AccountId: 011433970860
ContactId: 747a0d37-30c1-4dfd-bdf6-66073579a9bd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 373140 ms
Total Talk Time (AGENT): 198535 ms
Total Talk Time (CUSTOMER): 149683 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/747a0d37-30c1-4dfd-bdf6-66073579a9bd_20250307T17:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII] speaking. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling. I was returning your call.
[AGENT][POSITIVE] Yes, hello thank you so much for returning my call um I wanted to just reach out and uh uh get some additional information regarding your claim if you'll bear with me for just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] I'm gonna pull your claim information back up so sorry about that.
[AGENT][NEUTRAL] OK, if you don't mind I'll have you verify some information. Go ahead and verify your date of birth please.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And your mailing address.
[CUSTOMER][NEUTRAL] Uh, 25, 0, now I gotta think 25.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the last piece of verification your email address.
[CUSTOMER][NEUTRAL] Um, it is, I think I put on there [PII].
[AGENT][POSITIVE] Yes, thank you so much.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] We're not quizzing you just verifying.
[CUSTOMER][NEUTRAL] I couldn't remember if I put my work one or my personal.
[AGENT][NEUTRAL] It's fine. OK, so I received your claim and the documents that you submitted with your claim. however, I noticed that the diagnosis is handwritten on your itemized statement from both of your visits to the emergency room and unfortunately if it's handwritten information we we need to reach out and verify.
[AGENT][NEUTRAL] So I tried to contact the hospital, but I had to leave a message there as well. So I was just hoping I could reach out to you and see, did, when you were discharged, did they give you like that aftercare summary stating why you were in the emergency room and then your next follow-up steps?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um, I think that they did.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Um, I would say, I was pretty doped up because my chin was busted open, so they gave me some pretty good meds.
[AGENT][NEUTRAL] Right. And, right, and I'm sorry that, I'm sorry that happened. And I see that the, the, the procedure on there is that you had to have some sutures. But like I said, because of um just our, the way we process the claims, we just have to be able to verify that information. So what I can do is um I, I actually sent a um a request to you to provide that diagnosis.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] But if you'd like I can um I can send your claim if you wanna go and check to see if you have that information and then if you're able to send it over to me I can go ahead and complete processing your claim.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, yeah, I was gonna say, I'm not home right now, um, but I can check. I don't know if I kept it or not, but otherwise, I could probably stop at the hospital and get them to print me off another copy of it.
[AGENT][NEUTRAL] Yeah, usually like I said, um, once you're seen they kind of give you that discharge summary it's called the aftercare summary, and it just states your name and then the dates and what you were there for.
[CUSTOMER][NEUTRAL] Yeah they
[CUSTOMER][NEUTRAL] I would say, I know when I went back in to get my sutures removed and it was infected, like I got more information from that visit than I did my first one. I don't know what happened with the first one, but I know there wasn't very much, and I don't know if it was just because of, I was so kind of out of it and everything or what, but like I said, I can, um, if anything, I can stop at the hospital when I get back to town because it's right where I live.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And just have them print me off another copy of it because I'm not quite for sure if I kept the other one or not because I was like, oh, I don't need this anymore and I'm pretty sure I threw it away.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, where do I need to send that to?
[AGENT][NEUTRAL] OK, so what I'm gonna do is like I said, I'll temporarily kind of pend your claim and wait for that additional information so you can just submit it back through that online portal the same way you submitted your other claim and um I know and we'll know because like I said I put notes on your account and also I'll check for it and I'll just go ahead and pull that and continue process and once I receive that confirmation for the diagnosis.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it probably if I'm leaving for the day actually in a little bit, so I'll get to it first thing on Monday though.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yep, that's fine. Yeah, I kind of figured when I had called them and asked them for an itemized statement and that's how they put the codes on there, I was like, I don't know that that's gonna fly, but because I used to process insurance claims, so I get it.
[AGENT][NEUTRAL] OK, so they are actually the ones that wrote the diagnosis there.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, yup. The hospital is the one. Like I called the billing and I asked them for an itemized statement and that's what they gave me.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] OK, great.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] Well, I'll go ahead and note that and like I said I'll just kind of pend your claim and wait for that additional information that I can go ahead and and uh you know continue process that once I receive that.
[CUSTOMER][POSITIVE] OK, sounds good.
[AGENT][NEUTRAL] Now, um, just so you're aware, Ms. [PII], um, that because it's the same accident for those two days of service, we'll only pay that first visit because it's, it's, uh, basically that initial treatment just so you're aware.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] Yeah, they're supposed to be bundling that together. They're supposed to be working on that because I was told that when I went in to get my sutures removed, that that would be included in with the first ER visit. So that's the only reason why I went back to the ER to have them removed, so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright well I'll go ahead and put the notes in your file and I'll wait for that document and then uh I'll continue processing.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, sounds great. Thank you.
[AGENT][POSITIVE] You're welcome and thank you for returning my call. I hope you have a great rest of your day and a great weekend.
[CUSTOMER][NEUTRAL] Yup.
[CUSTOMER][NEUTRAL] You too, bye.
[AGENT][POSITIVE] Thank you bye bye.