AccountId: 011433970860
ContactId: 59aa532d-23ba-4a43-bea1-e5cb5dee109e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1306709 ms
Total Talk Time (AGENT): 494638 ms
Total Talk Time (CUSTOMER): 434762 ms
Interruptions: 15
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/59aa532d-23ba-4a43-bea1-e5cb5dee109e_20250409T16:14_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, I need to speak with someone in the that does the I don't remember what they said they were a claim specialist or something. I, I had put a claim in it got denied because they needed additional information and then they transferred me to the claims specialist that works on the claims yesterday.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] And I need to talk to them again they told me to submit this other thing and see if they can accept that, so I did and um now I'm calling back.
[AGENT][NEUTRAL] OK, I can take a look at it for you. Could I get uh your name and a callback number?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you and [PII], what is your policy number with us?
[CUSTOMER][NEUTRAL] 259-736-3
[AGENT][NEUTRAL] OK, if you could verify your date of birth and mailing address.
[CUSTOMER][NEUTRAL] Uh, [PII] mailing address is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you for verifying your account and let me take a look at the notes.
[CUSTOMER][NEUTRAL] Yeah, because the other part of it too is on the EOB that they sent like for the denial they have the service description all listed as outpatient benefits and it was inpatient surgery it wasn't outpatient.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] So you said you spoke with the, the examiner that's actually working on the claim? OK.
[CUSTOMER][NEUTRAL] So I know that the.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes, yesterday they transferred me to her because they.
[AGENT][NEUTRAL] OK, transferred to the claims department. OK, to the claims department. OK, so you spoke with [PII], so she did explain that we need the uh diagnostic diagnosis codes and uh told you to get maybe the office notes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] She she said the diagnosis codes or some kind of office notes so I called yesterday and they cannot send me the itemized bill via email which is super stupid if you because that's what she told me to ask for an itemized bill.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, she said or get the notes so what they could do was, um, the independence health system uses something called follow my health or whatever, um, so they sent me, they emailed me yesterday, um, a health record, a continuity of care document which shows because she said the discharge summary or uh notes it has both.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me take a look.
[CUSTOMER][NEUTRAL] Um, so it shows the diagnosis, it shows, um, it shows a whole bunch of shit you probably sorry about my French, a whole bunch of stuff that you probably don't need, um, but it, it's very, so it shows the surgical pathology report. It shows like the different exams that were done while I was there, um, and then it has the hospital.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Let me take a look here cause that information should be there.
[AGENT][NEUTRAL] That we're looking for.
[CUSTOMER][NEUTRAL] Yeah, it has the hospital summary note um and it shows it says right on the hospital summary note inpatient discharge instructions.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it shows the discharge summary, the surgical operation note.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I know it's really hard to see, but that's how the email came.
[AGENT][NEUTRAL] 38.
[AGENT][NEUTRAL] OK, I see it here. It has the information we need.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So is that what you were calling for to make sure this is the enough information to get your claim uh paid?
[CUSTOMER][NEUTRAL] Right, and I wanted again, it was inpatient, not outpatient, because I know I've already used my outpatient benefit. I don't have much outpatient benefits left because I had surgery on my foot. Then when I went to have everything done for the surgery on my foot is when they found the nodule in my lung.
[AGENT][POSITIVE] Oh, that's right. That's right. OK.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] OK. So let me ask you this, um, did, did she tell you, did you mention that to [PII] yesterday that the services were OK.
[CUSTOMER][NEUTRAL] And so then.
[CUSTOMER][NEUTRAL] No, because I didn't, I didn't see that I, I couldn't see that EOB until today.
[AGENT][NEUTRAL] OK, let me take a look and see.
[CUSTOMER][NEUTRAL] So I didn't know that.
[CUSTOMER][NEUTRAL] I mean and it clearly shows on that that it's inpatient.
[AGENT][NEUTRAL] OK. So you were admitted on the [PII]?
[CUSTOMER][NEUTRAL] Yes, through the [PII].
[AGENT][NEUTRAL] And discharged through the [PII]. OK, let me look and make sure, see.
[AGENT][NEUTRAL] If that is another.
[CUSTOMER][POSITIVE] And it should say uh I I believe all that stuff is in there as well.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Or I'm sorry, [PII].
[AGENT][NEUTRAL] [PII], let me know that.
[CUSTOMER][NEUTRAL] Yeah, like the surgery was actually on the [PII] and then I was discharged on the [PII].
[AGENT][NEUTRAL] Through [PII].
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] And like I said on there it shows like inpatient discharge instruction you know discharge summary or instructions or I can't remember what it says.
[AGENT][NEUTRAL] OK, let me just make sure it's on here and I can highlight it.
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] Um, that's a surgical report.
[CUSTOMER][NEUTRAL] Um, I'm looking at it too, so if you go under where it says, um, on mine it shows page 8 of 14 if I'm using your file viewer.
[CUSTOMER][NEUTRAL] It says hospital summary note.
[CUSTOMER][NEUTRAL] And then it says um like [PII] she inpatient summary.
[CUSTOMER][NEUTRAL] Author date and then it shows.
[CUSTOMER][NEUTRAL] Refresh DC instructions [PII] and my date of birth, my MRN number.
[CUSTOMER][NEUTRAL] Um, take the visit date from the day my surgery, take care, take home inpatient discharge instructions, personal plan for staying healthy after your hospital stay.
[CUSTOMER][NEUTRAL] Blah blah blah blah blah all the medicine I'm supposed to take and everything and.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, here's the discharge summary.
[CUSTOMER][NEUTRAL] Um, that's under the hospital summary note what I just told you, which is above the discharge summary.
[CUSTOMER][NEUTRAL] Oh, my discharge date was the [PII], it shows.
[CUSTOMER][NEUTRAL] Admin date [PII] discharge date [PII] my bad sorry about that.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm just making sure I see that.
[CUSTOMER][NEUTRAL] I think I had blood work on the [PII] maybe.
[CUSTOMER][NEUTRAL] Yeah, under discharge summary it says admin date [PII] discharge date [PII], and the discharge diagnosis.
[CUSTOMER][NEUTRAL] I truly appreciate all your help with this. I used my entire income tax to pay for this and now I have other stuff that's falling behind because I couldn't work either.
[AGENT][POSITIVE] Oh, no problem.
[AGENT][NEUTRAL] Yeah, OK, exam day, [PII].
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] yeah.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Hospital discharge instructions.
[AGENT][NEUTRAL] Hospital summary now.
[CUSTOMER][NEUTRAL] Are you like at the bottom on page 11 under discharge summary?
[AGENT][NEUTRAL] Yeah, I'm not the pages, I don't know if it didn't come through.
[AGENT][NEUTRAL] Let me, let me just make sure I don't wanna tell you the wrong information.
[CUSTOMER][NEUTRAL] This, uh, well, I'm viewing it from.
[CUSTOMER][NEUTRAL] Like on your if I go on my dashboard and you know where you upload a document.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm looking at it on that file viewer.
[AGENT][NEUTRAL] OK, yeah, it's, I can't.
[CUSTOMER][NEUTRAL] It says that there's
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Let me go back up here.
[CUSTOMER][NEUTRAL] So there's like it's in purple it says discharge summary and it shows on mine as page 11 of 14.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, see it's coming through and.
[AGENT][NEUTRAL] And my, when I'm looking at, OK, let me make sure because we show.
[AGENT][NEUTRAL] So we have a total of 16 pages because it's gonna give you like a cover page. So you're saying 11.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, and I think it might be.
[AGENT][NEUTRAL] Do you see something on there that says, uh, there's like a link?
[AGENT][NEUTRAL] That says [PII], heart failure. Do you see anything like that?
[AGENT][NEUTRAL] Cause it looks like
[CUSTOMER][NEUTRAL] Oh, OK, keep scrolling down, keep scrolling down.
[AGENT][NEUTRAL] OK, so now I see a smoke-free government.
[CUSTOMER][NEUTRAL] Yep, keep going, you'll see [PII]. then you'll see Excella. Follow my house keep going a little bit under that and it says discharge summary.
[AGENT][NEUTRAL] Keep going? OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] OK, so it is not coming. I can see discharge summary clear, but whatever is under there is just blank. So I don't, it's not reading.
[AGENT][NEUTRAL] And then I, it goes down and I, I, I, it must be, I can only see what's in bold. So then I see surgical operation note.
[CUSTOMER][NEUTRAL] Yeah, so it's above that which I can see it. It's just very light.
[AGENT][NEUTRAL] That's all that's, that's showing up on the page.
[AGENT][NEUTRAL] Yeah, so it's too, it's so light that it's not coming through.
[AGENT][NEUTRAL] I can only see what's bolted.
[CUSTOMER][NEUTRAL] So what do I need to do?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me see, we normally do not take information emailed, but let me check with my supervisor and see if what's your other option to get it to us because it's not showing up. Do you mind holding one moment?
[CUSTOMER][NEUTRAL] Well, because you said further up there you had the information that you needed correct or no?
[AGENT][NEUTRAL] Well, at the, at the beginning of the page, I'm, I'm thinking, uh, we're talking about the diagnosis. So there's documentation up at the top that I can read. Right, for us to have the information that shows you were actually in, you know, admitted on [PII] and discharged on [PII]. Uh, that's not showing up. So as far as your diagnosis, that's fine, but I wanna make sure you're getting your benefit under the inpatient benefit.
[CUSTOMER][NEUTRAL] OK, so that's there but for the inpatient.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and that information is not showing up. So you would only, you know, whatever you, we'll probably have to have you send just the discharge summary where you're saying it's showing that information, the discharge, the discharge diagnosis, and the dates. But let me, if you don't mind holding one moment, let me see if we can get you, you know, if we can allow you to email that over. It should show through the email.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, but yeah, as far as you uploading it, I.
[CUSTOMER][NEUTRAL] Well I mean I can upload it.
[AGENT][NEUTRAL] Well, uh, can you upload it to where it shows because I guess on your end, you're not able to see that it's not coming through clear enough for us.
[CUSTOMER][POSITIVE] I can upload it. I can upload it.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yeah, because on my end I can see it. I can read it.
[AGENT][NEUTRAL] You can read it on the portal.
[CUSTOMER][NEUTRAL] In the in your file viewer.
[AGENT][NEUTRAL] OK, OK. Let me contact my supervisor and see if she can pull that. That way, we can see it. Hold one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], thank you for holding. I do apologize for the wait. Um, my supervisor uh is looking into that. She's going to see if she can pull it in a different system and see if the information comes up. Um, let me see, I have your number 724-7.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yeah it's weird because if I'm on my file viewer and you're like under.
[CUSTOMER][NEUTRAL] You know, in the APL website.
[CUSTOMER][NEUTRAL] It's I can read it.
[AGENT][NEUTRAL] Right. Yeah, I think she's gonna go in and pull it from there, uh, because the way it shows up to me and what I can see, it's too light for me to see it, but she says she should be able to go into another system and pull it and be able to see exactly what you, what you've sent in and what you can see. Um, if you
[CUSTOMER][NEUTRAL] It's light, but I can read it.
[CUSTOMER][NEUTRAL] And did you tell her where to go to see the admin dates?
[AGENT][NEUTRAL] Yes, I gave, I gave her a screenshot the page uh where it has the discharge summary, letting her know that uh the information I'm needing is your
[AGENT][NEUTRAL] Admitting discharge and then your discharge diagnosis, which we do have the uh other diagnosis is. You're admitted, admitting uh diagnosis at the top of the page. So that's not a problem, but I'd, you know, if she can just pull that page. Um, and if you don't mind, uh, she's gonna, she said she is going to a meeting but she's going to pull it and I can give you a call back once she gets back with me.
[AGENT][POSITIVE] And we can go ahead and get that, you know, make sure, you know, that it's taken care of.
[CUSTOMER][NEUTRAL] OK, so that would be today?
[AGENT][POSITIVE] That would be today. Yes, ma'am, for sure.
[CUSTOMER][POSITIVE] OK perfect thank you so so much for all of your help.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] No problem. You are welcome and.
[CUSTOMER][NEUTRAL] I mean norm like because normally like then I get when you guys do it then I get paid like the next day um it's just I'm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I'm at a loss right now so I really appreciate all of your help.
[AGENT][POSITIVE] OK, no problem. What I will do, oh, no problem. What I will do is see if, you know, since we talked about it, to just forward the information to me and I go ahead and get it processed so there's no issues. OK, she just res responded. She said she can see it.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh da da da da. Yeah, she said.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] She can see, uh, she said it is like she's going to make a copy.
[AGENT][NEUTRAL] And so, you should be fine. I have your number. If anything changes, uh, I'll let you know, but expect that the claim will be processed in the next 2 business days.
[CUSTOMER][POSITIVE] OK, so thank you so very much.
[AGENT][POSITIVE] You're welcome. Um, and my name is [PII]. If you need to call back and just check on anything, you can give my name. Um, if I'm not able to, if they're not able to transfer at that time, I will definitely call you back.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. You've been such a huge help. I really appreciate it.
[AGENT][POSITIVE] You're welcome, [PII]. Is there anything else I can help you with? Uh, and just, you know, for your comfort, just once everything's done, I'll give you a call and just let you know everything's good.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK great yeah if they can forward it to you so you can finish processing it that would be awesome.
[AGENT][NEUTRAL] OK, yeah, I'm gonna make that request and then that way I can just uh give you a call back and let you know or like I said, if before I call you back, if you have any questions, just call in and ask for me.
[CUSTOMER][POSITIVE] OK, thanks so much.
[AGENT][POSITIVE] You're welcome, [PII]. You have a wonderful day. Thank you for calling APL.
[CUSTOMER][POSITIVE] Thanks you too.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.