AccountId: 011433970860
ContactId: 8c6ea8a2-905e-413a-afa5-f8253994cfc9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 388040 ms
Total Talk Time (AGENT): 147707 ms
Total Talk Time (CUSTOMER): 151020 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/8c6ea8a2-905e-413a-afa5-f8253994cfc9_20250415T15:51_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, Ms. [PII]. This is [PII], um, in the care team. I have, um, Miss [PII] on the phone. She is the contact for the group 17816.
[AGENT][NEUTRAL] Can I, OK, number.
[CUSTOMER][NEUTRAL] Uh, she is
[CUSTOMER][NEUTRAL] She is calling on policy number 2,138,760.
[CUSTOMER][NEUTRAL] I have already uh got the member to verify that it is OK for us to speak to Ms. [PII] about a claim. The claim number is 3573829.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, he is also the owner of the group, um, for.
[CUSTOMER][NEUTRAL] This is his daughter's claim?
[CUSTOMER][NEUTRAL] He did mention that his daughter was involved in an accident and was hospitalized and it's not outpatient, but I did read the remarks to Ms. [PII] about needing the itemized statement and the EOB.
[CUSTOMER][NEUTRAL] When I looked to see the date that she sent it in, it just said it was a duplicate claim, so she's needing more information on this claim um to help get it processed.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You can send her over.
[CUSTOMER][NEUTRAL] OK, thank you. Bye-bye, Ms [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Alright
[AGENT][POSITIVE] Good morning. Thanks for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], I'm calling.
[CUSTOMER][POSITIVE] Oh my goodness.
[AGENT][NEUTRAL] I'm here.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEGATIVE] I'm calling on, every time I, I'm on your website, every time I go to a different window, I lose.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have to start all over.
[AGENT][NEUTRAL] No, uh, she gave me, you're calling about a claim where we requested the, um, item, yes ma'am.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and that is for Saint Mary's Medical Center?
[AGENT][NEUTRAL] Is that correct? OK, alright.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, so we are needing.
[AGENT][NEUTRAL] Give me one second, let me pull the claim information up just to make sure, see what we have one second.
[AGENT][NEUTRAL] 3573829
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So we have the itemized charges.
[AGENT][NEUTRAL] So we would need a copy of the explanation of benefit.
[CUSTOMER][NEUTRAL] For Saint Mary's.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I believe I sent that to you, so.
[AGENT][NEUTRAL] Yes ma'am. I'd say we have the, we have.
[CUSTOMER][NEUTRAL] Around, around [PII].
[AGENT][NEUTRAL] OK, yes ma'am, we have the itemized charges, but in order for us to finish or to continue processing the claim, we would need a copy of the explanation of benefits from the major medical.
[AGENT][NEUTRAL] And then we would also need uh medical documentation showing the diagnosis code, uh, which is the reason why they went into the uh emergency room.
[CUSTOMER][NEUTRAL] OK, hold on, I gotta write all this down. I thought I sent it already.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Yes ma'am, the explanation of benefits.
[AGENT][NEUTRAL] From
[CUSTOMER][NEUTRAL] And itemized bill.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] From
[CUSTOMER][NEUTRAL] From asthma, that's the medical.
[AGENT][NEUTRAL] No, uh, from [PII].
[CUSTOMER][NEUTRAL] That's his medical
[AGENT][NEUTRAL] From [PII]'s. We need something from [PII] [PII]'s that has the diagnosis code listed.
[AGENT][NEUTRAL] And the diagnosis code tells us the reason she went to the emergency room.
[CUSTOMER][NEUTRAL] Saint Mary.
[CUSTOMER][NEUTRAL] But she also was in ICU for 3 days. Did you see that?
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] Not, not just the outpatient emergency room.
[AGENT][NEUTRAL] Uh, let's see
[AGENT][NEGATIVE] Give me 1 2nd because it's kind of hard to read this one.
[CUSTOMER][NEUTRAL] They have a $164,000 bill.
[AGENT][NEUTRAL] Yes, ma'am. I
[CUSTOMER][NEUTRAL] It wasn't just emergency.
[AGENT][NEGATIVE] OK, it's kind of illegible, so that's why we were unable to read it.
[AGENT][NEUTRAL] Uh, so I can see emergency room.
[AGENT][NEUTRAL] So we probably just need the itemized statements so we could see it because it tells us the date that she was admitted it doesn't give us like a to and from date like she went in on [PII] for example.
[AGENT][NEUTRAL] So it doesn't list uh everything that we would need to know that it was inpatient.
[CUSTOMER][NEUTRAL] OK, so you need the EOB from his carrier.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] His medical carrier, an itemized bill from Saint Mary's showing codes.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] The diagnosis code, yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, we'll try again.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now, is there um a certain number I can direct it to when I mail it in, or?
[CUSTOMER][NEUTRAL] What do you call it, uploaded in?
[AGENT][NEUTRAL] Uploaded? No, ma'am, you would just upload it the same way they did all the rest of their forms.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And was there anything else you can uh we can help you with?
[CUSTOMER][NEUTRAL] So you do understand this, you do understand this is not just outpatient.
[CUSTOMER][NEUTRAL] You can see that, right?
[AGENT][NEUTRAL] No ma'am, actually we cannot, we cannot, so that's why we're needing the itemized bill.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am, because the the information that you sent over just shows one date of service 24, that's it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] All right, we'll we'll be sending it over shortly. Thank you.
[AGENT][POSITIVE] You're welcome have a great rest of your day.
[CUSTOMER][NEUTRAL] You do.
[AGENT][NEUTRAL] OK.