AccountId: 011433970860
ContactId: efb06c28-ff71-4c65-900d-0ba0f310fd71
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 528770 ms
Total Talk Time (AGENT): 221795 ms
Total Talk Time (CUSTOMER): 235249 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/efb06c28-ff71-4c65-900d-0ba0f310fd71_20241230T17:32_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Calling APL, my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Hello, how you doing, [PII]? Uh, I previously spoke to someone because I was getting ready to file a claim, um.
[CUSTOMER][NEUTRAL] For the data service 1022 to 1029, um, I was calling because they said that before I my client I have to upload the um I have to upload the uh diagnostic code with it as well, OK, um, I have uh my spouse who's on my APL as well. She, um, um, she was admitted for one week.
[CUSTOMER][NEUTRAL] Um, for critical illness like with, with the baby cause she's pregnant and um they were saying that I need a diagnosis code. I received a diagnostic code and I just wanna make sure it's the correct thing, the correct thing to put on there.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'd be happy to assist with this claim today. um, first I'll need to gather some information. um, what is your policy number?
[CUSTOMER][NEUTRAL] Um, one second.
[CUSTOMER][NEUTRAL] It's 2552435.
[CUSTOMER][NEUTRAL] You said
[CUSTOMER][POSITIVE] You pretty good did you?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, and if I can get your name, date of birth, and email address.
[CUSTOMER][NEUTRAL] Um, my name is [PII] Last name [PII] Date of birth is um [PII].
[AGENT][POSITIVE] Thank you for that information Mr. [PII].
[AGENT][NEUTRAL] OK, and you said um they sent you the diagnosis code for her hospitalization?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, she told me over the phone. I'm gonna make sure it's the correct thing, OK, um.
[CUSTOMER][NEUTRAL] Because I have the EOB itemized to upload the claim, but I know you guys need the diagnostic code as well, so, um, she sent me and I was want to confirm that it's the correct thing to put on it before I file.
[AGENT][NEUTRAL] OK, what did she give you?
[CUSTOMER][NEUTRAL] She gave me a code of.
[CUSTOMER][NEUTRAL] It says
[CUSTOMER][NEUTRAL] Um, 9299291.
[AGENT][NEGATIVE] OK, that is not correct. What she gave you was a procedure code and that procedure code means that she has 74, 30 to 4 minutes of critical care. What we need is the diagnosis code which says why she was in the hospital. Like, for example, pneumonia, COVID-19, the flu.
[CUSTOMER][NEUTRAL] OK, so what
[AGENT][NEUTRAL] Kidney disease.
[CUSTOMER][NEUTRAL] It, it would be alright she went with critical illness, so that would be 10.1, correct?
[AGENT][NEUTRAL] OK, there we go.
[AGENT][NEUTRAL] OK. So that's what we, we need that code.
[AGENT][NEUTRAL] We need that code.
[CUSTOMER][NEUTRAL] But I just wanna make sure is that specific enough or is that, you know.
[AGENT][NEUTRAL] No, that's fine. So they couldn't give you that on any paperwork. Does she not have any discharge papers for when she was discharged that says why she was treated?
[AGENT][NEUTRAL] Because we need official medical documentation.
[CUSTOMER][NEUTRAL] Um, I mean, I talk.
[CUSTOMER][NEUTRAL] I mean, I called and tried to get the correct um the, the one, OK, because um I called and tried to get it, but they, they were not, they kept giving me revenue codes and the code I just gave you was like you said was incorrect. So, but um she was admitted because she's um she's pregnant and she lost 60 pounds and um.
[CUSTOMER][NEUTRAL] And the lady said that like critical illness, so I'm asking is that good on you guys and as critical illness? Is that considered critical illness? Cause I have the code for critical illness.
[AGENT][NEUTRAL] Well, see, that's
[AGENT][NEUTRAL] But that's the thing, we need official medical documentation. We just can't.
[AGENT][NEUTRAL] Have you write it on the paperwork? We have to have official medical documentation. That's why I'm asking is there any way she can get a copy of her discharge paperwork because that will say why she was hospitalized, but we need something official.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] From them.
[CUSTOMER][NEUTRAL] Yes, I'm sure I can try to get on her discharge papers. Um, I can try to get her discharge paper, yes. But um, I mean, I went to the hospital and I was um for critical illness and I filed a claim that was processed already and um it was critical illness and I was provided with the um correct DS code to put on there which was J10.1.
[AGENT][NEUTRAL] That's a code for influenza.
[CUSTOMER][NEUTRAL] Oh, OK, so it's more you need a more specific code basically.
[AGENT][NEUTRAL] Right, unless she had influenza.
[CUSTOMER][NEUTRAL] Oh no, she's pregnant and they admitted her because she was having a high risk pregnancy and
[AGENT][NEUTRAL] OK. So, call them back, let them know that you either need a, and I'm, unless you're, I don't know if they'll give it to you unless you, your wife is consenting to getting it. But you need her either have them send you a copy of her discharge paperwork showing why she was hospitalized or the hospital billing because they know what you need.
[AGENT][NEUTRAL] To file a claim because they send claims all the time so they know exactly what you need.
[CUSTOMER][NEUTRAL] The hospital.
[AGENT][POSITIVE] Yes, they know what you need.
[CUSTOMER][NEUTRAL] OK, so you be your um.
[AGENT][POSITIVE] They know exactly what you need.
[CUSTOMER][NEUTRAL] Um, the lady told me.
[AGENT][NEUTRAL] If you can get a UB from them, then that would be great.
[AGENT][NEUTRAL] Because that's what they send to get their money.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, so that, OK, because she said she would send one in the mail, but it takes 15 to 30 business days, but last time I was sick, I called and I I was received over the phone with the actual code for when I was sick.
[CUSTOMER][NEUTRAL] For the influenza, so.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I mean,
[CUSTOMER][NEUTRAL] So basically the more specific code.
[AGENT][NEUTRAL] It's not a more specific code, it's.
[AGENT][NEUTRAL] It we need official documentation from
[AGENT][NEUTRAL] From the provider we can't get it we can't just take it from you.
[AGENT][NEUTRAL] We have to have something official, some, some form of paperwork, official medical documentation from her provider or from the facility where she was.
[AGENT][NEUTRAL] Hospitalized stating her diagnosis.
[AGENT][NEUTRAL] What she's sending you in the mail is what you need, that you be that is what you need, that and the explanation of benefits from your primary insurance, those are the two pieces of information we need to pay a claim. So she's sending you what you need is just you want to expedite the process, but if you want to expedite the process, then y'all are going to have to get some type of discharge paperwork that says on there.
[AGENT][NEUTRAL] Hey, Miss [PII], you were seen, you were hospitalized. This is why you were hospitalized and it, it goes into detail and says, here's what you were diagnosed with and why you were treated. That's what we need if you want to expedite the process and you don't wanna wait for the UB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and that, but um, so, um, that, that discharge paper and they have to have a code with it as well. I have to say that it has the code with it as well.
[AGENT][NEUTRAL] It doesn't have to have the cold. It can just say, hey, Ms. [PII], you came into the ER and we treated you for um dehydration. It just has to say why she was there.
[CUSTOMER][NEUTRAL] Oh I I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, the description, OK, yes ma'am.
[AGENT][NEUTRAL] There, there we go, so you understand now?
[CUSTOMER][NEUTRAL] OK. So
[CUSTOMER][POSITIVE] Yes, yes, yes, I do.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, so, alright, alright, thank you so much, um, um, I just call you guys back later when I get those things because I'm currently at work, so when I get the, the discharge paper out, I mean.
[CUSTOMER][NEUTRAL] I'm good to submit my claim because I had to itemize and I had the EOB. I just needed that or the UBO.
[AGENT][NEUTRAL] Just need the diagnosis.
[CUSTOMER][NEUTRAL] All right, OK.
[AGENT][NEUTRAL] OK, was there anything else I can assist with today?
[CUSTOMER][POSITIVE] Uh, no, thank you, that's everything. Thank you.
[AGENT][POSITIVE] Well thank you for calling APL you have a good day.
[CUSTOMER][NEUTRAL] Alright you as well.
[AGENT][NEUTRAL] Mhm. Bye bye.