AccountId: 011433970860
ContactId: 89f9f956-0df4-4de8-8a77-04331e801bcf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 436959 ms
Total Talk Time (AGENT): 229614 ms
Total Talk Time (CUSTOMER): 143034 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/89f9f956-0df4-4de8-8a77-04331e801bcf_20250401T22:05_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] May I help you?
[CUSTOMER][NEUTRAL] Hi, yes ma'am. I was calling to get some information about the claim that I submitted.
[AGENT][NEUTRAL] OK, I can give you claim status. Can you please give me your name and your policy number?
[CUSTOMER][NEUTRAL] Uh, I don't have my policy number on me cause I'm driving.
[AGENT][NEUTRAL] OK, what is your name and your social?
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[CUSTOMER][NEUTRAL] And my social is [PII].
[AGENT][NEUTRAL] OK, Miss [PII], let me look that up real quick.
[AGENT][NEUTRAL] OK, Ms. [PII], I think I have found you. Can you please verify your policy for me? Can you give me your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is your address, phone number, and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] My address is [PII]. My telephone number is [PII] and my email is [PII].
[AGENT][NEUTRAL] Thank you Ms. [PII] and if we get disconnected, can I call you back on that number that you just verified for me?
[CUSTOMER][POSITIVE] Oh absolutely.
[AGENT][NEUTRAL] OK, thank you. You have 3 different policies with us. Which one, did you file the claim on?
[CUSTOMER][NEUTRAL] So I think I picked all of them because I didn't know which one it belonged under. Um, but I was admitted to the hospital. I think all of them have kind of gotten closed and put with uh one of them put $50 for a wellness exam. I guess maybe they did the wellness screen, since I went to the ER and then from the ER they admitted stand-alone ER. They admitted me and transported me by ambulance over to the hospital.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, Ms. [PII], do you?
[CUSTOMER][NEGATIVE] But I got a letter in the mail yesterday that the hospital portion of it was denied and not quite sure why.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. That is the one I have pulled up since you mentioned you're admitted in the hospital. Houston Methodist Baytown. Uh, the date of service was [PII]. Is that correct?
[CUSTOMER][POSITIVE] That's correct. Yes, ma'am.
[AGENT][NEUTRAL] to [PII].
[AGENT][NEUTRAL] OK, let me see what I'm gonna check the remarks and see what it says.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so it's just asking for more information. In order to process your claim, we need the itemized hospital bills with the admission and discharge dates and times.
[CUSTOMER][NEGATIVE] So I went through this last time, they will not give me that. Um, Houston Methodist takes 6 months to start their billing. Um, and so a year and a half ago when I was admitted into the hospital, I, I need to stay out of that place. I don't really like it. But, um,
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] That uh they took exactly what I sent to you guys. It was um my discharge paperwork.
[AGENT][NEUTRAL] OK, so that's
[CUSTOMER][NEUTRAL] Because it shows my admission date and my release date.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, um, and you said that we have accepted that in the past?
[CUSTOMER][NEUTRAL] Yes, if you look at the one I was admitted, it was like [PII].
[CUSTOMER][NEUTRAL] [PII] I believe and they didn't process the claim. I had a lot of trouble processing this claim. Um, it wasn't processed until like [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, I see that there was um a payment in [PII].
[AGENT][NEUTRAL] Well, you can send that in. Did you send that in with this paperwork with this claim information?
[CUSTOMER][NEUTRAL] Yes, I did.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I did. It was all in there.
[AGENT][NEUTRAL] I'm gonna go ahead and let you speak with the claims examiner to see if there's something else that they will accept since you've already sent it in and uh see where we can go from there Ms. [PII], so it's gonna be a brief hold while I get somebody on the phone for you and this is gonna be somebody that actually looks at the claims so maybe they'll have.
[CUSTOMER][POSITIVE] OK, sounds good.
[AGENT][NEUTRAL] Another way to be able to get that itemized statement, OK?
[CUSTOMER][POSITIVE] OK awesome thank you.
[AGENT][NEUTRAL] You're welcome. Is there anything else I can help you with before I transfer you?
[CUSTOMER][NEUTRAL] No, ma'am, I think that's it.
[AGENT][POSITIVE] OK, well you have a good night and thank you for calling APL it's gonna be a brief hold.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Hi [PII], it's [PII]. I've got an insured on the phone. Hi, her name is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Her policy number is 2402681.
[AGENT][NEUTRAL] And she has been verified the number she's calling from is a good call back. She's calling about claim number 3580187.
[AGENT][NEUTRAL] The claim was denied needing itemized statement with uh admission and discharge dates on it.
[AGENT][NEUTRAL] She told me that she sent in her discharge summary that had her discharge.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, her, oh gosh, I got my tongue twisted, has her admission date and her discharge date and the times on it that the hospital is not giving her the information that she needs and they don't bill for six months, she said, and that she sent the same paper yeah she sent the same paperwork back um in [PII] and the claim was paid with it because they were asking that claim was asking for the same thing.
[CUSTOMER][POSITIVE] Oh wow.
[AGENT][NEUTRAL] And she's just wondering, she said she sent that with this claim.
[AGENT][NEUTRAL] And she's just wondering if there's a something else that she can do. She needs to talk to somebody to see if there's something else that can be done or can we request it or something that can help her get the correct information to us.
[CUSTOMER][POSITIVE] Sure, um, I'm pulling up the mail now, um, so you can patch her through and I'll do my best to assist her.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right. Thanks, [PII]. You take care. Bye-bye.
[CUSTOMER][POSITIVE] You're welcome you too [PII], thanks.