AccountId: 011433970860
ContactId: 3970be1b-f039-4058-a26c-2a5ccf9ef312
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 352630 ms
Total Talk Time (AGENT): 187091 ms
Total Talk Time (CUSTOMER): 82951 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/3970be1b-f039-4058-a26c-2a5ccf9ef312_20250129T16:27_UTC.wav
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[AGENT][NEUTRAL] [PII] this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes, I was calling about a claim that I did for my insurance.
[CUSTOMER][NEGATIVE] Um, it says that it was approved, but it didn't give me any other information.
[AGENT][NEUTRAL] OK, so you're just checking on the status of the claim?
[CUSTOMER][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK, I can help you with that. And may I ask who I'm speaking with?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Hey, Ms. [PII], in case this call is disconnected, may I have your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And may I have your policy number, please?
[CUSTOMER][NEUTRAL] Wait what?
[AGENT][NEUTRAL] Your policy number?
[CUSTOMER][NEUTRAL] Uh, give me just a second, let me.
[CUSTOMER][NEUTRAL] 3556109
[AGENT][NEUTRAL] That wouldn't be the policy number. Was that the claim number that you gave me? It sounds like that's the claim number.
[CUSTOMER][NEUTRAL] Yes, I think, yeah, I believe it's the same number. I don't.
[AGENT][NEUTRAL] And that was 355-6109?
[CUSTOMER][NEUTRAL] 6109 yes.
[AGENT][NEUTRAL] And can you please verify your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And can you also verify your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And for our records, can you verify your email address?
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, I do show this claim was processed. It was processed.
[AGENT][NEUTRAL] On the [PII]. It looks like on this particular claim it for dates of service for [PII]. Looks like there were for um a surgical procedures that were performed. This policy does not cover for surgical procedures on the policy.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] OK, then what is the purpose of this thing? If I would have known that, I wouldn't have been paying so much on my insurance. You guys don't cover anything then, pretty much.
[AGENT][NEUTRAL] Looks like the coverage that you currently have is you have the hospital admission benefit and a hospital confinement benefit, but those benefits does not cover for the surgery itself.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Was there a was he, was there a hospitalization where they, where they were confined as inpatient?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And she stayed over, yes.
[AGENT][NEUTRAL] OK. Because this policy only covers for hospitalization if confined at least 24 hours or more. If she was confined at least 24 hours more, then we would need the itemized hospital billing that provides the admin and discharge information.
[CUSTOMER][NEUTRAL] Yeah, I sent that.
[CUSTOMER][NEUTRAL] Yeah, I sent all that in.
[AGENT][NEUTRAL] Let me take a look and see exactly what documents we have.
[AGENT][NEUTRAL] OK, so the only thing that I showed that we did was we only received the surgeon's bill.
[AGENT][NEGATIVE] I don't see that we receive any hospital bill.
[AGENT][NEUTRAL] We would need the actual hospital, the itemized hospital billing that provides the day.
[CUSTOMER][NEUTRAL] That's what it is because it has the code, it has all the codes and surgical procedures and everything on that. That's what they told me to turn in.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] This is.
[AGENT][NEUTRAL] Yeah, this is the actual, this is not the hospital bill. This is for the physician charges, which is the surgeon.
[AGENT][NEUTRAL] This is a surge in charges bill that you submitted to us.
[AGENT][NEUTRAL] That will be a different, the hospital bill is a different bill that I actually have the hospital's name listed and it'd be an itemized list of services received during the hospitalization and it'll provide us with the day.
[CUSTOMER][NEUTRAL] The hospital's name is on there.
[CUSTOMER][NEUTRAL] It shows the hospital name on there. It says Love Heart Hospital.
[AGENT][NEUTRAL] There's
[AGENT][NEUTRAL] But this is
[AGENT][NEUTRAL] Right, but the, this is the surgeon's bill, not the hospital. We can't determine benefits based off the physician's charges.
[AGENT][NEUTRAL] We will actually need the Lubbock Heart Hospital billing, which indicates the day and time they were admitted and discharge cause the policy only covers if they were confined at least 24 hours or more. I'm sorry, 18 hours or more.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you have, so if you, or even if you have the admin discharge summary that provides the day and time that she was admitted and discharge, we can also use that.
[CUSTOMER][NEUTRAL] Alright then
[CUSTOMER][NEUTRAL] OK, yeah, because she was, she went in on the [PII] and was released the [PII].
[AGENT][NEUTRAL] OK. Yeah. So, yeah, we would need the actual hospital billing cause even this the surgeon's bill here says that they were admitted on [PII] in discharge [PII]. So we would need the actual hospital billing with that information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that's gonna be all. Thank you.
[AGENT][POSITIVE] OK, you're welcome. Thank you for calling APO you have a good day.