AccountId: 011433970860
ContactId: dac6cec6-e0fe-46a3-b27d-4977504afd76
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 352890 ms
Total Talk Time (AGENT): 139883 ms
Total Talk Time (CUSTOMER): 92105 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/dac6cec6-e0fe-46a3-b27d-4977504afd76_20250214T16:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes, good morning, [PII]. My name is [PII], and I, we saw a claim. The claim number is 3563361.
[AGENT][NEUTRAL] OK, I can help you with the claim. Can I get your um callback number first just in case our call is disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and then what is your policy number?
[CUSTOMER][NEUTRAL] 02110350
[AGENT][NEUTRAL] 02110.
[CUSTOMER][NEUTRAL] 350.
[AGENT][NEUTRAL] What was the rest of it?
[AGENT][NEUTRAL] 350. OK, let me look that up.
[AGENT][NEUTRAL] OK, Ms. [PII], what is um your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank
[AGENT][NEUTRAL] Thank you. And verify the address, a phone number and email address on the policy, please.
[CUSTOMER][NEUTRAL] The address is [PII].
[CUSTOMER][NEUTRAL] The email on the policy I believe is uh [PII] [PII].
[AGENT][NEUTRAL] OK, and then the cell phone number that's on the policy?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. I appreciate you verifying the policy. So was the um claim for yourself?
[CUSTOMER][NEUTRAL] Yes, it was for me. I had surgery in December.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me look real quick.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, we've got a few remarks on your claim, um.
[AGENT][NEUTRAL] The first one is, please provide a diagnosis code for this state of service. This information may be obtained from your physician.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] The next remark is this.
[CUSTOMER][NEUTRAL] So what was submitted was not.
[AGENT][NEUTRAL] Right, they need.
[CUSTOMER][NEUTRAL] What was submitted from the hospital was not uh.
[AGENT][NEUTRAL] Right, they need the diagnosis code.
[CUSTOMER][NEUTRAL] The right diagnosis codes?
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEGATIVE] And then the next remark is this policy does not provide a benefit for surgical procedures.
[AGENT][NEUTRAL] And then we have another remark that office visits are not covered by the policy.
[AGENT][NEUTRAL] And um physical therapy and occupational therapy, speech therapy or or any other types of therapy is not provided as a benefit.
[CUSTOMER][NEUTRAL] You know, and I understand that I knew that it was um because if you stay overnight in the hospital.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] The medical records from the Artesia General Hospital were submitted with a claim and.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They all had a, a code.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, that's what it's asking for um is.
[AGENT][NEUTRAL] A diagnosis code and this is this was sent through the online service that it was not sent by the um let's see.
[AGENT][NEUTRAL] Yeah, it was sent by in the online service center.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] But it's basically asking for the diagnose code to be submitted.
[CUSTOMER][NEUTRAL] The diagnosis code.
[CUSTOMER][NEUTRAL] So what you have the 6, the 4 pages that are attached to the claim.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Don't have the diagnosis code?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEGATIVE] The summary code is not.
[AGENT][NEUTRAL] Not for the um let's see.
[AGENT][NEUTRAL] The diagnosis code has not been provided for the hospital stay.
[CUSTOMER][NEUTRAL] Hm, OK.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, I'll call them again and find out what's going on.
[CUSTOMER][NEUTRAL] Because I had asked him for a breakdown with the diagnosis code and.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I had to drive to go pick that up and.
[CUSTOMER][POSITIVE] But OK, thank you.
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] You're so very welcome. I hope you have a happy [PII], Ms. [PII]. Thank you so much for calling APL.
[CUSTOMER][POSITIVE] Thank you you as well bye.
[AGENT][NEUTRAL] Bye-bye.