AccountId: 011433970860
ContactId: ead263e7-6798-4ef0-aee1-3aa6d6d12181
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 702760 ms
Total Talk Time (AGENT): 287281 ms
Total Talk Time (CUSTOMER): 212955 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/ead263e7-6798-4ef0-aee1-3aa6d6d12181_20250103T18:44_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes, um, I have sent in some documents to file a claim for hospital and accident indemnity, and I just wanted to verify that you received them.
[AGENT][NEUTRAL] OK, so you just need to verify that we received the claims under the hospital and didn't need an accident policy for you?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I can help you with that. And may I ask who I'm speaking with?
[CUSTOMER][NEUTRAL] This is [PII].
[AGENT][NEUTRAL] And Ms. [PII], in case this call is disconnected, may I have your callback number?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you. And do you have your policy number?
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] It's 244-506-7.
[AGENT][NEUTRAL] Thank you, and it was 244-5067?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And Ms. [PII], can you please verify your mailing address?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And can you also verify your date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And for our records, can you verify your email address?
[CUSTOMER][NEUTRAL] Uh [PII] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And this is a claim for yourself?
[CUSTOMER][NEUTRAL] Uh, for my husband.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't show any claim under your hospital indemnity for him. Let me check the accident policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not showing any claim on file. When did you submit the claim?
[CUSTOMER][NEUTRAL] Um, I submitted them. Let's see, I've got my, uh.
[CUSTOMER][NEUTRAL] Let me find the I faxed them in.
[CUSTOMER][NEUTRAL] Um, let me just find it.
[CUSTOMER][NEUTRAL] Confirmation of the fax.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] Sorry, take me a minute. I just have to scroll through my email here real quick.
[CUSTOMER][NEUTRAL] Uh, looks like the hospital one was sent in on [PII].
[AGENT][NEUTRAL] OK. Let me take a look.
[CUSTOMER][NEUTRAL] And I'm looking for that other one here.
[AGENT][NEUTRAL] OK. I do show we did receive it. It looks like it was actually processed under you in error. The documents are not clearly legible that we have. Let me take a look.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] It look a little blur at the documents that we received.
[AGENT][NEUTRAL] And did you submit them by fax or how did you originally submit?
[CUSTOMER][NEUTRAL] Yeah, like that.
[CUSTOMER][NEUTRAL] Yes, by fax. The other one, the hospital was sent in on uh [PII], and it was sent through fax also.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I take a look at the information that we received a little further. Give me one moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding, Ms. [PII]. So yeah, it looks like we did receive it under both policies, but it looks like since some of the documents were not legible, it was processed under you. So I'll get a request in to get those processed under the correct um member. Also it looks like in reviewing some of the documents under the, it looks like, so you found this for the dates of service of [PII], is that correct for under both policies?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, that, that sounds correct, yes.
[AGENT][NEUTRAL] So it looks like as far as the accident policy, it looks like from the information that we have, we're not able to determine exactly um the time that he was admitted and the time that he was discharged from [PII] to [PII] from the information that we have.
[AGENT][NEUTRAL] So we're needing information that provides that what time he was admitted on [PII] and what time he was discharged on [PII] because it doesn't list the observation hours on the billing that was received.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So if you can get that information to us, we can further proceed as far as those particular benefits on the claim.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] So it looks like that's what was missing as far as the accident claim, and then I'll make sure these claims get processed under the correct member. On the hospitals, so these are the same.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The same document information, I'll have it sent over to the hospital claim cause for some reason the, when the facts came in, some of the pages are not really legible. They were reason we kinda had to decipher some of the information from what was submitted submitted.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] So if you can get that information over to us, if you have that information.
[CUSTOMER][NEUTRAL] OK. Um, I can contact the um emergency room and see if they have a report that shows his admission and discharge time.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then when I do I just fax it back to the same number and do I need to um what do I need to indicate on that fax?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh, the fax number because it looks like you possibly faxed it. You didn't have the correct fax number and so it was forwarded over to us. So the correct fax number [PII] is [PII].
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh yeah that's where I faxed it.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that's, that will be the same fax number that you're wanting to fax it to. So yeah, we will need that information to determine if the duration of how long he was confined in order to consider the hospital benefits under the accident in the hospital indemnity policy as well.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So the, the accident, um, when he originally went to the hospital to the emergency room, um, we went to the hospital that was closest to us. Um, and they, they're the ones that saw him. They just kind of wrapped it up. They said that they couldn't handle the injury that he had. And so they referred us to the other hospital, and that's where he actually went and had the surgery. Um, so is that,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So there was an accident where he went, initially went to the emergency room. They kept him under observation, they cleaned it. They wrapped it up for him, referred us to the um hand surgeon, and then he went to that hospital. It was a different hospital the next day. So do you need the information for
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The actual surgical portion also when he had that done.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] We, we're just needing the information as far as when, when he was those, the dates for [PII] 3[PII]17 looks like he was at Intermountain Medical Center.
[CUSTOMER][NEUTRAL] For the 2
[CUSTOMER][NEUTRAL] Uh, he was, well, it said, um, American Fork Hospital is the name of it, but I believe it belongs to the same network, the Intermountain Health.
[AGENT][NEUTRAL] From the
[AGENT][NEUTRAL] I do see we got information for 3:15. He was at American Fork where it looks like he was admitted in the ER and discharged the same day. And it looks like the following day, 316 to 317, he was seen at Intermountain Medical Center from the billing that was submitted to us.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, so the 3, the American Fork Hospital, that is when the accident occurred, and they're the ones that initially saw him and took care of the triage portion of this accident. And then the 3, 16 to 17 is when he had the actual surgery, when he saw the hand surgeon and went in for surgery.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, yeah, we will need the 316 to 317 information. So, under the accident, we'll consider the emergency room since we have that information for the 315, but as far as the 316, 317, once we receive that information from you, then we can proceed with um processing those benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and is that for the hospital portion or the accident portion?
[AGENT][NEUTRAL] Yes, for the hospital for the hospital and accident. Under the accident policy, you must be confined at least 18 hours or more for hospital benefits and under the hospital indemnity, you must be confined at least 24 hours or more. So, once we have that information, um, we can proceed with those hospital benefits under the accident in the hospital indemnity.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, perfect. OK, I will gather that information and uh I will fax it over to the same number.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I think that's everything. I really appreciate your time.
[AGENT][POSITIVE] OK, you're welcome. Thanks for calling APO you have a good day.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][POSITIVE] You're welcome bye.