AccountId: 011433970860
ContactId: 358e2a1e-3068-48b5-8ec6-69f4bb23be9b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 678679 ms
Total Talk Time (AGENT): 208584 ms
Total Talk Time (CUSTOMER): 215020 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/2025/05/15/358e2a1e-3068-48b5-8ec6-69f4bb23be9b_20250515T13:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I have a question concerning a claim.
[CUSTOMER][NEUTRAL] Can I give you the claim number or what, what do you need to look it up? The claim number is 3.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] 3601.
[CUSTOMER][NEUTRAL] 282.
[AGENT][NEUTRAL] Let me pull that up.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] [PII], if I can get you to verify, please.
[AGENT][NEUTRAL] Uh, date of birth and then address?
[CUSTOMER][NEUTRAL] Sure, my date of birth is [PII]. Address is [PII].
[AGENT][POSITIVE] All right, thank you so much. OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So it looks like
[AGENT][NEUTRAL] On this claim, it's showing the denial.
[AGENT][NEUTRAL] It says ambulance benefits are only payable if insured is admitted.
[CUSTOMER][NEUTRAL] Right, I printed off the claim thing. It's the only thing I'm questioning is it's kind of conflicting here. It says hospice care is only covered in an in hospice care facility, which he was for 5 days.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I unders I understand the one above that that it has to come from a hospital into that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] But it's just hard for me to believe that this policy designed for cancer is turning down 5 days in an in hospice care facility.
[AGENT][NEUTRAL] OK, let's see here.
[AGENT][POSITIVE] Good question, [PII].
[AGENT][NEUTRAL] OK. Um,
[AGENT][NEUTRAL] Let me get somebody.
[AGENT][NEUTRAL] I can look at the
[CUSTOMER][NEUTRAL] And he was also under the ambulance. He was admitted as an inpatient there for 5 days, and we had to have him transported of course by ambulance and he brought, he was brought home by ambulance also.
[AGENT][NEUTRAL] Mm. Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me get somebody on the line who is a claims examiner that can look at this to see if maybe there was just something you were missing on it um that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, and you know, I, I called initially the hospice facility and said I need copies of an itemized bill, yada yada yada, because I know what typically and when I got the Medicare statement, I thought, well, that shows what it is. It shows what the price was because the hospital now wants me to pay.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Right, yes, ma'am.
[CUSTOMER][NEGATIVE] A filing fee of $20 some dollars and then it's so much per page for the statement and.
[AGENT][NEUTRAL] Mm mm.
[CUSTOMER][NEGATIVE] You know, if it's only paying $50 a day for hospice, it's honestly, it's just not worth $250 for me to take half a day off work to go up there and pay all this money to get copies of something that.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] They filed with socials with Medicare.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And if nothing's payable I get the whole hospital thing I just you where I'm coming from I just.
[AGENT][NEUTRAL] Right, yeah, so.
[CUSTOMER][NEUTRAL] Need to make sure they considered both of those.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, um, yeah, absolutely. OK, let me get somebody on the line in claims. Is this number you're calling from a good call back if anything happens on the hold?
[CUSTOMER][NEUTRAL] No, no, let me give you my cell number. It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Let me um place you on just a brief hold, be right back with you, OK?
[CUSTOMER][POSITIVE] Thank you. Appreciate it. You are on hold.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Oh my gosh
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Ferring
[AGENT][NEUTRAL] She.
[CUSTOMER][NEUTRAL] For calling APL, this is [PII]. How can I help you?
[AGENT][NEUTRAL] Good morning, [PII]. This is [PII] over in customer care. How are you?
[CUSTOMER][NEUTRAL] Fine, how are you?
[AGENT][NEUTRAL] I'm good. Um, I have an insured on the line. Her name is [PII], and she's wanting to speak to somebody on a denied claim. I was hoping you could help with.
[CUSTOMER][NEUTRAL] What's the policy number?
[AGENT][NEUTRAL] 736958
[CUSTOMER][NEUTRAL] And which claim is it on?
[AGENT][NEUTRAL] It's 360-1282.
[AGENT][NEUTRAL] And her question on the denial is really the hospice not covered.
[AGENT][NEUTRAL] Um, she said that he was in a like hospice facility, um, and so she's just questioning why that was denied.
[CUSTOMER][NEUTRAL] Oh, OK, so this is on part 2. I was under part 1. Let me see.
[AGENT][NEUTRAL] Oh, yes, I'm sorry. Yeah, it's for [PII].
[CUSTOMER][NEUTRAL] See what we got here.
[AGENT][NEUTRAL] I looked at what she submitted, but.
[CUSTOMER][NEUTRAL] So you said it was in regards to the hospice care, you said?
[AGENT][NEUTRAL] Yeah, so that was really her biggest concern. Um, she said that.
[AGENT][NEUTRAL] She understood the ambulance, um.
[AGENT][NEUTRAL] Even though she said he was admitted, she's like, I guess it was an ambulance ride to the hospital admitted, and then back home. But really, the biggest one she was worried about was the hospice. She didn't understand why it wasn't being paid when it's a cancer policy.
[CUSTOMER][NEUTRAL] Mm let me see what did she send us here.
[AGENT][NEUTRAL] She said, I see the EOB. I see.
[CUSTOMER][NEUTRAL] You can see.
[CUSTOMER][NEUTRAL] Give me a second, let me pull up the certificate to see.
[AGENT][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] What the policy says about it.
[AGENT][NEUTRAL] I see it says hospice care center. I'm wondering now in my brain like, did she, did, did he just get hospice at home? I didn't ask that, but now I'm wondering if maybe that was the case.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] In a hospice care center, yeah, it has to be benefits for each day it received in the hospice care center.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So what we got was
[CUSTOMER][NEUTRAL] Just some EOB so you say the name of the.
[AGENT][NEUTRAL] Uh, I saw hospice, but let me see if I can find anything.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I'm looking at here.
[CUSTOMER][NEUTRAL] Mm, it looks like it could, it says, it says the name which is Northeast Georgia Medical Center, but it's
[CUSTOMER][NEUTRAL] Return home.
[CUSTOMER][NEUTRAL] So, I'm not sure if this was at home with the home healthcare.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] For the hospice care, I guess we'll have, I have to clarify that from her. And this is um Ms. [PII] on the line?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, we're speaking with Ms. [PII], and I have a callback number for that's different than the one she's calling from if you want it.
[CUSTOMER][NEUTRAL] OK, what is that number?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Yeah, no worries, [PII]. I appreciate you.
[CUSTOMER][POSITIVE] Mhm. You're welcome.
[AGENT][NEUTRAL] All right, here she comes.
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] Claims department this is [PII].
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII].
[CUSTOMER][NEUTRAL] Hi.