AccountId: 011433970860
ContactId: ce82ee1a-0b00-4d96-a20d-27acc2eb3a1b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 189139 ms
Total Talk Time (AGENT): 96058 ms
Total Talk Time (CUSTOMER): 91129 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/ce82ee1a-0b00-4d96-a20d-27acc2eb3a1b_20250422T18:47_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm an agent broker and I'm calling, uh, following up regarding a Med gap claim that we had submitted for a member.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status, and [PII], may I have a good contact number in case we're disconnected and then the policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sure, area code [PII].
[CUSTOMER][NEUTRAL] And the policy number is 2019733.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] And that's for [PII].
[AGENT][NEUTRAL] OK, and I have the policy here and can you verify the date of birth for me?
[CUSTOMER][NEUTRAL] Uh, yeah, his date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment, let me look for the claim. OK, well, there's only one. Hold on one second.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure, yeah, there's one, yeah, on 47.
[CUSTOMER][NEUTRAL] That we submitted and it's a data service for 1226 of 24.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK, so it looks like as of [PII], the claim is not, there's a denial code, but it's not denied. It's requesting additional information. So, it says we've received the claim, however, for further consideration of the loss, please provide supporting documentation to um
[AGENT][NEUTRAL] Sorry, please support, please send in supporting documentation to evidence the accident or sickness. Supporting documents could be itemized billing with the diagnosis code, super bills, office notes, hospital admission and discharge summaries, or diagnostic testing.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] So basically whatever was received, it didn't have the diagnosis.
[CUSTOMER][NEUTRAL] OK, with diagnosis codes. OK.
[CUSTOMER][NEUTRAL] Yeah, um, OK, OK, so I'll go ahead, yeah, we had the EOB, uh, from the carrier. OK, so hospital will need to provide us with an itemized bill with diagnosis code. OK, that would be the, what is it, the UB 92.
[AGENT][NEUTRAL] UB 04.
[CUSTOMER][NEUTRAL] Yeah, OK, 04, I'm sorry, yeah, UB 04. OK, alright, I'll go ahead and.
[AGENT][NEUTRAL] If it's a hospital.
[CUSTOMER][NEUTRAL] Yeah, it is, it is a hospital, so it'd be the, yeah, yeah, and that on that UBO4 is the uh diagnosis on there? I don't think so, right? Isn't that separate?
[AGENT][NEUTRAL] It is? OK, OK, yes.
[AGENT][NEUTRAL] No, yes, sir. The, the UB has the diagnosis code, the procedure code, basically everything from that day they had surgery, yeah, everything.
[CUSTOMER][POSITIVE] OK perfect so it's got everything.
[CUSTOMER][POSITIVE] OK, OK, OK, perfect. I'll go ahead and have the member request that information.
[AGENT][POSITIVE] Alright, well, was there anything else I can help you with today? You're very welcome.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] No, that should be it. Thank you so much. You have a great day.
[AGENT][NEUTRAL] Alright, [PII]
[AGENT][POSITIVE] You also, and thanks for calling APL.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.