AccountId: 011433970860
ContactId: 999177fe-8c5a-4e0f-b7f2-28ae511d61c0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 754030 ms
Total Talk Time (AGENT): 336961 ms
Total Talk Time (CUSTOMER): 236922 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/999177fe-8c5a-4e0f-b7f2-28ae511d61c0_20250403T17:32_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling. I received a voice message from someone today about a claim I had a question about.
[CUSTOMER][NEUTRAL] And the message said that I was in the hospital for over 24 hours, so my claim was considered inpatient. I have not been in the hospital over 24 hours since having a baby.
[CUSTOMER][NEUTRAL] And my youngest is [PII] old.
[AGENT][POSITIVE] Oh my goodness.
[CUSTOMER][NEUTRAL] So I, I'm not sure.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] I'm not sure where this information is coming from.
[AGENT][NEUTRAL] All right, Ms. [PII].
[CUSTOMER][NEUTRAL] I got outpaces.
[AGENT][NEGATIVE] OK. I don't even know what to say right now. You, I, I don't think I've ever taken a call with this circumstance.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, I thought that was very odd to say to me that I was in the hospital for it. It was an outpatient surgery. I was there for a few hours and went home.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And they're saying that I was in there over 24 hours. That's not the case.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, Ms. [PII]. So what I will need to do, so we need to look at this claim that you received a voicemail about stating that it was showing you as an inpatient, correct? Is that right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, that's what it's saying.
[AGENT][POSITIVE] Yes, ma'am. All right, well, I can help you with this. So first off, what is a good call back number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, and your policy number please.
[CUSTOMER][NEGATIVE] Oh sucks, uh, one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that number is.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK, the outpatient number is 01568608 M as in Mary, L as in Larry 8.
[AGENT][NEUTRAL] OK, thank you. So give me one moment to get your information pulled up, Miss [PII]. Once I do, I will need to verify several things with you first for security and also any information that's provided would be a verification of benefits and not a guarantee of payment. So first off, if you will please verify your date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. The phone number that you gave to me is also the one that we have on file for you, so that is your best contact number, is that correct?
[CUSTOMER][POSITIVE] That's correct, yes.
[AGENT][NEUTRAL] Alright thank you and the last piece of information to verify is your email?
[CUSTOMER][NEUTRAL] OK, that's [PII].
[AGENT][POSITIVE] OK, thank you very much.
[AGENT][NEUTRAL] Now Miss [PII], I do have one question for you while some other information is loading. Have you ever set up your profile in our portal called the online service center where you can log in and have access to your ID cards, policy information, and also your claims information?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I have gone on there just to submit claims, but.
[CUSTOMER][NEUTRAL] No, no, I haven't done it. I'm sorry. I haven't. I don't think so anyway.
[AGENT][NEUTRAL] Oh, OK, well, what I will do then when you and I are done with our call I'm gonna send you an email with the user guide that explains how to set that up um so if you choose to do that you can and that way you'll be able to access all of your information online as well.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Oh, all right.
[AGENT][NEUTRAL] All right. So let me um give me just a moment.
[AGENT][NEUTRAL] And what is the data service, Ms. [PII], that you're calling about?
[CUSTOMER][NEUTRAL] It's 1117 1117 2023.
[AGENT][NEUTRAL] 2023. OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And do you have a billed amount for that specific data service?
[CUSTOMER][NEUTRAL] Um, I don't have that in front of me, but I, I spoke with the, the young lady the other night and it was 3,416, I believe was the amount of the invoice, but there.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They're billing me for, I think it was $392.
[AGENT][NEUTRAL] OK, so give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I can see a note um.
[AGENT][NEUTRAL] Or someone did call you today and the note on here states that.
[AGENT][NEUTRAL] The claim shows you were in an observation for over 24 hours.
[AGENT][NEUTRAL] And therefore we consider that as an inpatient and any claims.
[CUSTOMER][NEUTRAL] I was not
[CUSTOMER][NEUTRAL] I was not under observation. I had surgery.
[AGENT][NEUTRAL] Right, but
[CUSTOMER][NEUTRAL] They keep you there a few couple of hours and then you go home, so I'm not sure.
[AGENT][NEUTRAL] And that's
[AGENT][NEUTRAL] And that is, that is the observation part of it. However, per your policy information,
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] That's not making very much sense at all. How can you say I'm in the hospital for 24 hours when I'm not? If I'm at home,
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] How can that be a 24 hour stay?
[AGENT][NEUTRAL] OK. So, so what I'm gonna do for you, um, Ms. [PII] is since someone has already called you today, I'm going to connect you over to one of our claims examiners.
[AGENT][NEUTRAL] From the department that would have called you and left you that voicemail so that they can, um, further go over this with you, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] All right, well, before, and I will the email just so that you know, the email I'm gonna send to you about the portal that will come from [PII], [PII] and I will put APL in your subject line for you so that that's easy to recognize.
[CUSTOMER][NEUTRAL] Care team
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK. And you'll be getting that from me within the next, you know, less than 10 minutes for sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, all right, thank you so much.
[AGENT][NEUTRAL] All right. Well, you're certainly welcome, Ms. [PII]. And is there anything else that I can help you with today before I transfer you?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK, well then, thank you again for calling APL and I hope you have a great afternoon.
[CUSTOMER][NEUTRAL] All right, you do the same.
[AGENT][NEUTRAL] Uh, yes, ma'am. Thank you. So, one moment, please.
[CUSTOMER][NEUTRAL] Deferring
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Well, hey, Ms [PII], it's [PII]. How are you?
[CUSTOMER][POSITIVE] I'm good how are you?
[AGENT][NEUTRAL] Well, I'm fine. I have an insured on the line who had received a voicemail. It looks like it was from [PII].
[AGENT][NEUTRAL] Today on a hub ticket and [PII] left her a voicemail um and she does have some additional questions because she's the OK, let me give you the policy first.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 156.
[AGENT][NEUTRAL] 8608.
[AGENT][NEUTRAL] For Ms. [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The data service she's calling about is 11:17-23.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the amount, uh, it would be on claim number 3500111.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And she is stating that that doesn't make sense because she was not there 24 hours. She was at home.
[CUSTOMER][NEUTRAL] 1117 2023.
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, give me one second.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] She said she went and had her procedure. She was there for a few hours and went home.
[CUSTOMER][NEUTRAL] 7:17.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I'm sorry, I talked to myself.
[AGENT][NEUTRAL] That's OK, [PII]. I do too.
[AGENT][POSITIVE] Uh, I do too. It keeps me, it keeps my feet on the ground at times. It's OK, no judgment here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It does it's online lip, so she said she had.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] What date was it on?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And I looked at Misty's notes.
[AGENT][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] You know, she's the, the lady said she was it, that doesn't make sense. She was at home.
[CUSTOMER][NEUTRAL] Let me pull this up. um, I'm just trying to get everything pulled up and I'm gonna let you send her over to me.
[AGENT][POSITIVE] Yeah, sure. No, that's, yes ma'am, thank you for your help.
[CUSTOMER][NEUTRAL] It looks like we have a hospital bill.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm just trying to look at both of them, see what we got 3 423.
[AGENT][NEUTRAL] Sure. Mhm.
[CUSTOMER][NEUTRAL] Most people try to say, well, yes, I was there over 24 hours.
[AGENT][NEUTRAL] Right? And this like, that's what she said, I've not been inpatient since I had my baby over 31 years ago.
[CUSTOMER][NEUTRAL] Oh, OK, I can explain it to her cause she was there, she was in observation. They did 24 hours of observation, so that's over 18 hours.
[AGENT][NEUTRAL] Right, but she says she was not there that long. I went over that part with her again, but she says she was not there anywhere near that long. She was at home. She went to have a procedure, stayed a few hours, and went to her house.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, you can send her on over and I'll try to talk to her.
[AGENT][NEUTRAL] So,
[AGENT][POSITIVE] OK, [PII], and I'm making up my, I'm making my note now. So thank you so much.
[CUSTOMER][POSITIVE] OK. No problem. Have a great one.
[AGENT][POSITIVE] All right. Have a good afternoon.
[AGENT][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.