AccountId: 011433970860
ContactId: f6ae9a45-6f8f-43c5-9e39-ace3749f7a80
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 713580 ms
Total Talk Time (AGENT): 218854 ms
Total Talk Time (CUSTOMER): 230162 ms
Interruptions: 7
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/f6ae9a45-6f8f-43c5-9e39-ace3749f7a80_20250410T20:00_UTC.wav
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[CUSTOMER][NEUTRAL] tell me that.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] I'm calling to check on the claim.
[AGENT][NEUTRAL] OK. Is it for yourself or are you with the provider?
[CUSTOMER][NEUTRAL] It's I'm the ins it's for my husband, but I'm the insured.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, can I get your name and your policy number?
[CUSTOMER][NEUTRAL] Sure, sure, it's [PII] and I don't have my policy number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I know what I looked online, it's not even showing my accident policy anymore that I um sent in.
[AGENT][NEUTRAL] Um, let me look it up by your name.
[AGENT][NEUTRAL] OK, let me see what's going on. Um.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEGATIVE] Oh, they not, what the hell.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] OK, and you spell your first name [PII] Is that correct?
[CUSTOMER][NEUTRAL] I didn't do nothing about it and things still work there. There is the truth about days.
[CUSTOMER][NEUTRAL] I don't know to do that.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] design.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm. I had an accident policy that I turned in on before and also hospitalization.
[AGENT][NEUTRAL] This was on the group accident policy.
[CUSTOMER][NEGATIVE] Hospital indignity.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I show these are active. Um, which policy are you wanting to check on?
[CUSTOMER][NEUTRAL] What they want
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Uh, the hospital, the hospital indemnity and also the accident.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] I know they're active, but nothing's there. It's not showing.
[CUSTOMER][NEUTRAL] On accident anymore that I what I put in for 44.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] OK, and um let me verify just a few pieces of information. What's your birth date?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And your address?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And then your email address?
[CUSTOMER][NEUTRAL] Uh, sure, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And then lastly, do you have a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Still to this day.
[AGENT][NEUTRAL] OK, so you submitted a claim under the accident policy, is that right?
[CUSTOMER][NEUTRAL] In the hospital indemnity.
[AGENT][NEUTRAL] OK. And was it for, you said it was for yourself or your husband?
[CUSTOMER][NEUTRAL] My husband [PII].
[CUSTOMER][NEUTRAL] So you know.
[AGENT][NEUTRAL] Um, let's see
[CUSTOMER][NEGATIVE] A lot of all around. I think that I they rip them all out or they just like have somebody cut them off with that.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] What you got.
[CUSTOMER][NEUTRAL] I don't, I got to choose one thing so don't eat the food.
[AGENT][NEUTRAL] OK, it looks like we did receive a claim.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Looks like there are charges that were denied, and then there are charges that were requesting additional information.
[CUSTOMER][NEUTRAL] Why don't you say like I like you.
[AGENT][NEUTRAL] Let me see what we received.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] That was no.
[AGENT][NEUTRAL] What date of service was that for?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so we received a, looks like an itemized bill.
[AGENT][NEUTRAL] Um, or, well, it's not a bill. It looks like your invoice, I guess, from
[AGENT][NEUTRAL] The provider, let me see.
[CUSTOMER][NEUTRAL] I sent them a physician statement.
[AGENT][NEUTRAL] Looks like what we're missing is a diagnosis for what he was seen for.
[CUSTOMER][NEUTRAL] It's on there.
[AGENT][NEUTRAL] I see a list of all of the procedures.
[CUSTOMER][NEUTRAL] He had surgery.
[AGENT][NEUTRAL] Right, I do see a list of
[CUSTOMER][NEUTRAL] He had surgery, knee surgery.
[AGENT][NEUTRAL] Correct. I see, I see a list of all the procedures.
[AGENT][NEUTRAL] But I don't see a diagnosis.
[CUSTOMER][NEUTRAL] It's a knee surgery. It's on there. I mean, what else do you want us to turn in?
[AGENT][NEUTRAL] So you could ask the provider if they can provide you with a UBO4, that's an actual claim.
[AGENT][NEUTRAL] It shows us, because this doesn't have the diagnosis on it. It does list everything that the procedures that were done, but there's two parts that we need, and that's the procedures that were done, and then the diagnosis of why the procedures were done.
[AGENT][NEUTRAL] So that's what we're missing
[CUSTOMER][NEUTRAL] The physician's statements, the the physician's statement tells you that.
[AGENT][NEUTRAL] Um, I just have this itemized bill.
[AGENT][NEUTRAL] And it doesn't have a diagnosis code.
[CUSTOMER][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] You don't have the physician's statement?
[AGENT][NEUTRAL] This is for August or I'm sorry, [PII].
[AGENT][NEUTRAL] I have
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I have from OSA Health. This is not a bill.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then it goes on to list all of the dollar amounts and procedures. There is no diagnosis code that is listed on this.
[CUSTOMER][NEUTRAL] And, and then you have a physician statement that was turned down.
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] Did you submit that at a later date?
[CUSTOMER][NEUTRAL] No, actually, they submitted it before me and then I submitted it.
[CUSTOMER][NEUTRAL] It was there yesterday. I don't know what happened.
[AGENT][NEUTRAL] Let me pull up this other document. Give me one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I do see an attending physician statement.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] I don't know why it's not attached to this. OK. Um, let me see.
[AGENT][NEUTRAL] Our claims department is the one who looks at these documents and then determines how they pay um do you mind if I get you over to them and they can assist you with what's going on? OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Please.
[AGENT][NEUTRAL] Um, give me one, give me one moment. Hold on one moment, OK?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, [PII], this is [PII] on the care team. I've got an insured on the line that is checking on a claim status, um, and it looks like we got the physician's statement, but the claim is still, it's still denied for needing additional information, which I assume is the diagnosis, but the physician's statement has that, so she's wanting to ask questions on that.
[CUSTOMER][NEUTRAL] OK, and what was the policy number?
[AGENT][NEUTRAL] Policy number is 254.
[AGENT][NEUTRAL] 592 7.
[CUSTOMER][NEUTRAL] And the name of the person who's calling?
[AGENT][NEUTRAL] It's the insured, [PII].
[AGENT][NEUTRAL] Um, but it's for a claim on her spouse.
[CUSTOMER][NEUTRAL] And what was the policy number? I mean sorry, the claim number.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] The claim number is 35875552.
[AGENT][NEUTRAL] And it looks like right underneath it, there's a document, but it's all zeros and that's the physician's statement.
[AGENT][NEUTRAL] Not sure.
[CUSTOMER][NEUTRAL] OK, give me just a second.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, sorry, give me just a second just pulling up the information here.
[CUSTOMER][NEUTRAL] I can know what to tell her.
[CUSTOMER][NEUTRAL] OK, you can go ahead and transfer over.
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] And did you verify all her information?
[AGENT][NEUTRAL] I did. Yes, I did.
[CUSTOMER][NEUTRAL] OK, and what was the callback number?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][POSITIVE] OK great thank you.
[AGENT][POSITIVE] OK, thank you. Here you go.
[CUSTOMER][POSITIVE] Thank you for holding this is [PII].