AccountId: 011433970860
ContactId: 0d47f50f-9843-4541-921f-8379a8a1b3bb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 900000 ms
Total Talk Time (AGENT): 435098 ms
Total Talk Time (CUSTOMER): 386124 ms
Interruptions: 6
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/0d47f50f-9843-4541-921f-8379a8a1b3bb_20250328T16:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. How are you? This is [PII].
[AGENT][NEUTRAL] Hi [PII], how are you?
[CUSTOMER][POSITIVE] I'm good thank you. Ready for the weekend and.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Um, I have a, uh, Ms. [PII] on the line. Um, she has a, um, ICU policy or critical illness, and, um, she said that, um, we are overlooking his her information for her husband's claim, um, because she said that she did send everything and they were just overlooking, so I don't know if you can help her with that.
[AGENT][NEUTRAL] I can certainly attempt to. What's the policy number?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's 472-533.
[CUSTOMER][NEGATIVE] And I'm transferring her because she sounds a little aggravated about it, so.
[CUSTOMER][NEGATIVE] I'm like, mm, yeah, I'm not even gonna try to tell her to wait 24 hours.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yeah, and it's Mr. uh [PII] is the patient.
[CUSTOMER][POSITIVE] Yes, she's a patient and I can is with [PII], the wife on the line.
[AGENT][NEUTRAL] And everything's been verified so.
[CUSTOMER][NEUTRAL] Everything's been verified and the callback number is
[AGENT][NEUTRAL] And I'm speaking to [PII].
[CUSTOMER][NEUTRAL] The one in the system. Yes, you're, you're gonna be talking to [PII].
[AGENT][NEUTRAL] [PII] that number listed as her call back.
[CUSTOMER][NEUTRAL] Yeah, the [PII].
[AGENT][NEUTRAL] OK, so it looks like uh they sent in a few things and we're asking for additional information she's saying that we have it, is that correct?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, she's saying that it's there that we're just overlooking.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alrighty, let me see what I can figure out. Go ahead please.
[CUSTOMER][NEUTRAL] Let me know when you're ready.
[CUSTOMER][POSITIVE] OK. All right, thank you. Have a good day. One moment, let me put her in.
[AGENT][NEUTRAL] You too, so. OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you for holding and being patient for you, Ms. [PII]. I got Ms. [PII] on the line. She's in the claims and support team and she's gonna assist you from here, OK?
[CUSTOMER][POSITIVE] OK, thank you. You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Hi there, good afternoon, Mrs. [PII]. My name is [PII]. I'm on the claim support team and I understand you have some uh additional questions just in regards to uh what we're uh requesting for uh Mr. [PII]'s claim, is that right?
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Well, yes, I sent the first claim. I thought that would be enough.
[CUSTOMER][NEUTRAL] Uh, y'all sent it back saying y'all needed more info, so I called and I talked to someone and they told me now that you had to have everything. So I went in there and I printed out everything because that's the only way you can do it now with Methodist is through the MyChart.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so I've done that. It breaks it down, you know, um.
[CUSTOMER][NEUTRAL] You know, regular room, ICU, all the medicine they done, everything.
[CUSTOMER][NEGATIVE] So I uploaded that. So now y'all sent me a thing saying this is a duplicate.
[CUSTOMER][NEUTRAL] When y'all can look at the original and see what you're looking to ask me for and that's what I'm trying to send you.
[AGENT][NEUTRAL] OK, so I'm just taking.
[CUSTOMER][NEUTRAL] It shouldn't be this hard. You can see when, I mean, I don't think we've ever used this over once and we've probably had it 20 some 20 plus years.
[AGENT][NEUTRAL] Uh huh
[CUSTOMER][NEGATIVE] But if I can, if they can't get done more better than this, I'm just gonna cancel everything I got with y'all and go with my other people that.
[CUSTOMER][POSITIVE] Take care of me just fine.
[AGENT][NEUTRAL] OK, I understand. Yeah, let me just take a look and see if.
[CUSTOMER][NEUTRAL] When my regular hospital was open.
[CUSTOMER][NEUTRAL] I mean this is
[AGENT][NEUTRAL] What we did receive, OK? I'm gonna look at each document, so bear with me for just a moment because I have to pull it up individually as they were sent in.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I am looking at the first submission so it looks like that was um the billing that we it gave the billing account details however it's not what we consider that detailed itemization so some of the services on that bill are um like for instance the the on the first I'm talking about the first um submission and that's what I'm I'm starting with that first time you send it in, OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Y'all needed more.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] That's when I called and she told me what all.
[CUSTOMER][NEUTRAL] I needed to send so I went back in and printed all that extra stuff out along with the same sheet.
[CUSTOMER][NEUTRAL] That I sent in the first.
[CUSTOMER][NEUTRAL] So that's what should be on the 2nd.
[AGENT][NEUTRAL] OK, and now I'm pulling that uh that list up so just bear with me please.
[AGENT][NEUTRAL] OK, so this one does list the itemization. however, let me just take a look here. I don't see.
[CUSTOMER][NEUTRAL] Uh, no, yeah.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] What what I sent you is all that I can get because Methodist Hospital has restructured their medical billing and there is nobody at any facility that I, I have stopped at 3 of them over here. I've wasted $600 of my time already.
[CUSTOMER][NEGATIVE] Um, by having to do this and not out making money when I'm on commission. So I have stopped and the doors are locked. I've called, I've left messages. Nobody will return. They have me a thing, how to go about getting it off of my chart on a, in a holder, post it up on the door. I've done exactly what they said and that's exactly what I sent you, and that's all I'm gonna be able to get my hands on.
[AGENT][NEUTRAL] OK, now um let me just ask.
[CUSTOMER][NEUTRAL] Unless you got a contact over Methodist.
[AGENT][NEUTRAL] Um, uh, not that I'm aware of. However, I will do my best to assist you here. So, um, it looks like I'm not certain why that was denied as duplicate because it definitely wasn't duplicate of it's part of what it, it was part of what we received that first submission.
[CUSTOMER][NEGATIVE] It was not.
[AGENT][NEUTRAL] However, it looks like what we're, what we are missing is a diagnosis code. So that diagnosis code would be the reason he was admitted to the hospital. Now, um you said you have access.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEGATIVE] Well, when the hell do I find out?
[AGENT][NEUTRAL] OK, and that's why I was just gonna ask you said.
[CUSTOMER][NEUTRAL] Yeah, I have access to my chart.
[AGENT][NEUTRAL] OK, OK, so, um, when he was discharged from the hospital, usually, um, there should be like an aftercare summary or a discharge summary, um, and usually what that contains is the day he was discharged from the hospital. Usually it will give you kind of a summary of, you know, it will have the patient's name and it will have the dates um of confinement, you know, in the hospital and then the reason why he was confined to the hospital.
[AGENT][NEUTRAL] Um, now, it may not be a, a diagnosis code. It could just be a description and we can use that as long as we can verify, like I said, the reason for the um admission to the hospital because that's the only thing that I see is missing at this point is we don't have that diagnosis. So again, that reason for uh uh admission. Now, usually, if you're able to find it on my chart, like I said, you can um
[AGENT][NEUTRAL] Uh, uh, it, it will give you, like I said, that description and usually what it contains in that information is like your next step whether he follows up with his primary care physician or if he's been referred to a specialist or usually kind of gives you that information for discharge.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEGATIVE] OK, well, I'm gonna try this one more damn time as, as what I'm gonna say, and if not, y'all usually get about $200 for me a month. I'm cutting you all out. I've wasted my money with y'all.
[CUSTOMER][NEUTRAL] When I, when Miss [PII] was still there, I never had an ounce of problem, but since she retired a few years back, I can't get nothing out of y'all.
[AGENT][NEUTRAL] Well, I'm, I'm, I'm sorry, like I, I, like I said, I, I do know that that this policy because it is that um intensive care, it does need that diagnosis.
[CUSTOMER][NEUTRAL] Nothing.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And you can see also how many times we've used it, how many times we've used it, and we've had it since probably the freaking 90s.
[CUSTOMER][POSITIVE] And here it is [PII]. You've made a heck of a lot more money off of me than 650 measly little dollars. It's what I got to say.
[AGENT][NEUTRAL] But is there any other questions I can answer for you at this time?
[CUSTOMER][NEGATIVE] No, except your company is just too hard to contend with. So I will try to see what I can say and if uh y'all deny me again.
[AGENT][POSITIVE] That's right.
[AGENT][POSITIVE] I'm, I'm sorry.
[CUSTOMER][POSITIVE] I will do that plus, I will also see what I can do, uh.
[CUSTOMER][NEGATIVE] By getting an attorney because this is just way too much.
[AGENT][NEUTRAL] Well, again, my.
[CUSTOMER][NEGATIVE] I wasted a lot, a lot of money with y'all.
[AGENT][POSITIVE] My apologies. I'm sorry. Um, it, it is, like I said, that requirement. So, and, and it's not that we're trying to hold it up, um, but I do apologize if you, I mean, um, and, and if there's any way I can assist you, I'd be happy to.
[CUSTOMER][NEUTRAL] Lot of money.
[CUSTOMER][NEUTRAL] I know
[CUSTOMER][NEUTRAL] Well, first off, can you tell me, Miss [PII], like I said, she was over, over our account for the Arkansas State Police for years, and then she got sick and had to retire, but they never gave us anybody else.
[CUSTOMER][NEUTRAL] So can you tell me he's actually assigned to my account?
[AGENT][NEUTRAL] I do not know and you're speaking of um like the person that was over like your administration, right? Yeah, I wouldn't have that information unfortunately so a lot of times they've, you know, if that person moved on they probably delegated that responsibility but um unfortunately I don't have that information so I'm not sure who would, you know, be facilitating that role now.
[CUSTOMER][NEUTRAL] The Arkansas State Police account.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Well it should be somewhere I want policy, so, but OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, norm yeah, normally.
[CUSTOMER][NEGATIVE] Whatever. I'm gonna try this. So do I, so tell me this before y'all go back all through this again saying it's a damn duplicate. If I upload another one, do I do a separate or is there a way that I can attach it to the second one I've done?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Well, I can give you the if you'd like to reference the claim number on it I can give you that now you don't need to send the itemization again um like I said you want to go ahead and just if you're able to obtain that discharge summary or it can be any anything related to this uh admission to the hospital that just like I said has the reason for the admission.
[AGENT][NEUTRAL] Um, and, and you know for that confinement to the, to the hospital, so, um, you can reference the previous claim number where we asked for that additional billing information so I can give you that claim number and.
[CUSTOMER][NEUTRAL] So I can put both claim numbers on there?
[AGENT][NEUTRAL] You can, uh-huh.
[CUSTOMER][NEUTRAL] OK, I'll try it again if not then um.
[AGENT][NEUTRAL] Do you have the, do you have the claim number, Mr. [PII]?
[CUSTOMER][NEUTRAL] I'm looking at I'm looking at everything on on the website.
[AGENT][NEUTRAL] You're on the website, OK.
[CUSTOMER][NEGATIVE] That's the reason I can't understand why y'all couldn't figure out and y'all just said it was duplicate instead of coming back and telling me that I needed this more.
[AGENT][NEUTRAL] Right, like I said, I, I'm not sure why that remark code was used. I would have used something different like.
[CUSTOMER][NEUTRAL] Well I mean you're in the claims department that's what you're for so you know that's.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, uh, right, and like I said, I can't.
[CUSTOMER][NEUTRAL] Whoever does all this, I need to let.
[AGENT][NEUTRAL] Yeah, I'm not, I mean, I can't speak on what, you know, the person.
[CUSTOMER][NEUTRAL] You know, they need to let people know if it's just something missing.
[AGENT][NEUTRAL] Right, um, and like I said, my apologies, like I said, it should not have been a duplicate. It should have been, you know, asking specifically what we needed. And like I said, by looking at it, because I do do claims, that's the only thing I see that is missing is that diagnosis code or again that reason for that admission and confinement.
[AGENT][NEUTRAL] And I will definitely put the notes in your uh in your file that you know we spoke and what we spoke about specifically.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][POSITIVE] Well, I'm fixing to try to find it right here and now and so I might call you back in a few minutes.
[AGENT][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] OK, do you want I can give.
[CUSTOMER][NEUTRAL] And make sure that this has gotten.
[AGENT][NEUTRAL] Sir, would you like me to um contact you or would you like me to, um, can I do that once you've, um, I can give you a few minutes and I'll check back on it. Um, I'm actually getting ready to go to lunch when I return from lunch. I'll take a look and if it's, um, I if it's there I'll go ahead and call you back and confirm it's what we needed.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that number I can reach you at [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, um, like I said, I've returned from lunch uh in about an hour and I'll call you back shortly after that once I see the documents uploaded and I, I can verify for you if it's what we needed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you have any other questions at this time?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK, I'll I'll call you back shortly.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you Mr. [PII]. Thank you for for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Bye.