AccountId: 011433970860
ContactId: 6fd22895-6c64-4f9f-8091-85bc8011afa4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 594820 ms
Total Talk Time (AGENT): 375204 ms
Total Talk Time (CUSTOMER): 176493 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/6fd22895-6c64-4f9f-8091-85bc8011afa4_20250416T18:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] on the care team. I've got a member on the line that has a question on what exactly is needed to get his claim processed. Um, I would try to help him, but my on base is not working, and I don't know if I, I, I'm gonna have to restart my computer, so I was gonna see if you could help him.
[AGENT][POSITIVE] Certainly I'd be happy to [PII], what's the policy number please?
[CUSTOMER][NEUTRAL] Policy number is 1206176.
[AGENT][NEUTRAL] And for Mr. [PII]?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, and um, has he been verified, [PII]?
[CUSTOMER][NEUTRAL] Yes, I've verified him.
[AGENT][NEUTRAL] OK, and that phone number listed on the [PII] is this call back?
[CUSTOMER][NEUTRAL] Yes, and then I've got the claim number.
[AGENT][NEUTRAL] Sure, go ahead with that when you're ready.
[CUSTOMER][NEUTRAL] Uh, claim number is 3587044.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and I will take it from here when you're ready, go ahead and transfer.
[CUSTOMER][POSITIVE] OK, thank you so much here he is.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Hi, good afternoon, Mr. [PII]?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hi, my name is [PII]. I'm on the claim support team and [PII] transferred you over to me. Um, you had some additional questions in regards to what we were requesting for your claim, is that right? OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Alright, just give me one moment because it looks like um there's some additional documents have been submitted um so I'm gonna pull that information up so bear with me for just one moment.
[CUSTOMER][NEUTRAL] If, if I may, if I may, the document that was just submitted was for the uh different month. I submitted that this morning.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But I'm speaking of, I'm speaking of a document that was previously sent and I got a remarks explanation for explanation of beneficial remarks for and uh so it's not the one I just sent it's it's, it's one that I sent before that, right.
[AGENT][NEUTRAL] Uh huh.
[AGENT][NEGATIVE] It's not OK.
[AGENT][NEUTRAL] OK, let me go ahead and pull up that information because it looks like we needed some additional billing for, um, looks like for the hospital stay for the consignment to um uh looks like UT Southwestern University Hospital for [PII]. OK.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Let me just take a look at that information. Yes, OK.
[CUSTOMER][NEUTRAL] And that's the one I'm talking about.
[AGENT][POSITIVE] Thank you for clarifying that.
[AGENT][NEUTRAL] Normally, um, when I see information if we've requested something and I see new information came in, you know, I go ahead and pull that information forward so let me just pull this up and and uh see exactly what it is we're needing so bear with me for just a moment while I do that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, um, when you reached out to get this billing information from the uh hospital, is this the only uh information they provided for you?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Well, it's what I requested and what I just let you know, I requested the date that I was admitted.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the date that I was discharged and that's what they sent me and that's what I sent you guys thinking that that was all I needed so uh if I need more.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, cause it looks like
[AGENT][NEUTRAL] Yeah, and that's what I'm looking at now because it looks like what they provided for us was uh for you was just it looks like there's just laboratory services listed on this bill and what we're needing is that um.
[AGENT][NEUTRAL] We need the room and board charges and the attending physician charges. So in other words, that room and board charge would be the days you were confined. There's usually a a charge for the room and board, um, usually there's a room charge and then the attending physician, it would be an itemization that possibly could be obtained by the physician that, uh, that.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That you saw you in the hospital, you know, when they come in for the, um, usually it's they come in to, you know, do that inpatient visit. That's what we're needing. So we're needing that itemization for the room and board and then the itemization for attending physician.
[CUSTOMER][NEUTRAL] Right, I, I understand, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, let me just, uh, ask the question here, uh.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] If you look at the bottom of that, what I sent.
[CUSTOMER][NEUTRAL] It, it has uh.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It has a doctor on there, in physician, it doesn't say that.
[CUSTOMER][NEUTRAL] And then it also has
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I was in the hospital. I, I was thinking that if you look at the bottom of that, that, that I sent that attachment.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] You'd have what you need, uh, is that not what you need? Do you need more than that?
[AGENT][NEUTRAL] Yeah, because it looks like so these charges, um, and that's what I was just gonna tell you is that the charges they gave you were physician charges because if you read at the top it says physician services um at that very first page. So what that tells us is that and it looks like also that um it's missing some dates. So um on the admission for it says that you were admitted from [PII].
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So on that very last page, those charges are, that's the, so the physician bills um for those hospital uh charges and it does say the first day and then it has the [PII] and [PII], but it doesn't tell us, um it doesn't tell us.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You know that physician itself, usually the physician will build their services in addition to the hospital billing. So these are physician services that were billed by the hospital but not the physician. I know that's confusing a little bit, but um and they don't seem to have all your dates there either. Were you at, were you there till the [PII] or just to the [PII]? You were there till the [PII].
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, yes.
[CUSTOMER][NEUTRAL] No, just a second.
[AGENT][NEUTRAL] OK, yeah, so, um, hopefully you can reach out and get those, uh, like I said that would be a separate charge from you might have received the, have you received any it might be a little early you may have received bills you should or at least um possibly an explanation of benefits from your primary insurance that would tell you who those physicians are that are billing for those services um and that's what we'd need.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so there's a separate charge that the physician for that attending physician.
[CUSTOMER][NEUTRAL] OK, now a question I have for you, do you need uh.
[CUSTOMER][NEUTRAL] That information for more than just the dates I was in and out or just during the dates I was in and out.
[CUSTOMER][NEUTRAL] In other words, the [PII].
[AGENT][NEUTRAL] Yes, at least, right, yeah, at least for the services that you submitted thus far, that's what we're asking for is those dates that are shown on that bill from from the [PII] date [PII], um, so at this point now if there are future or do you have other hospitalizations or or any future billing it would be the same you would need to submit that itemization like like we're requesting for.
[CUSTOMER][NEUTRAL] Any information that I need to go ahead.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, OK, so I'm gonna get back to them and, and see if I can get, uh, explain to them what they sent me and let them know what I need and maybe they can send me the additional information that you're talking about and then then I'll send you the I'll send you.
[AGENT][NEUTRAL] Yeah, now for the.
[AGENT][NEUTRAL] OK, now just um just to let you know for those hospital charges like I said they didn't provide you that hospital um.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Like the charges for the hospital itself, so a lot, a lot of times that's gonna be a lot larger bill, um, because it's, it's gonna have, you know, like I said that room and board charge, and that's a per day charge, you know, depending on what type of room that they had you in, um, but they don't have that room and board charge for each day you were in there and then of course there's gonna be a lot of other additional charges possibly for lab.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] any diagnostic testing and you know of course any uh pharmacy and stuff like that so it's probably gonna be a lot larger bill so you want the hospital charges for those dates of of confinement like I said and then the attending physician that that itemization of charges um that would give us again that um that attending physician that saw you each day you were confined to the hospital.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, I'll go back and try to get it and resend that and send it back to you guys.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Certainly, and Mr. [PII], did you have any other questions at this time?
[CUSTOMER][NEUTRAL] No, that was it.
[AGENT][POSITIVE] OK great well thank you so much for calling APL and I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You too thanks bye.
[AGENT][POSITIVE] And thank you for being a valued customer. Take care.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Bye bye.