AccountId: 011433970860
ContactId: 6db9c7ba-63cf-4fd0-9765-31235172c1e7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 538090 ms
Total Talk Time (AGENT): 169560 ms
Total Talk Time (CUSTOMER): 243650 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/6db9c7ba-63cf-4fd0-9765-31235172c1e7_20250617T20:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey [PII], I am.
[CUSTOMER][NEUTRAL] Trying to get
[CUSTOMER][NEUTRAL] Some claims paid.
[AGENT][NEUTRAL] OK. Are you the insured or provider?
[CUSTOMER][NEUTRAL] I'm the insured.
[AGENT][NEUTRAL] OK, may I have your name and a callback number?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And may I have your policy number?
[CUSTOMER][NEUTRAL] Oh, let's see.
[CUSTOMER][NEUTRAL] Policy number 2282936.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And [PII], I do need for you to verify your date of birth and then your mailing address.
[CUSTOMER][NEUTRAL] Uh date of birth is [PII]. Mailing address is [PII].
[AGENT][NEUTRAL] And it does like we have an email address on file. Could you verify that for me please?
[CUSTOMER][NEUTRAL] Uh, should be [PII].
[AGENT][NEUTRAL] And thank you so much for verifying your policy. Is this claim submission for you or for someone else's listed on the policy?
[CUSTOMER][NEUTRAL] And it listed on the policy.
[AGENT][NEUTRAL] You said someone else listed?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. May I have that person's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] So we have already filed a claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] For this that was declined.
[CUSTOMER][NEUTRAL] Because it needed diagnosis codes.
[CUSTOMER][NEUTRAL] I have 50 this is a this is a hospital stay. I have 15 pages of a hospital bill.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I'm not entirely sure what to do with it.
[AGENT][NEUTRAL] OK, so is that for the data service of 1228 and 1231?
[CUSTOMER][NEUTRAL] Yeah, that's, that's that one.
[AGENT][NEUTRAL] OK. So the main thing that we're needing that is listed on the hospital bill, it would be just indicating for the reason of the visit.
[AGENT][NEUTRAL] So if you, if you have the discharge papers, it will indicate why the defendant was in the hospital.
[AGENT][NEUTRAL] So that's the main one that we would need.
[CUSTOMER][NEUTRAL] OK, discharge.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So, uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have, I mean, I've got.
[CUSTOMER][NEUTRAL] Like I said, I've got 15 pages of documents here, and I have no idea what the discharge papers are. Most of this stuff looks like billing information and health insurance claim forms.
[AGENT][NEUTRAL] OK. Is that what you received from the hospital itself, the date that he was released?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, that I don't know. I have no idea what was received on that day. My wife was with him. I was not.
[AGENT][NEUTRAL] OK. That's the discharge papers. The discharge papers is what you will receive once you leave the hospital. And that paper will indicate the reason of that visit. Now, you said you have bills, you said you have bills or something from the provider?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So yeah, so the last person that I talked to, I've been obviously dealing with this one for a little bit.
[CUSTOMER][NEUTRAL] The last person I talked to at APL told me that I needed what was called a diagnosis code, and then I, I called um the hospital system and they said the only way to get the diagnosis codes was to have
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] I don't even remember what they an itemized account statements sent to me.
[CUSTOMER][NEUTRAL] And it took 2 months to get, and I finally and I finally got it, um, but I just don't know what I'm supposed to do with it.
[AGENT][NEUTRAL] OK, the automatic deal.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it sounds like it would have just been simpler to upload the uh.
[CUSTOMER][NEUTRAL] Discharge documents but I didn't know that was an option.
[AGENT][NEUTRAL] Yes, now the itemized bill, it possibly can have that information listed on there, but with me not, you know, seeing the documents I'm not able to verify if it's listed.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Oh, of course.
[AGENT][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK, I mean, should I upload this stuff to.
[CUSTOMER][NEUTRAL] The portal under that claim or should I just try to go find the.
[CUSTOMER][NEUTRAL] Discharge paperwork and I'm not even sure we still have it.
[AGENT][NEUTRAL] Now if you would like to locate the discharge papers you can but yes you can submit that those pages that you do have via the portal. Now it won't go up under the same claim it will give a different claim number or OSC.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Confirmation number and we would just be able to verify since it is the data service entered that we will be able to review that document to see if that diagnosis code or reason of the visit is listed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so because of the date of service.
[CUSTOMER][NEUTRAL] You'll know that it corresponds with that claim.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK cool alright I will see if I can scan all these pages and upload it um.
[CUSTOMER][NEUTRAL] And then I'll see if I can find the.
[CUSTOMER][NEUTRAL] Discharge paperwork, um, would I do if I find the discharge paperwork, would I do the same thing with the discharge paperwork?
[AGENT][NEUTRAL] Yes, you would just submit it via the portal as well. Now you may, I don't know if everyone has this, but a lot of times you know you can go online and check your portal for that stay and you may be able to pull that data service and see if the discharge summary is listed and probably pull it from there.
[CUSTOMER][NEUTRAL] Via the portal, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, let's see, cause I do have.
[CUSTOMER][NEUTRAL] OK, let me see because I am looking at that right now actually.
[CUSTOMER][NEUTRAL] Oh, let's see.
[CUSTOMER][NEUTRAL] I'll have to figure that out. OK, um, so I may be able to find that on here as well, got it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Would you mind just staying on the phone with me for just a second?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] While I look at this really quick.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So there's a, I don't, I haven't found the exact date of service yet for whatever reason it's only listing things [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Maybe under the wrong account but it says.
[CUSTOMER][NEUTRAL] There's a section where it says view notes and it just gives a description of like what happened.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I'm assuming that's what you would need, is that right?
[AGENT][NEUTRAL] So that this, could you just give me somewhat detail of what is it saying?
[CUSTOMER][NEUTRAL] Uh, I was looking at one from [PII] for my wife when she was actually pregnant with my son, so.
[CUSTOMER][NEUTRAL] Um, it just gave notes of like,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have to see if I can find this one. OK, let me just do this. I'll see if I can find the one.
[CUSTOMER][NEUTRAL] For that date of service.
[CUSTOMER][NEUTRAL] And then if I can, I will.
[CUSTOMER][POSITIVE] Call back and make sure that's the right thing.
[AGENT][POSITIVE] Yes, that will work.
[CUSTOMER][POSITIVE] OK, thank you for your help. I really, really appreciate it.
[AGENT][NEUTRAL] You're welcome. Is there anything else that I can assist you with today, Mr. [PII]?
[CUSTOMER][NEUTRAL] Oh wait, I actually just found it discharge summary here it is.
[CUSTOMER][NEUTRAL] [PII] is a [PII] previously healthy male admitted to mercy kids with acute hypoxic respiratory failure and dehydration and secondary human metapneumovirus. So this is the thing you would need.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, this is the exact thing. OK, let me download this I'll upload it to the portal and then it should be.
[CUSTOMER][POSITIVE] Everything should be good to go.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Cool, thank you. I appreciate your help. That was very helpful.
[AGENT][POSITIVE] All right. You're welcome. No problem. You're welcome.
[CUSTOMER][POSITIVE] Have a good rest of the day.
[AGENT][POSITIVE] Same to you and thank you so much for calling American Public Life. Have a great day.