT][NEUTRAL] On the bill that you submitted along with the claim, it doesn't have a diagnosis code. Uh, diagnosis code will let us know the reason for the ER visit.
[CUSTOMER][NEGATIVE] Well, well, yeah, well, that's good. So I, I have to call to follow up. So I have to call the hospital or whatever and they ask you, I mean, they send you the, the reason why because the EKG, I was not feeling good. I was at like a, you know, a pinch on my heart.
[CUSTOMER][NEUTRAL] So when that was the weekend, the, the, my doctor was closed, I called the doctor and the nurse, she asked me what kind of symptoms do you have because the symptoms didn't go away like all day. That's why she was like, sir, don't waste your time, go to the ER. So I did the.
[CUSTOMER][NEUTRAL] You know, the AKG like whatever the the bill say.
[CUSTOMER][NEUTRAL] So what do you need the code I have to find out the code and the email it to you or what is, I mean this is.
[AGENT][NEUTRAL] Uh, we will need the billing, showing the diagnosis code. Uh, you can call the billing department, um, at the hospital and request the itemized bill showing the diagnosis code.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEGATIVE] Oh, OK. Well, how come they never send me email? So now I have to follow up. You see how how many times I have to spend at least 2 hours every day for this bill, you know.
[AGENT][NEUTRAL] We don't respond, we don't send emails in regards to a claim being received. We'll send out an explanation of benefits once the claim has been processed.
[CUSTOMER][NEUTRAL] Well I.
[AGENT][NEUTRAL] But your claim hasn't been processed yet. As a courtesy, I'm reviewing your claim and the billing we have does not have diagnosis codes that will be needed in order to process the claim.
[CUSTOMER][NEUTRAL] For what
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Give me one second because I'm really stressed out now too much going on. So if I call the hospital, what I'm gonna ask for the code for.
[AGENT][NEUTRAL] The itemized bill showing the diagnosis and procedure code, the diagnosis.
[CUSTOMER][NEUTRAL] I send it uh I sent the uh that's what I have. I send it by email. I have the, I mean, I have the email I sent.
[CUSTOMER][NEUTRAL] I have the AKG.
[CUSTOMER][NEUTRAL] The price for EKG, the emergency room, laboratory, radiology, diagnostic. I have it. Do you have this detail? I send it by email with the, with the, with the form I I signed.
[AGENT][NEUTRAL] Yes, I I'm looking at what you saying, but I'm just letting you know it does not have diagnosis codes needed to process the claim, and that can put a a delay on any kind of claiming process because more likely if they process it, process is needing itemized bill showing diagnosis codes.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So now I'm gonna call the hospital and ask for diagnostic code, right?
[AGENT][NEUTRAL] Itemized bill with the diagnosis codes. Yes, sir.
[CUSTOMER][NEUTRAL] And they I'm gonna email it to you or email it to the same one I emailed the the the form.
[AGENT][NEUTRAL] Uh, you can mail it or fax it or set up on an online service center or you can upload it. Claims cannot be sent via email because our email is not secure. So it's best to either mail or fax it, and I'll give you a fax number if you like.
[CUSTOMER][POSITIVE] Thank you, go ahead.
[AGENT][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. So [PII].
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Correct?
[CUSTOMER][NEUTRAL] And then I'm gonna ask for the diagnostic code and the.
[CUSTOMER][NEUTRAL] What the
[CUSTOMER][NEUTRAL] Bill a bill, right?
[AGENT][NEUTRAL] The itemized bill showing diagnosis and procedure codes. Yes, sir.
[CUSTOMER][NEUTRAL] What's that?
[CUSTOMER][NEUTRAL] O
[CUSTOMER][POSITIVE] OK, thank you, ma'am.
[AGENT][NEUTRAL] Uh, yes, sir. And is there anything else, Mr. [PII], I can assist you with today?
[CUSTOMER][NEUTRAL] No, that's all I'm gonna call the hospital now too.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] To provide me with this information, thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too. Bye bye.