AccountId: 011433970860
ContactId: b47a4edd-0133-422a-9bd6-4cb18eb5104a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 420519 ms
Total Talk Time (AGENT): 176432 ms
Total Talk Time (CUSTOMER): 155514 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/b47a4edd-0133-422a-9bd6-4cb18eb5104a_20250421T15:47_UTC.wav
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[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Thank you for calling ATL. This is Sa[PII]How can I help you?
[CUSTOMER][NEUTRAL] Hi Sa[PII]my name is Ho[PII]nd I am just calling to check the status of my son's claim. I had to upload some new information last week, but I don't see that anything has changed on when I log in.
[AGENT][NEUTRAL] OK, let's take a look, Ho[PII]Do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, my policy number is 24087.
[AGENT][NEUTRAL] Are you still there?
[CUSTOMER][NEUTRAL] Yes I'm sorry, I muted the phone because my dog is barking at the moment.
[AGENT][NEUTRAL] That's OK. I just got part of the policy number. I got the 2407, and then I need the rest.
[CUSTOMER][NEUTRAL] I'm sorry about that. It is 240573.
[AGENT][NEUTRAL] OK, so I copied down Ho[PII]40573, is that what you said?
[CUSTOMER][NEUTRAL] Uh ma'am it's 240-573-9.
[AGENT][NEUTRAL] OK, I missed the 9 at the end.
[AGENT][NEUTRAL] 573 9. OK. And then I just need to verify please Ho[PII]your date of birth and address.
[CUSTOMER][NEUTRAL] My date of birth is 9-[PII]Address is 18[PII].
[AGENT][NEUTRAL] Thank you. And then who is the claim on? Is it on uh which dependent?
[CUSTOMER][NEUTRAL] It's on Keenan
[AGENT][NEUTRAL] OK. Let's see.
[CUSTOMER][NEUTRAL] Keenan.
[AGENT][NEUTRAL] All right. So, I do see a recent claim it looks like from like the 18th that was denied. It looks like we requested diagnosis codes.
[AGENT][NEUTRAL] Um, and then that was what you had uploaded recently, is that correct?
[CUSTOMER][NEUTRAL] Um, they requested an explanation of benefits from my, um, provider, and then they also requested detailed billing from the hospital, so like my son had to call them and wait 24 hours and then go pick it up. So they sent over like with all the charge descriptions, the service date, and the pricing. I don't, I don't know anything about codes.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, yeah, cause now it's saying.
[AGENT][NEUTRAL] Looks like no diagnosis code provided. Receipt of your claim is acknowledged. How, however, in order to provide further consideration to this claim, we need supporting documentation to the evidence of the accident or sickness. This documentation can include but not limited to.
[AGENT][NEUTRAL] Uh, itemized bill with a diagnosis code, hospital admission or discharge summaries also will work. I don't know if it was a hospital or a physician.
[CUSTOMER][NEUTRAL] It was, he had surgery, yeah.
[AGENT][NEUTRAL] Um, so it looks like we do need that, um.
[AGENT][NEUTRAL] For the
[CUSTOMER][NEGATIVE] OK, so the, the, the detail, the second bill that we've provided is not enough.
[AGENT][NEUTRAL] I can double check the bill, but it looks like it's still saying that it needs a diagnosis code. I know that there are times whenever you request like an itemized bill, it'll just have CPT codes.
[AGENT][NEUTRAL] And what that is, is basically the procedure code as far as like what they did in the hospital, but what they're asking for is what was the diagnosis. We have the codes for what was actually performed, but what was the diagnosis.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] OK, this seems like a lot of jumping through hoops to get the information. I mean, obviously he was in the hospital. There's a $3000 bill, um, and he was in an OR because there's those charges there. So, I mean, I, I, my son physically went to this hospital and picked up that paper. And so it's just a little frustrating, um.
[AGENT][POSITIVE] Yeah, I'm sorry.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] It just seems like a way to get around not paying people if you want me to be fully transparent with you, but so I'm gonna call back to the hospital and tell them that this detailed billing that they provided is again not enough and I need coding.
[CUSTOMER][NEUTRAL] You said these codes aren't good enough, so what specifically does it need to what codes do they specifically need to put on the bill?
[AGENT][NEUTRAL] Just let them know that you need a diagnosis code on an itemized bill for the date of service.
[AGENT][NEUTRAL] And they can submit it or you can submit it um they can always file the claims on your behalf as well.
[CUSTOMER][NEGATIVE] I would not trust a hospital to have to go through all this that I'm having to go through for someone else. I really don't think they would do that. So diagnosis codes.
[CUSTOMER][NEUTRAL] On an itemized bill.
[CUSTOMER][NEUTRAL] And an admission and discharge summary to the hospital. He's never admitted to the hospital. He was in the emergency room, he had surgery, he went home. So my guess is there wouldn't be an admission.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] Yeah, and it doesn't, it doesn't have to be all of those, um those are just different options. So you can just submit the itemized bill with a diagnosis code or you could do an admission discharge summary if that was applicable, but we're not requiring all of that.
[CUSTOMER][NEUTRAL] Right?
[AGENT][NEUTRAL] It's an either or situation just stating that this would work or this would work, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK, I'll try to get back on the phone with the hospital. Thank you.
[AGENT][NEUTRAL] You're welcome, Ho[PII].