AccountId: 011433970860
ContactId: 981ce967-44cf-4a8e-a99b-ac2c6c301dc2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 671979 ms
Total Talk Time (AGENT): 152369 ms
Total Talk Time (CUSTOMER): 218398 ms
Interruptions: 1
Overall Sentiment: AGENT=1.8, CUSTOMER=-1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/981ce967-44cf-4a8e-a99b-ac2c6c301dc2_20250606T13:46_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Um, yes, ma'am. I had some questions about a claim I have with y'all.
[AGENT][POSITIVE] OK, sure, I can assist you with claims. May I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] My name is [PII]. My callback number is [PII].
[AGENT][NEUTRAL] Thank you. Do you have the policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am, it's 02581933.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, Mr. [PII], for security, may I have your date of birth, mailing address and email address on file?
[CUSTOMER][NEUTRAL] Uh, my birth date is [PII].
[CUSTOMER][NEUTRAL] My address is [PII].
[CUSTOMER][NEUTRAL] And my email address is [PII].
[AGENT][POSITIVE] Perfect. Thank you. And how may I assist you with the claim?
[CUSTOMER][NEUTRAL] Uh, ma'am, I, I have a claim with y'all, uh, stayed in the hospital that I believe this is the gap insurance claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And, uh, I was wondering, uh, what, is there anything else that y'all need from us?
[CUSTOMER][NEUTRAL] Any paperwork or anything because it's this is it's just we've been trying to get this taken care of and.
[CUSTOMER][MIXED] It paid out, but I just, I'm not I'm unsure of what all y'all need.
[AGENT][NEUTRAL] OK. So this is the date of service for [PII] for Lubbock Health Hospital.
[AGENT][NEUTRAL] The part, OK, um, let me look at that paperwork and see what we need, OK, um, do you mind holding for me?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEGATIVE] No ma'am, not at all.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Miss [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so, um, based on the notes and the information that I have found out, it looks like um we are, we were asking for the itemized bill with the diagnosis codes.
[AGENT][NEUTRAL] And, and that's for the date of service [PII]. Now, for the [PII], we need the uh let's see, the discharge summary.
[CUSTOMER][NEUTRAL] OK, hold on for a 2nd [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], and that, what, what was that you were needing?
[AGENT][NEUTRAL] OK, for the [PII], we need the itemized bill with the diagnosis code.
[CUSTOMER][NEGATIVE] In itemized.
[CUSTOMER][NEUTRAL] Bill with diagnosis code.
[AGENT][NEUTRAL] Bill, mhm.
[AGENT][NEUTRAL] With that, right.
[CUSTOMER][NEUTRAL] And what, and I know my wife sent you something.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I think we got it here, we got it here also, but they just.
[CUSTOMER][NEUTRAL] What what I went and picked up is they put it on a formal letterhead saying that I, I came in on [PII] it's at like [PII] and then [PII].
[CUSTOMER][POSITIVE] I was able to go home like at [PII] or something like that.
[CUSTOMER][NEUTRAL] And I, I, I know we've sent that to y'all.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Like a discharge thing, right?
[AGENT][NEUTRAL] Mhm. Yes. OK. So um that is the, the one you just uploaded, um, I believe it was um yesterday.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] So that paper is in line to be processed. So that one, OK, so that one has not been processed yet, um but that, that's what they were asking for.
[CUSTOMER][NEUTRAL] Yes, so
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK, now.
[CUSTOMER][NEUTRAL] Hold on, I'm, I'm taking notes so I can tell my wife when I get home what's what's going on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so this [PII] at [PII].
[CUSTOMER][NEUTRAL] What, what I, my question is, is that, I called the doctor and I tried to get this paperwork, but it's in it.
[CUSTOMER][NEGATIVE] It's sending me somewhere overseas and they're trying to send these papers from overseas and I don't know where, where they're at. I'm fixing to have to call them again, but this [PII], that was at Grace Clinic, correct?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm let me see. Let me go back to that paperwork. One moment.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] And that was Gray Surgical Hospital. Mhm.
[CUSTOMER][NEUTRAL] Very surgical.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Now, I've, I've talked to, talked to some people about doing that, that, for that [PII] appointment, that had nothing to do with, because [PII] is when I went in and had a hip replacement.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So this doc, I called the doctor's office, I asked him what was done there, and they said all that I had done was a metabolic panel and a lipid panel.
[CUSTOMER][NEUTRAL] Now, do y'all need this thing with the diag diagnostic code and everything is just, just for uh.
[CUSTOMER][NEUTRAL] Uh, for like, uh, co-payment stuff and deductible stuff for the insurance, is that correct?
[AGENT][NEUTRAL] Um, yes, we, for any claims that are submitted to us as for a secondary policy, which is what you have, uh, we ask for itemized bill with diagnosis codes and then we ask for the explanation of benefits indicating the amount applied towards the deductible co-payment and co-insurance. Those are the two documents that we request for any of our claims because that's how we determine benefits.
[CUSTOMER][NEGATIVE] OK, so now my next question is, since I'm having such a hard time getting this.
[CUSTOMER][NEUTRAL] Is there anything y'all could do on y'all's end to get this itemized?
[CUSTOMER][NEUTRAL] It's an itemized itemized bill with the diagnosis code.
[CUSTOMER][NEUTRAL] For [PII], is there any way y'all could help me get that or y'all could get that, or, or as soon as I get off the phone with y'all, do I need to start calling Grace surgical Center?
[AGENT][NEUTRAL] OK, unfortunately, we don't get, we cannot get that information because it is not provided to us due to security, um, so you have to call them and get that information to be sent over to us for your claim.
[CUSTOMER][NEUTRAL] OK, so I just need to call that doctor's office to see if I can get an itemized bill from them.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so, so so far since we've already sent that one in the discharge paper.
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][POSITIVE] That's not processed yet, so all I need to do is get you this one for [PII] and maybe we can get this ball rolling and I could get my money in.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, I, I sure do appreciate you uh let me get to work on this and see if I can get a hold of somebody up there and get this itemized bill.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yeah, OK. Is there anything else I'm gonna help you with today, Mr. [PII]?
[CUSTOMER][NEUTRAL] Uh, no, ma'am, there isn't.
[AGENT][POSITIVE] No, OK. Well, thank you for calling APL. You have a good day, Mr. [PII].
[CUSTOMER][POSITIVE] Alright you have a good weekend, ma'am thank you very much.
[AGENT][POSITIVE] Thank you. You as well. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Alright bye bye.