AccountId: 011433970860
ContactId: 2efcaf97-61c0-497f-b6bc-e0dbbde65658
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1530000 ms
Total Talk Time (AGENT): 854510 ms
Total Talk Time (CUSTOMER): 414080 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/2efcaf97-61c0-497f-b6bc-e0dbbde65658_20250401T22:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], it's [PII]. I've got an insured on the phone. Hey, her name is [PII]. Her policy number is 2402681.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And she has been verified the number she's calling from is a good call back. She's calling about claim number 3580187.
[CUSTOMER][NEUTRAL] The claim was denied needing itemized statement with uh admission and discharge dates on it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] She told me that she sent in her discharge summary that had her discharge.
[CUSTOMER][NEUTRAL] Our her, oh gosh, I got my tongue twisted, has her admission date and her discharge date and the times on it that the hospital is not giving her the information that she needs and they don't bill for six months, she said, and that she sent the same paper yeah she sent the same paperwork back um in [PII] and the claim was paid with it because they were asking that claim was asking for the same thing.
[AGENT][POSITIVE] Oh wow.
[CUSTOMER][NEUTRAL] And she's just wondering, she said she sent that with this claim.
[CUSTOMER][NEUTRAL] And she's just wondering if there's a something else that she can do she needs to talk to somebody to see if there's something else that can be done or can we request it or something that can help her get the correct information to us.
[AGENT][POSITIVE] Sure. Um, I'm pulling up the mail now. Um, so you can patch her through and I'll do my best to assist her.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thanks, [PII]. You take care. Bye bye.
[AGENT][POSITIVE] You're welcome. You too, thanks.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[AGENT][NEUTRAL] Ms. [PII]? Hi, can you hear me OK?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK hi my name is [PII] I'm in the.
[CUSTOMER][NEUTRAL] I'll switch over so you can hear me too.
[AGENT][NEUTRAL] I'm in the claim support team so I'm just taking a look to was giving me a little bit of information about why you're calling. So what I've done is pulled up the claim information that you submitted to us. So if you'll give me just a second, I'm gonna take a look here and see um.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][POSITIVE] Just what we've got here.
[AGENT][NEUTRAL] And
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] I see it's a discharge summary and [PII] said that there was some um information in here as to how long you were in the hospital. So basically that's what's going on with this um claim and that's why it was requested those discharge uh time uh date and time. It is a time sensitive benefit basically it means that um for in order for this particular benefit to pay we have to verify.
[AGENT][NEUTRAL] Um, how long you spent, um, in the hospital. And, and with this policy, it's 18 hours or longer to be considered inpatient. So just give me a moment and I'm gonna review this and see if we can't uh find those times in here.
[AGENT][NEUTRAL] Uh, because [PII] was saying that you were having a hard time getting the billing, is that right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And did that change from last year to this year? Because both times I stayed.
[CUSTOMER][NEUTRAL] The same amount of time and I mean they paid out on my last claim and took it off of my discharge information.
[AGENT][NEUTRAL] Yeah, I'd have to pull that up to see it. Let me just take a look real quick.
[AGENT][NEUTRAL] While I'm trying to wait for these pages to load my apologies, it takes a little bit of time.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Um, I'm not certain about that. I don't see that there were any charges, so it does look like you sent in the same type of information, but let me just, um.
[AGENT][NEUTRAL] Like I said, if I can determine that time we can have it reviewed, um.
[AGENT][NEUTRAL] So just bear with me for just a moment.
[AGENT][NEUTRAL] Sometimes that you have to kind of look for it through this paperwork and then sometimes it's right exactly where you think it will be so just bear with me.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Now they told you they couldn't get you the billing. Is there any chance um were you able to speak to somebody at the facility?
[CUSTOMER][NEUTRAL] Yeah, so this is a this hospital is.
[AGENT][NEUTRAL] You know
[CUSTOMER][NEUTRAL] And they've got 40 something campuses, so it takes months and months and months to build.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Because it doesn't tell me that I do see where they gave you the discharge documents and they time stamped it at [PII] on [PII], but it's not telling us the time of the admission and so that's what I'm trying to locate now if there's anything in these documents that tell us that, um.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm not finding that information. Like I said, it tells me that this charge was 2:19 and the time stamp again for the documents was [PII] So what we need to verify is that admission, uh, basically when you went into the facility, um, the date and time. So that's what we need to verify. And again, it's because of the benefit being sensitive. Let me just take a look. I'll, I'll see.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] If I can compare what we had last time.
[CUSTOMER][NEUTRAL] Well, the, the, the, I was gonna say the policy doesn't state that and they didn't ask me any of this the last time I literally sent the same exact document.
[AGENT][NEUTRAL] Well it it could be like I said that there was information in those documents that verified that for us so we didn't have to uh.
[AGENT][NEUTRAL] We didn't have to hold the claim up we had everything we needed so I'm just taking a look at that now. I mean it's possible like I said I could um.
[AGENT][NEUTRAL] I could try to help you obtain it usually um if you can't get the billing there's.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Just give me one moment, I'm taking a look at those other documents.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, there's a little bit more information on these documents than what we what they provided you with. There's actually the hospital course and everything was included in those documents for the admission that you submitted last year, um, and it does tell us that, uh, you know, it, it does verify that information for the admission and those documents, um.
[AGENT][NEUTRAL] And then there's also the discharge, uh, stamped on it as well, um.
[AGENT][NEUTRAL] So I think it that's that could be why there was a difference in what we were what we obtained for this claim this year than the one we had last year because like I said it really doesn't give us that um admit information, the admission information.
[AGENT][NEUTRAL] And like I said, because the policy does require it to be 18 hours or more, um, either you know a room and board charge or um like I said we can verify that it was 18 hours or more for like an observation status if there's no room and board charge um because that's like I said that for this particular policy that's what it requires now um.
[AGENT][NEUTRAL] Is it possible, uh, Ms. [PII], that I could send over to you an authorization form and what that entails is, um, I think.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] I don't see where um so when you submitted the claim last year you also included a claim form and it had that um that second page of the claim form is actually an authorization uh for for us to reach out on your behalf so I would be happy to try to reach out to them and see if I can obtain the information.
[AGENT][NEUTRAL] But in case uh they ask me for authorization I'm gonna need an up to date authorization from you um I can send a blank form over to you um and I can have you go ahead and complete that for me and upload it through the system and like I said I can try to reach out on your behalf. I can call medical records and see if they'll give me that information, but a lot of times they'll ask us for that authorization page would it be OK to send that to you?
[CUSTOMER][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Um, and go ahead and verify your email address for me.
[CUSTOMER][NEUTRAL] Uh-huh
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so I'm gonna send over that like I said that blank uh page to you usually we don't email because it's not secure means of transmitting information but because it's gonna be a blank form all you'll do is just sign your name um date and then there's a place to print it and like I said that just gives us.
[AGENT][NEUTRAL] Authorization to reach out on your behalf to the um hospital provider's office doctor's office or hospital and then um like I said now um I'm sure it's probably too late to contact them this evening um but if you'll go ahead and just complete that authorization for me and upload it through the portal um and I'll be looking for it and then I can do it first thing tomorrow morning once I have that authorization.
[AGENT][NEUTRAL] I will reach out to them and see if I can obtain the information for you so we can get uh the information that's needed to process the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then um would it be OK? I can go ahead.
[CUSTOMER][NEUTRAL] And I can
[CUSTOMER][NEUTRAL] I was definitely there longer than 18 hours because I admitted at [PII] on um the [PII] and they didn't get out until.
[CUSTOMER][NEUTRAL] [PII] on the [PII] and I, I was chomping at the bit to get out because that was my husband's birthday.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] I bet and nobody likes to be in the hospital anyway for anything or any day, but that's especially, I can understand.
[CUSTOMER][NEUTRAL] And I was in
[CUSTOMER][NEUTRAL] No, and I was, and I was on a heart unit and they wouldn't let anybody in.
[AGENT][NEGATIVE] Oh boy, that makes it even worse.
[CUSTOMER][NEUTRAL] So which is even right, so I couldn't even see him.
[AGENT][NEUTRAL] Yeah, I'm sorry. Well, I'm gonna send that authorization page to you and like I said as soon as you get that filled out, go ahead and upload it back through the portal and then um I'll try to contact them in the morning and see if I can obtain this information and I can call you at this number. [PII] provided me your callback number of [PII].
[CUSTOMER][NEUTRAL] No, she got that wrong it's [PII].
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] [PII], I could have maybe misspoke. That's my, I'm not sure if I just, I might have heard her wrong. So [PII].
[CUSTOMER][NEUTRAL] Oh, that's OK.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, and you know what? that's the number on my screen, so it was me. I apologize.
[AGENT][NEUTRAL] Um, but again, my name, my name is [PII], and I'm on the claim support team so like I said, I'll get this information in the morning. Um, I'll be in now you're in, uh, [PII], correct?
[CUSTOMER][NEUTRAL] That's that's OK.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, so we're on the same central time, so yeah, I arrive in I arrive in the office at [PII], so I will try to contact them um as soon as I'm able to and like I said, a lot of times they may give us the information over the phone but they may require me to send that authorization page over so that's why I'm gonna go ahead and send that to you um in the email and like I said just go ahead and upload it back through the portal and I'll be looking for it.
[CUSTOMER][NEUTRAL] OK, sounds good. And then while I have you on the phone, let me ask you just cause I don't know which one is, uh,
[CUSTOMER][NEUTRAL] Submit this under. My son is actually is also actually on this policy, um.
[CUSTOMER][NEUTRAL] And he has an ER claim. Dude drop the barbecue pit on his toe and almost cut his toe off last week. Um, do I put that under the accident or hospital since he went to the ER?
[AGENT][NEGATIVE] Oh no.
[AGENT][NEUTRAL] Well, let's take a look real quick.
[AGENT][NEUTRAL] You would actually wanna put it if it, if you have the accident policy you definitely wanna go ahead and submit it under the accident policy but let me check and see um.
[AGENT][NEUTRAL] And make sure you complete that accident claim form for the accident policy.
[AGENT][NEUTRAL] Um, but you do have some, you do have, um, emergency room benefit, uh, under the hospital indemnity as well. So, um, and you did go to the emergency room or was it like urgent care?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, we went to the emergency, we actually went twice, Saturday and Sunday.
[AGENT][NEUTRAL] OK, and that was for uh.
[CUSTOMER][NEGATIVE] It, it would not, it just wouldn't stop bleeding. It was insane.
[AGENT][NEUTRAL] Oh boy, and this was um is it for your dependent [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, alright, yeah, so um what will happen is you'll wanna go ahead and now under the accident policy when you submit the claim in the portal um it's gonna allow you to go ahead and upload it through that accident policy and then if you want to go ahead and submit the same information um.
[AGENT][NEUTRAL] For the uh hospital indemnity you don't necessarily have to fill out a claim form, but like I said, it is kind of helpful for this situation where we would like I said, if we need to or you would, you know, uh, want us to we could request that information.
[AGENT][NEUTRAL] Um, and sometimes it's necessary that you know we need to reach out anyway to those providers so when we have that authorization on file, it makes it a little bit easier and it doesn't hold up the claim because if there's something that's needed and we need to reach out, we have that authorization to do so, um, but once you submit it under.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, this one, this
[AGENT][NEUTRAL] Yeah, go ahead.
[CUSTOMER][NEUTRAL] This ER is a little bit easier to deal with because they're a standalone and so they have like their own little billing place. And I mean, I think last time I literally just called them and said, hey, I need um.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] A detailed with um ICD 9 codes and procedure codes I think is what the lady told me to ask for.
[AGENT][NEUTRAL] Yeah, ICD 10, uh huh, yeah, yeah, they changed a little, they changed that number that it's diagnosis and procedure codes, but yes, you're on the right track for sure, um, and a lot of times, yeah, a lot of times they will provide that.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK. So I'll, I'll just tell them.
[AGENT][NEUTRAL] And, and, and, you know, just.
[CUSTOMER][MIXED] OK, I'll tell them diagnosis and procedure codes, and they have it to me like within 2 minutes. They're so helpful over there. Methodist, unfortunately, is not.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Oh wow.
[AGENT][NEUTRAL] Yeah. Now,
[AGENT][NEUTRAL] Do you have a portal for Methodist?
[AGENT][NEUTRAL] Do you know? Do you have like a patient portal?
[CUSTOMER][NEUTRAL] I have a My Health chart.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I have on my health chart, but that's it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And on there let me see if they have a billing thing. They do have a billing thing let me see if there's anything in there.
[AGENT][NEUTRAL] And if they and if they don't have billing, the other thing that could be helpful and that's basically what I'm gonna ask for the information if I contact them.
[AGENT][NEUTRAL] I would ask them like there's a um a history in physical or is what they call it and basically that history and physical tells us, you know, that you came to the emergency room and they needed to do further work up on you and usually they'll kind of tell us you know exactly what happened but most importantly it usually has those dates and times on there so if we could get even that history and physical.
[AGENT][NEUTRAL] For your, uh, visit, um, we could use that as well you know I can I'll be happy to, um, you know, like I said whatever information we can get I'll be, you know, happy to take a look at the claim myself or have it reviewed so that we can go ahead and make that determination, you know, based on that information so if you're able to um go to through the portal sometimes they might have that.
[AGENT][NEUTRAL] Um, it's usually like a history and physical or even a discharge summary, and it's kind of like similar to what you send in that just kind of gives us the overview of the, you know, that aftercare summary when they discharged you, but if they have a discharge summary, they'll usually tell us that you were admitted like I said, if you went to the emergency room and then they decided they needed to um do further testing and keep you in observation or even put you up to a room, it'll be in that and in those documents as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Unfortunately, they do not have any of that in here. So I looked under billing and it's just a statement and that's it. And then um under hospital visit, they have a a view after visit summary and then clinical notes, um.
[AGENT][NEUTRAL] Ah.
[AGENT][NEUTRAL] Now do the clinical notes, are you able to see those?
[CUSTOMER][NEUTRAL] And that, that's it.
[CUSTOMER][NEGATIVE] I am, but they didn't put anything helpful in there, um, that I saw. This one's something about the use of Tramadol.
[AGENT][NEUTRAL] Not at all. Of course, right?
[CUSTOMER][NEUTRAL] This one which I ended up not even taking, it's all about usage of medication, which I didn't take any of the me oh wait, there is a discharge summary. Let me see if this helps.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Admission date [PII] discharge date [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] There's a discharge diet.
[CUSTOMER][NEUTRAL] Procedures. It's got my vitals.
[CUSTOMER][NEUTRAL] It still doesn't necessarily state a time. It just says start [PII].
[CUSTOMER][NEUTRAL] Um, I'm sorry, does that say [PII]? Yeah, it does, but I went in on [PII].
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh, see, and sometimes like I said that that kind of information could be um not so helpful because if they don't record the correct information.
[CUSTOMER][NEUTRAL] If it's for yeah.
[AGENT][NEGATIVE] Unfortunately.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] These are a lot of tests that they did.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] That's a collection of tests.
[CUSTOMER][NEUTRAL] Yeah, and that's all the way back to the 08.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] Yeah, it still doesn't have intake time.
[AGENT][NEUTRAL] Now are you able to um.
[AGENT][NEUTRAL] Are you able to upload that or save it to a file?
[AGENT][NEUTRAL] That information.
[CUSTOMER][NEUTRAL] Um, tomorrow at work I can.
[CUSTOMER][NEUTRAL] Tomorrow at work I can.
[AGENT][NEUTRAL] OK, because I was gonna say I'm gonna send this authorization page over to you now if you wanna um if you wanna include those documents in the file with this authorization I can also check that to see if I can find anything in there that would be useful otherwise like I said we're gonna reach out and see if we can obtain the information for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And then I'll give you a call either way and give you kind of an update.
[CUSTOMER][NEUTRAL] I don't know. What is 2, when they did, they did blood work but it says 2258, but I was there way before they ever did my blood work.
[AGENT][NEUTRAL] And it doesn't, there is nothing like a history and physical kind of form where it says, you know, like I said, where, where they might have, um, did you go through the emergency room?
[CUSTOMER][NEUTRAL] I mean they
[CUSTOMER][NEUTRAL] They have one called H&P, but I'm reading over it and it says, I mean, my name, my age, symptoms.
[CUSTOMER][NEUTRAL] But it doesn't have, it doesn't have a date.
[CUSTOMER][NEUTRAL] Past medical history?
[CUSTOMER][NEUTRAL] Surgical history.
[CUSTOMER][NEUTRAL] Medications prior to admission, current facility administered medications. It's got all that in there.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Symptoms, physical exam.
[CUSTOMER][NEGATIVE] Shows that my blood work looks terrible.
[CUSTOMER][NEUTRAL] But yeah, other than that, I mean, it doesn't have any admission times.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And this just says H&P by whoever it was, and they did it at [PII] on the [PII]. So, I mean, they entered that, I guess, after I've been there for several hours.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] That's not from the notes to sell medical education materials, friends and family updates. They didn't do any.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Those are the ones that I just looked at as notes from the care team.
[CUSTOMER][NEGATIVE] Yeah, definitely not, uh.
[CUSTOMER][NEUTRAL] That's just not allergic to.
[CUSTOMER][NEGATIVE] Yeah, unfortunately they didn't put any of that in there.
[AGENT][POSITIVE] Well, um, then we'll just go ahead and go through with, you know, like I said trying to obtain it, um, like I said, I'll I'll be happy that once I have that authorization, I'll go ahead and call them in the morning and see if I can't sometimes you get lucky and you get somebody that's helpful, real helpful, and they, you know, you tell them what you're calling for they'll they're, you know, we'll provide that information for you, um, you know, for me, um, which would be.
[AGENT][NEUTRAL] Uh, great, but sometimes it's not so easy, so, but like I said, at any rate, as long as I have that authorization if they ask me for it I have it and I can send it right over to them and hopefully get the information that we need.
[CUSTOMER][POSITIVE] OK, that sounds good.
[AGENT][NEUTRAL] OK, and I'm sending this to you now and it it's gonna come to you, um, say it's gonna come to you from the care team, um, from our care team here at at APL, um, but like I said, the authorization page will be attached as a PDF and you'll just go ahead and complete that and, uh, and just go ahead and upload it back through the portal and then if you wanna submit those uh additional claims uh for your dependent.
[AGENT][NEUTRAL] Um, like I said, I would put them under both policies, um, just so that you know that you filed them under the hospital indemnity as well as the accident policy.
[CUSTOMER][NEUTRAL] OK, I sure will.
[AGENT][NEUTRAL] And did you have any other questions, Ms. [PII]?
[CUSTOMER][NEUTRAL] I think that's it.
[AGENT][POSITIVE] OK, and I will again, I'll contact you tomorrow um at the number that we verified and let you know what I'm able to find out. Hopefully I'll have good news for you.
[CUSTOMER][POSITIVE] OK awesome thank you so much.
[AGENT][POSITIVE] You're welcome. Have a great evening. Thank you so much for calling APL.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.