AccountId: 011433970860
ContactId: 894d06dc-411a-482d-95d4-0c344796df18
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 478209 ms
Total Talk Time (AGENT): 136420 ms
Total Talk Time (CUSTOMER): 221283 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/894d06dc-411a-482d-95d4-0c344796df18_20250522T14:52_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi Miss [PII], this is [PII] in the care team. I've got Mr. uh, [PII] on the phone. He's already got a call back today, but he's calling because he has more, uh, questions about his claims. Um, his policy number is.
[AGENT][NEUTRAL] His policy number.
[CUSTOMER][NEUTRAL] 2581933.
[CUSTOMER][NEUTRAL] And he's specifically calling about claim number 3,597,460. He has been verified.
[CUSTOMER][NEUTRAL] And let me give you the call back number.
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] It's, yes ma'am.
[AGENT][NEUTRAL] OK, what's his callback number?
[CUSTOMER][NEUTRAL] The callback number is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alrighty.
[CUSTOMER][POSITIVE] OK, thank you, Ms. [PII].
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, yes, ma'am. I'm trying to get some information and, and talk to you all about it, a claim I have with y'all.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] I can help you with that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I can help you with that. Oh, totally awesome. I need somebody smarter than me to help me.
[AGENT][POSITIVE] I'll do my best.
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes, ma'am. Uh, is there any information that you need from me, ma'am, to get this ball rolling?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] She gave me your policy number and she told me that you were calling about a claim ending in 7460, is that correct?
[CUSTOMER][NEUTRAL] I, I believe so was for a hip replacement.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I was in that, I had the surgery on [PII] and I stayed overnight until [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I was, and I was talking to one of your other representatives, ma'am, that said that uh.
[CUSTOMER][NEUTRAL] You, you need an admin, date and time discharge from Lubbock Heart Hospital.
[CUSTOMER][NEUTRAL] Where I stayed overnight and there was a
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hey uh.
[CUSTOMER][NEUTRAL] I'm sorry, I lost my train of thought. There was a another, she said something about another claim.
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I needed to call Grace Surgical Center is what she was telling me, but when I called Gray Surgical Center.
[CUSTOMER][NEUTRAL] To find out if this, that doctor's visit on [PII] really had anything to do with the uh
[CUSTOMER][NEUTRAL] With the surgery, what I'm trying to claim on, and what I got from there uh.
[CUSTOMER][NEUTRAL] From their, their records department is that that [PII] really didn't have to do.
[CUSTOMER][NEUTRAL] Anything with the hip replacement, it was just like a routine checkup. And they took a metabolic panel and a lipid panel. They took some blood for me to check my metabolism and my lipids and stuff, man.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I was just wondering if y'all still if you still need that.
[CUSTOMER][NEUTRAL] Cause you're telling me I need a UBL4 form.
[CUSTOMER][NEUTRAL] Through that, and I'm not, I don't, I just, I don't see how that has to do anything with the surgery, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Because basically, you know, we're your secondary insurance so we pick up your deductibles, your co-pays, and your co-insurance. So you do have um.
[AGENT][NEUTRAL] Amounts that were applied to your deductible for uh the lab work that you had at Grace Surgical Hospital.
[AGENT][NEUTRAL] And so if we have the diagnosis code which tells us why you had that lab work performed, then we can pay you the money that's owed on that uh.
[AGENT][NEUTRAL] Facility charge.
[CUSTOMER][NEUTRAL] And, and what about for the uh for the cert uh so they, they do need that, the UBL4 form or diagnosis code.
[CUSTOMER][NEUTRAL] For [PII]. That's what y'all need.
[AGENT][POSITIVE] Yes, sir. Yes. Yes. Yes, sir.
[CUSTOMER][NEUTRAL] OK. Uh, and you also need, and also, and your paperwork, does it say something about a, a, a summary for
[CUSTOMER][NEUTRAL] An admit date and a discharge date for [PII].
[AGENT][NEUTRAL] Uh, yes, so we, uh, let me see, give me one second.
[AGENT][NEGATIVE] I'm, I'm going back to your work and it's like 37 pages. I was trying to go through while you were talking.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, yes, uh, yes, we need the, um, admin and discharge time if they can give you something that lets us know.
[AGENT][NEUTRAL] How, uh, what time you were admitted to the hospital and the time that you were discharged to go home?
[AGENT][NEUTRAL] Um, because right now your outpatient benefit is only $1000 per calendar year and so if we can determine which benefit to process it under, we could possibly pay you more than the $1000.
[AGENT][NEUTRAL] Uh, which this hospital stay, uh, was it more.
[AGENT][NEUTRAL] So you would
[CUSTOMER][NEUTRAL] Yes, ma'am. What is one of the, the gentleman that signed me up for this.
[CUSTOMER][NEUTRAL] When, when we're going through my company, he said that if I stayed overnight, it'd be pay pay out like $5000.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah, but we have to be able to see that you we know you were there from [PII], but we have to know how long you were there because you have to be there at least over 18 consecutive hours.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] So we just have to have proof that you were, yes, sir.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so for, for, for me, you need the uh admin and date time, admin and discharge date and time from Lubbock Heart Hospital, but you also need that UVL4 form for that [PII] doctor visit, correct?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] Mhm. Yes, sir. That's correct.
[CUSTOMER][NEUTRAL] And that, that should be all the paperwork you need from me?
[AGENT][POSITIVE] Yes, that should be it.
[CUSTOMER][NEUTRAL] OK, so I guess I need to get hot on the phone and call these people and see if I can get that.
[CUSTOMER][NEUTRAL] And get it uh uh put in a PDF and send over to y'all this evening or something, ma'am.
[AGENT][NEUTRAL] OK, and I'll keep your, uh, I'll keep your policy number and I'll watch for that information to come in so we can try to get your claim taken care of.
[CUSTOMER][POSITIVE] Yes ma'am, yes ma'am. Let me, let me get on the phone and let me see what I can do.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, thank you, Mr. [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Thank you. Thank you. You have a good day.
[AGENT][NEUTRAL] Have
[AGENT][POSITIVE] You too thank you.
[CUSTOMER][NEUTRAL] Alright bye bye.
[AGENT][NEUTRAL] Bye bye.