AccountId: 011433970860
ContactId: 2405b8e2-523b-465f-964a-f79a7775d9f9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 558919 ms
Total Talk Time (AGENT): 214077 ms
Total Talk Time (CUSTOMER): 302586 ms
Interruptions: 5
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/2405b8e2-523b-465f-964a-f79a7775d9f9_20241230T19:43_UTC.wav
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[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hello, thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Hi, I was having issues, so I received a form today that my claims are not being paid for the ones I submitted for my son [PII].
[AGENT][NEUTRAL] Can I have a policy number?
[CUSTOMER][NEUTRAL] Yeah it's 016.
[CUSTOMER][NEUTRAL] 536-54
[AGENT][NEUTRAL] And what is your name, mailing address, and your date of birth?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII] and then my mailing address is [PII], and then my date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is your son's name and date of birth?
[CUSTOMER][NEUTRAL] Um, my son's name is [PII], [PII], and his date of birth is [PII].
[AGENT][NEUTRAL] And a callback number for you is [PII].
[CUSTOMER][NEUTRAL] Yes ma'am, uh, uh, do not eat Playto, sir, no sir.
[AGENT][NEUTRAL] Can I have the email address that we have on file for you?
[CUSTOMER][NEUTRAL] Yep, it should be [PII] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you're calling in regards to a claim?
[AGENT][NEUTRAL] Do you have a claim number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, we just need to.
[CUSTOMER][NEUTRAL] The reference number is 01.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] 016.
[CUSTOMER][NEUTRAL] Oh, it looks like it's the same, OK, um.
[AGENT][NEUTRAL] It should say claim number 3543738. Do you see that anywhere?
[CUSTOMER][NEUTRAL] Oh claim number 3543647.
[AGENT][NEUTRAL] Give it to me again.
[CUSTOMER][NEUTRAL] Um, it's 354-364-7.
[AGENT][NEUTRAL] So we need to um
[AGENT][NEUTRAL] Need the EOB, I mean, the um diagnosis.
[AGENT][NEUTRAL] The diagnosis codes for each data service. Well, it's inpatient, so you just need the diagnosis code to be sent into us. That's what we're requesting.
[CUSTOMER][NEGATIVE] From from me like I don't know how I'm supposed to send that to you because I don't, I'm not the doctor's office.
[AGENT][NEUTRAL] So you, you have to contact, right? I get that you're not the doctor's office, however, just like you call the insurance company and requested the EOB you can call the facility and request for an itemized bill with the the diagnosis listed on there and it definitely will be listed on there and it needs to be sent here to us.
[CUSTOMER][NEUTRAL] OK, because I guess what I was confused about is I like when I sent over the documentation I had highlighted the ones that I was talking about, not all of the Middleton ones if that makes sense. It was the [PII] ones.
[AGENT][NEUTRAL] Right, and those are the ones that we're requesting the diagnosis for. The ones for [PII] is not covered because we don't, your policy don't cover treatment in the office.
[CUSTOMER][NEUTRAL] Diagnosis codes.
[CUSTOMER][NEUTRAL] Yeah, I
[CUSTOMER][NEUTRAL] No, I knew that and that's why for this the submit that I sent over like I knew that wasn't like I don't know why that was included in there I guess maybe whoever looked at it.
[AGENT][NEUTRAL] But we have to
[AGENT][NEUTRAL] Cause we have to
[AGENT][NEUTRAL] We have to put in everything that was sent to us even if you have 10 things that you don't want us to add to the claim, but we have to add it because it was sent to us.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Gotcha. And then same thing, this does not provide a benefit for home healthcare services.
[CUSTOMER][NEUTRAL] Hold on, I'm so sorry because I'm looking at my other one for [PII], um.
[AGENT][NEUTRAL] We need the, the diagnosis codes for him as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, it says for home healthcare services. This all happened in the hospital though.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It wasn't
[AGENT][NEUTRAL] Orlando Health Home Care. No, I'm talking to myself about what like, what they, [PII] Home Health.
[CUSTOMER][NEUTRAL] I'm talking about
[CUSTOMER][POSITIVE] Yeah, that was the hot.
[CUSTOMER][NEGATIVE] Like, I don't know why cause that was, uh, the hospital never came to my home. That's what's crazy to me. That was like when he saw David Sonnenberg group in the hospital, so I don't know why that's even on there.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] I know, isn't that weird?
[AGENT][NEUTRAL] So, um,
[AGENT][NEUTRAL] Orlando Home Health, that's what it say Orlando Home Healthcare. So someone must have submitted a claim on your behalf.
[CUSTOMER][NEUTRAL] Cause I was like, I've never done home health.
[AGENT][NEUTRAL] For your son in [PII] for Orlando Home Healthcare, like he, once he got discharged from the hospital, then there was a nurse there or while he was at the hospital, there was a nurse watching him, sitting there watching him or something. I'm not sure, but it says it's from Orlando Home Health, so it must have been submitted with listed on the EOB that you sent in from the primary.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But if you say you haven't received any of that, I will call them. Google their name, Google Orlando Home Healthcare.
[CUSTOMER][NEUTRAL] Yeah, and those
[AGENT][NEUTRAL] And see
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEGATIVE] And then I guess the other one, OK, so diagnosis code for [PII] because that was the other one that I was like that happened in the hospital and our insurance doesn't cover. It's weird. I hate how hospitals they have these providers that you have no, what's it called like you have no say whether they can see your kids or not, they just see them after you have your kids and it's like.
[AGENT][NEUTRAL] Because they're not in network.
[CUSTOMER][NEGATIVE] Yes, it's so frustrating.
[AGENT][NEUTRAL] It's, it's crazy.
[CUSTOMER][NEUTRAL] Like, what do I say to them? Like, no, don't see my child.
[AGENT][NEUTRAL] But they're, they're credited into, they're credited at the facility though. That's uh that's crazy. Who's your primary insurance company?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, I'm
[CUSTOMER][NEUTRAL] Isn't it crazy?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] So we've changed like 3 times. So first, it was Aetna, which was covered under these guys, but Aetna kept denying all my claims cause they said, oh, your husband, who he had through through United Healthcare at the time, they're like, oh well, they provide, uh, what's it called, uh, for when you have the baby, the 1st 30 days of life automatically, but his specific employment plan did not. So I had a fight over 2 years with them for them to cover everything.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What?
[CUSTOMER][NEGATIVE] It's crazy. I, I kid you not. Like people are like, that's why this is such a late bill from [PII] because it took them so long. I had a $50,000 bill being like, oh no, your husband's insurance covers that. And I'm like, do I have to get on a recorded phone call with my insurance and his insurance to be like, no, our plan doesn't cover that. This is like an employee plan. This is not like the normal United Healthcare.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] And then it shouldn't matter because that shouldn't have mattered about your husband's policy because you're, so you had your own personal policy through your employer, right?
[CUSTOMER][NEGATIVE] That's why it's taking me so long.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Yeah, yeah, so I had Aetna.
[AGENT][NEUTRAL] So that shouldn't matter. Yours would have been primary, then his would have been the secondary. Like what? That, that, but it's the insurance company.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] I know, so it's taken me so long to get these stuff done, so that's why this one's so delayed, but um, yeah, we don't have gap anymore, but like I said, I'm still fighting with the insurance companies to all this other stuff in order. So, um, but yeah, so I will contact the facility for the diagnosis codes for [PII] and [PII], and I will, I just upload it to those, is that correct?
[AGENT][NEUTRAL] Mhm. Just upload them and you can reference for your son for Parker, for [PII]. Uh, what's
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Put um write down this claim number for him so when you submit the information they'll know that it's for this claim number.
[CUSTOMER][NEUTRAL] OK, hold on, let me get a piece of paper.
[AGENT][NEUTRAL] Let me know when you're ready.
[CUSTOMER][NEUTRAL] 0
[CUSTOMER][NEUTRAL] For [PII] let me write that.
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] It's 3543738. It's 3543738.
[CUSTOMER][NEUTRAL] That's.
[CUSTOMER][POSITIVE] OK, perfect. And what about [PII]?
[AGENT][NEUTRAL] [PII] is 354-3647.
[CUSTOMER][NEUTRAL] 543-543
[AGENT][NEUTRAL] 647.
[CUSTOMER][POSITIVE] 647. OK, perfect.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Nope, that is all. I will um get those diagnosis codes and send them over. Thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling ATL and have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye.