AccountId: 011433970860
ContactId: 3f5fe22d-0217-4b3c-a9ab-d17b557eafab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 486260 ms
Total Talk Time (AGENT): 188117 ms
Total Talk Time (CUSTOMER): 264616 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/2025/02/19/3f5fe22d-0217-4b3c-a9ab-d17b557eafab_20250219T14:50_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Um, hi, my name is [PII], and I'm calling in reference to, um, a claim I submitted.
[AGENT][NEUTRAL] OK. And Ms. [PII], do you have that uh policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am, um.
[CUSTOMER][NEUTRAL] It's 007.
[CUSTOMER][NEUTRAL] 20563
[AGENT][POSITIVE] OK, thank you so much. Give me one moment. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, thank you. And verify your date of birth, mail address and email address, please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, [PII] [PII] and the email is [PII].
[AGENT][NEUTRAL] OK, thank you, Ms. [PII]. You say you're calling about a claim that was processed?
[CUSTOMER][NEGATIVE] Yeah, they, they sent me back some stuff they wanted. I've spent 3 days and um.
[CUSTOMER][NEUTRAL] It's been crazy, but uh
[CUSTOMER][NEUTRAL] I just wanted to talk to someone about it. Um, I have a claim number. Do you want that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, yes, ma'am. What's that claim number?
[CUSTOMER][NEUTRAL] 3562288
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] OK, it looks like we're needing the itemized surgeon's bill as well as the diagnosis code for this data service of [PII].
[CUSTOMER][NEUTRAL] Yeah, and I thought I said because I'm looking at it right now from the hospital.
[CUSTOMER][NEUTRAL] And when I, I'm pretty sure when I looked on there, did I not send nothing? Because
[CUSTOMER][NEUTRAL] I thought I uploaded that.
[AGENT][NEUTRAL] Uh, let me see what we were seeing.
[CUSTOMER][NEUTRAL] So I went and got an itemized, yeah, I went and got another itemized statement. Um, I got an itemized statement from the hospital and it has all the codes, anesthesia.
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It looks like all their CPT codes are there HCPSC codes are there.
[CUSTOMER][NEUTRAL] Um, there, I said, well, who was that anesthesiologist and I got a last name, not a first name. I've been trying for 3 days.
[CUSTOMER][NEUTRAL] Um, from the hospital to the doctor, to who else did I call?
[CUSTOMER][NEUTRAL] Hospital doctor
[CUSTOMER][NEUTRAL] Someone told me to Google it. Um.
[CUSTOMER][NEUTRAL] I'm like the hospital has to know what groups but this is on there so I don't know if I just didn't upload this because this has everything on it that you're asking for.
[CUSTOMER][NEUTRAL] It looks like to me, I don't know. It says it's an itemized statement from the hospital.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Yeah, then it's showing this is for charges for the facility. They're needing the actual surgeon's bill because also on the billing for the hospital, it does not have the procedure codes for the surgical procedure, um, and it also doesn't have the description code or the diagnosis code like um that would state if it was for that looks like a colonoscopy, if it was for a screening or if it was for diagnostic for sickness. So,
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh, but I'm, I don't know if you have the last page of that. Um, it says diagnostic.
[CUSTOMER][NEUTRAL] And there's codes there so I don't know if that didn't upload.
[AGENT][NEGATIVE] I don't think so because the only um it looks like only one page has come through.
[CUSTOMER][NEGATIVE] Oh, that's the problem because on the last page it says diagnosis and then it has 12345 codes with exclamations next to it because I had an upper GI um because I have um cirrhosis this is why they do it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so I had the colonoscopy and the endoscopy all at the same time.
[AGENT][NEUTRAL] Oh, OK. If you can submit that, if it shows those diagnosis, if you can submit that to us. Oh, never mind, I do see it.
[AGENT][NEUTRAL] It's all on one page, yeah, but um.
[CUSTOMER][NEUTRAL] The very last one.
[CUSTOMER][NEUTRAL] Is that not what they want?
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Those are definitely diagnosis codes, but as far as the surgery, it doesn't have the procedure codes. And usually,
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Where would I get that? because I even called my insurance company yesterday.
[CUSTOMER][NEUTRAL] I'm like surely they have that, right? Like I don't know.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Everybody's giving me the runaround. This has been like 3 days of constant on the phone with them, and I tell them exactly what this paper says from y'all. I'm like, look, I've never had a problem before getting this. I just don't know why I am this time.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, who was the physician that performed the colonoscopy?
[CUSTOMER][NEUTRAL] Doctor [PII].
[AGENT][NEUTRAL] I would say you have to
[CUSTOMER][NEUTRAL] Doctor [PII], my liver doctor.
[AGENT][NEUTRAL] OK, I would say contact his office and ask for that surgeon's bill for that data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Surgeon's bill. OK. And that's what you mean? Is that all you mean? Surgeonsville, OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am, because, because the anesthesia, uh, usually from whatever they pay for the surgery, they pay 25% of the anesthesia, so that's not a bill from them, it's not really required. It's just the surgeon's bill we need. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Surgeon bills, so I'll call my doctor and get that and then I just need to upload that?
[AGENT][NEUTRAL] Uh, yes, ma'am. Uh, it would be as a new claim. You wouldn't be able to upload it to something that's already been received.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So do I just put that same claim number in there or I just do a new I can?
[AGENT][NEUTRAL] You can.
[AGENT][NEUTRAL] You just, you would just do a new claim, but you can put that claim number as reference, um, but when the examiner process, they'll go by the date and they'll see in history that oh we were needing itemized bill for this date and they would be able to process it.
[CUSTOMER][NEUTRAL] Oh, OK, and then it said it's because um let's see one of mine and I had several but one of my uh other questions was I looked at this and it said that um when I logged into APL it says that the hospital indemnity policy.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Lapsed, but I don't know why that would be either. I gave a thirty-day notice for both because we switched all the Globe Life.
[AGENT][NEUTRAL] Let's see. Are you still with Quality Estate?
[CUSTOMER][NEGATIVE] Um, no, not with quality.
[AGENT][NEUTRAL] OK. Well,
[CUSTOMER][NEUTRAL] I just kept the insurance with me when I moved.
[AGENT][NEUTRAL] OK. Well, it, your policy is, um, it was active for that data service, but yeah, it shows the policy term or real term on [PII].
[CUSTOMER][NEUTRAL] Oh yeah, I did cancel them from [PII]. We switched everything to globe watch so when we pass away, it's easier for people to.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Get into one place. OK, so I just need to call the hospital back and ask for the, the.
[AGENT][NEUTRAL] Call the surgeon's office.
[CUSTOMER][NEUTRAL] But that is my, my doctor did it. So, uh, my liver doctor, so that's who I would call, right, for that?
[AGENT][NEUTRAL] Yes, ma'am, and request a copy of the billing. Yes, ma'am.
[CUSTOMER][NEUTRAL] He was the one that did it.
[CUSTOMER][POSITIVE] OK. OK, I can do that. Thank you so much.
[AGENT][POSITIVE] Yes. You are welcome, Ms. [PII], and is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No, I think you gave me some answers, so.
[AGENT][POSITIVE] Oh good.
[CUSTOMER][NEUTRAL] Not running around crazy today.
[AGENT][NEUTRAL] No, I understand. Yes, ma'am.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] Alright, you're welcome and thanks for calling [PII]. You have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.