AccountId: 011433970860
ContactId: d2344a6c-2f6a-49ca-a6d3-a9ee75f59c45
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 502450 ms
Total Talk Time (AGENT): 145154 ms
Total Talk Time (CUSTOMER): 263491 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/d2344a6c-2f6a-49ca-a6d3-a9ee75f59c45_20250319T22:02_UTC.wav
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[AGENT][POSITIVE] Good afternoon thanks for calling APO this is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hi, Ms. [PII], it's [PII] in the care team. I've got, um, hey, I'm good. How are you doing?
[AGENT][NEUTRAL] Mhm. How are you?
[AGENT][POSITIVE] Good.
[CUSTOMER][NEUTRAL] I've got Miss [PII] on the phone. She is the spouse of the insured and he has given consent for us to talk to her. The policy number is 258.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 3787.
[CUSTOMER][NEUTRAL] They have been verified and the call back number is the one they're calling from.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And they are calling about claim number 357-7656.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I read the remarks to her and she is stating that she has sent in everything that we have been requesting.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And she just wants to know and I know what specifically said for accident or sickness that she needs to send in the diagnosis code for.
[CUSTOMER][NEUTRAL] And so she's questioning that also, but she just has further questions after I gave her the remarks.
[AGENT][NEUTRAL] OK, you can send her on over.
[CUSTOMER][POSITIVE] OK. Thanks, Ms. [PII]. Have a good night. Bye-bye.
[AGENT][POSITIVE] You're welcome. You too. Thanks.
[AGENT][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], um.
[AGENT][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] My name is [PII]. We were just on the phone, my husband and I with uh um another lady, and I was actually.
[AGENT][NEUTRAL] To me, yes, ma'am.
[CUSTOMER][NEUTRAL] Um, I was asking her about my husband's, um,
[CUSTOMER][NEUTRAL] Coverage because we sent in a claim last Thursday um and we sent in the itemization of the hospital services, the UVO4 um and uh just trying to see what is covered on.
[CUSTOMER][NEUTRAL] His uh policy.
[CUSTOMER][NEUTRAL] Because now it's asking, they're asking for more um information to see if it was an accident or sickness. And I'm like, I thought what he, what we were paying for was if you are hospitalized, whether accident or sickness, you would be able for these funds.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I, uh
[CUSTOMER][NEUTRAL] Uh, she was, she wasn't real sure, so she said let me get you to a claimant examiner. So that's why she referred me to.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. That's fine. OK. So I was, I was looking back through the information that you sent over. So we have to have something with the diagnosis code on it from the, from the hospital. And so I do see the UBO4 that they gave you, but it doesn't have the diagnosis code listed at the bottom of that form.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, so we would need.
[CUSTOMER][NEUTRAL] OK, so.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] OK, so how do we, how do we get that? What do we need to do?
[AGENT][NEUTRAL] So you would probably have to contact them again to let them know that you need uh the UBO4 that has the diagnosis code listed on it. Or uh let me ask you this. The, did he go to the emergency room or do you all have the discharge information?
[AGENT][NEUTRAL] From the hospital?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] He did go to the emergency room and I do believe um he has his
[CUSTOMER][NEUTRAL] Discharge papers.
[AGENT][NEUTRAL] Yes, and um, OK, on the discharge information, does it list why he was uh admitted or why he went to the emergency room?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, I, I, I think.
[CUSTOMER][NEUTRAL] I think so. I just have to look, look through it, yeah, this is discharge, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And he, OK, um.
[CUSTOMER][NEUTRAL] Uh, let's see, I'm sorry.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um, it's just, OK, let's see.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] It says a lot of difference. I'm so sorry.
[AGENT][NEUTRAL] OK. That's OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] This one says nephrotic syndrome.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] This one.
[CUSTOMER][NEUTRAL] Talked about blood pressure here. Um
[CUSTOMER][NEUTRAL] This one is postural orthostatic.
[CUSTOMER][NEUTRAL] Tachycardia syndrome.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so I guess.
[AGENT][NEUTRAL] OK, and so, and those were all the, all that information is from this hospital state that he just had that you submitted the claim information for, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so is there any way you can submit that to us and we can review that to see uh if we can use that information?
[CUSTOMER][NEUTRAL] Um, sure, I can, um, I can fax it, um, tomorrow morning.
[AGENT][NEUTRAL] OK, that'll be fine.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have a fax number?
[CUSTOMER][POSITIVE] I do. I sent the um yes ma'am, I do.
[AGENT][NEUTRAL] OK, OK, uh, yes ma'am, you can send that over and we can review it and to see to make sure that's what we're needing it sounds like it is, but I would rather review it just to uh be sure.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][POSITIVE] OK, I'll fax it over in the morning. OK, thank you.
[AGENT][NEUTRAL] OK, alright, was there any did you all have any other questions for me?
[CUSTOMER][NEUTRAL] No, ma'am, we were just confused over that, um, and like his, the benefits.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, we weren't sure if it was any hospital stay or if it was just for accident or just for sickness.
[AGENT][NEUTRAL] OK, no, it has to, uh, any of our policies, you know, it has to be, you know, we have to be sure that what you went in for was due to, you know, a sickness or accident because we will pay for those. So, you know, if it's something that's not due to a sickness or an accident, then those things are not payable and but in order for us to determine that we have to have the diagnosis code which is basically the reason why you went in for medical treatment.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, OK, OK, that makes sense because the, the, like I said, the lady I was talking to, she wasn't, she was trying her best but she wasn't sure and I was steady asking questions. She was like, you know what, let me get you a claim examiner and we can go from there. So thank you. OK, I'll send that off in the morning.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Alrighty
[AGENT][POSITIVE] Well thank you guys for calling APL and you have a great rest of your day.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] All right, bye.