AccountId: 011433970860
ContactId: 40240ff4-0a7b-4133-b303-7cd012682e62
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 555900 ms
Total Talk Time (AGENT): 294334 ms
Total Talk Time (CUSTOMER): 153101 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/40240ff4-0a7b-4133-b303-7cd012682e62_20250421T15:44_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh hello, [PII]. How are you? We need to confirm that they received our claim. Um, we're, we're doing OK. Uh, my name is [PII]. Well, I filed a claim with y'all and I'm just wanting to check on, make sure that y'all received the paperwork that we emailed. We uploaded that we uploaded to you.
[AGENT][POSITIVE] I'm good, thank you. How about you?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, sure. I can check on that for you. Oh, sure. Yes, I can check on that as well, Mr. [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] All right. And may I have the policy number?
[CUSTOMER][NEUTRAL] Uh, policy number is.
[CUSTOMER][NEUTRAL] 02581933
[AGENT][POSITIVE] Mm thank you.
[AGENT][NEUTRAL] I may have too much numbers, too many numbers. I think I got one number too much. Can you repeat the policy?
[CUSTOMER][NEUTRAL] Just pick up the.
[CUSTOMER][NEUTRAL] OK, then I believe it might be 258.
[CUSTOMER][NEUTRAL] 1933.
[AGENT][NEUTRAL] All right, yes. And may I have your date of birth, mailing address and email address for verification?
[CUSTOMER][NEUTRAL] Uh [PII].
[CUSTOMER][NEUTRAL] Is my birthday. My mailing address is [PII].
[CUSTOMER][NEUTRAL] [PII], and my email is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you. OK, I do see we received something on the [PII], which is today. Um, let me see how many pages. One moment.
[CUSTOMER][NEUTRAL] In case you need anything else.
[CUSTOMER][NEUTRAL] Yes, ma'am. We're just trying to make sure all our paperwork in because we're having.
[CUSTOMER][NEGATIVE] Some trouble with some other insurance stuff and they, they say, well, we sent you this paper and they never
[CUSTOMER][POSITIVE] They never sent the paper, you know what I mean? So I wanna make sure they have everything so we wanna make sure y'all have everything y'all need.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, we're not gonna know that until the examiner, which is the one that processed the claim process because they're the ones that go over all the paperwork to process the claim. Um, so I can tell you that I do see the claim.
[CUSTOMER][NEUTRAL] So what kind of person do you need?
[AGENT][NEUTRAL] Go
[AGENT][NEUTRAL] I'm sorry. Go ahead.
[CUSTOMER][NEUTRAL] Besides the the form, the claim form, what other things should I send, do you know?
[AGENT][NEUTRAL] OK, let me see what was required uh from the last claim, OK? Bear with me just a second. Let me pull that, the notes and everything, OK?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEGATIVE] Confuse me.
[AGENT][POSITIVE] No problem.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] Hopefully they got everything they need. That's what I'm looking for.
[AGENT][NEUTRAL] OK, uh, let me ask you a few questions because I'm not, I don't see any notes indicating any requests. Is this the first time you're trying to submit a claim?
[AGENT][NEUTRAL] Like yourself,
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] We're trying to submit we're trying to submit for the gap insurance.
[AGENT][NEUTRAL] OK. All right. And um OK, so what I can tell you is exactly what we're gonna need because um.
[AGENT][NEUTRAL] I see that you did send a um claim form.
[AGENT][NEUTRAL] And um but I don't see, let me see, I have the signature, I have that. I don't see any documents. So basically what we're gonna need is an itemized bill with the diagnosis codes and procedure codes.
[AGENT][NEUTRAL] And you will get that from the provider of service.
[CUSTOMER][NEUTRAL] We've got that. Yes, ma'am, we have that.
[AGENT][NEUTRAL] OK. Have you uploaded that?
[CUSTOMER][NEUTRAL] I'm about to
[AGENT][NEUTRAL] Oh, OK. I was just making sure I'm just not overlooking the paperwork. I'm like, OK, so the only thing I see, OK.
[CUSTOMER][NEUTRAL] No, no, I, that's why we're calling because we are not giving all the paperwork currently that we need.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Got you. OK, and then we need a copy of the explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] Explanation of benefits.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. That the um.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So that's gonna be for this specific date of service and it needs to show the amounts applied towards the deductible co-payment and car insurance.
[CUSTOMER][NEUTRAL] And it needs to show that what we paid for the deductible.
[AGENT][NEUTRAL] Uh, not what you paid. It's, it's the paperwork that they send in whenever they process a claim, they send you a document either electronic or either by mail and it says this is not a bill and it tells you how much they charge, how much, how much they discounted, and what is your responsibility and then that responsibility amount is gonna be either applied towards the deductible co-payment and co-insurance. So that is the paper that we're gonna need.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So those two documents.
[CUSTOMER][NEUTRAL] For the surgery, just for just the, just the surgery. For just the surgery, correct, ma'am?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, correct. Did you stay in the hospital?
[CUSTOMER][NEUTRAL] I guess for all
[CUSTOMER][NEUTRAL] Yes, I did. I stayed overnight in the hospital.
[AGENT][NEUTRAL] The overnight, um, was it more than 24 hours or less?
[CUSTOMER][NEUTRAL] Yes. Yes, ma'am, more than 24 hours.
[AGENT][NEUTRAL] More than 24 hours, OK. Um.
[AGENT][NEUTRAL] I will say if you wanna send the discharge summary, so we can go ahead and pay it on the inpatient instead of the outpatient, that will help as well, um, because sometimes the, you know, the billing information doesn't have the, the time that you, you was in the hospital. Um, but that's about it. Yeah, you just call the hospital, get the hospital to send you an itemized bill.
[AGENT][NEUTRAL] Uh, with all the charges. If you get a, uh, a different bill or if I'm not sure, usually the surgeon, they send in a different bill. It's gonna be like a separate bill and the anesthesiologist because those three bills are always like, you always get those. You will get one for the hospital, one for the um the surgeon, and you will get one from the anesthesiologist. So if you can call the hospital and get all 3, you can submit all 3.
[AGENT][NEUTRAL] Um, and go ahead and get the explanation of benefits for each one of them. So you have a full claim with all the charges that you have for that surgery.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, that helps me that it's more information than we've gotten so nobody's ever told this yeah.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Oh, sorry, yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, but that, that will be, that will be how they usually work whenever there's a surgery in a hospital and they're just gonna send 3 pills.
[AGENT][NEUTRAL] But yeah, once you receive those or if you wanna call and get them, you can go ahead and do that. That the easiest way or the fastest way would be to call them and let them know, hey, I'm trying to submit my claim. Please send me the, uh, fully itemized bill with diagnosis code. It's really important that they have the diagnosis code, OK? And you can ask them to see if they have the one for the surgeon and the one for the anesthesiologist. If they don't have it there, they will give you the information on who to call to get it, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, OK, that's perfect we'll get to work on that. Thank you.
[AGENT][POSITIVE] You're welcome. Is there, yes, is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, no, we'll get this taken care of and so then I can just upload it like I did that form and then you'll be able to process. OK, perfect.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] Yes, that'll be perfect, yes.
[CUSTOMER][POSITIVE] OK, we're on it.
[AGENT][NEUTRAL] OK. Well, if you have any other questions or concerns, just feel free to call us back, OK?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Alright thank you ma'am.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] All right, bye bye.
[AGENT][NEUTRAL] Goodbye.