AccountId: 011433970860
ContactId: 9fe0dbd5-ad93-456d-a18d-c30b7a84af9c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1186619 ms
Total Talk Time (AGENT): 481817 ms
Total Talk Time (CUSTOMER): 670288 ms
Interruptions: 6
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/9fe0dbd5-ad93-456d-a18d-c30b7a84af9c_20250527T15:08_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, yes, [PII]. Um, I've talked to you in the past. I do actually have your name on my piece of paper. Um, I'm trying to file some, um, claims for my husband who passed away in January. This is [PII].
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And um,
[CUSTOMER][NEUTRAL] My husband was [PII], Scotty Barber, and he was on the insurance that, that, uh,
[CUSTOMER][NEUTRAL] That I don't know. I'm trying to think of what it's actually called the rider on my cancer policy. Um, anyway, I have been trying for about 2.5 months to get the records from the hospitals to send to y'all because I filed a claim and they said those aren't good enough records. You all said, no, we have to have an itemized statement.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEGATIVE] And I'm having a trouble getting those from [PII]'s mother [PII] and [PII], and, and I, I don't understand.
[CUSTOMER][NEUTRAL] They said, well, do you, and, and then this I called this morning again and they said, do you need an itemized statement or do you need an EBO4 or UBO4 or something? And I said, all I know is I have to have one with all the procedure codes on it.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And you know y'all told me and so is, is that what is that called? What form is that called?
[AGENT][NEUTRAL] That is an itemized statement that has procedures, codes, and diagnosis codes on it. Now, they do have a UBO4 facility form um from
[AGENT][NEUTRAL] The, um,
[AGENT][NEUTRAL] Facility itself.
[AGENT][NEUTRAL] And which is usually what the facility sends to us to file a claim, um, Miss [PII], let me get your call back number, ma'am, just in case the call gets disconnected. I'll, I'll, I'll be able to call you back and also your policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, my num my phone number is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Um, my policy number is um.
[CUSTOMER][NEUTRAL] M I
[CUSTOMER][NEUTRAL] 01788
[CUSTOMER][NEUTRAL] 9754
[AGENT][NEUTRAL] OK, do you see a different number that's not one of APL's policy numbers or if you can give me your social I can pull it in that way also.
[CUSTOMER][NEUTRAL] Oh, I'm sorry. I'm sorry. I'm looking, I'm looking at the wrong thing. That was in a, uh, let's see, Ame.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] My policy number here, oh my gosh, OK, um.
[AGENT][POSITIVE] That's OK. Take your time.
[CUSTOMER][NEUTRAL] OK. The policy number here is cause, OK. um OK, 02088763.
[AGENT][NEUTRAL] OK, let me pull that up real quick.
[CUSTOMER][NEUTRAL] Because I had filed them and they said we need additional information.
[AGENT][NEUTRAL] Yes, that happens sometimes when um
[AGENT][NEGATIVE] Documents are missed, it does happen sometimes.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And then they'll send you a letters state, yes ma'am.
[CUSTOMER][NEUTRAL] Right. Oh, well, I think I just.
[CUSTOMER][NEUTRAL] OK, yes, ma'am. That's true.
[AGENT][NEUTRAL] OK, let me pull it up. OK. And for security reasons, Ms. [PII], I'll have to verify your policy. 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] Uh, [PII] uh the phone number is [PII].
[CUSTOMER][NEUTRAL] And the email address is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you very much, Ms. [PII].
[AGENT][NEUTRAL] Alright, so I'm looking at your policy and I can see um where you reported.
[AGENT][NEUTRAL] A claim on [PII], um, claim number 3587623. I'm gonna pull that up to see what the additional information that they needed um.
[AGENT][NEUTRAL] And it was for Wallace dermatology.
[CUSTOMER][NEUTRAL] OK, I have a
[CUSTOMER][NEGATIVE] Oh, OK. Well, that's not, that's not, that was on me. And that's when I figured out that I was doing it all wrong. This is all on my husband under God claimant.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] Oh bless your heart. OK, all under Scotty. OK.
[CUSTOMER][NEUTRAL] Under Scotty, um, it was the last ones, um, let's see, because, oh, I know after I realized that I, I just didn't understand the policy. And so, um, let me see trying to see where all the ones where I got for him.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, no. Yeah, I had, I had several 2 ambulance calls, an intensive care stay in the hospital, and then he will have, um, and he died with heart problems. And so the heart attack rider that, um, you know, until you'll have more information. Let me see what claims. It's all gonna be under him.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right. Yes, ma'am. I do see several, um,
[CUSTOMER][NEUTRAL] It's fine.
[AGENT][NEUTRAL] Several remarks. And let me just go through those real quick so that I can see what you're looking at.
[AGENT][NEUTRAL] Yes, I do see where it says in order to give consideration to this data service we will need a full itemized hospital facility billing with charges fully identified. OK, so that is for the facility billing that is the UB04 form.
[AGENT][NEUTRAL] That, which is p[PII] what the hospital mentioned.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because they said that would have.
[CUSTOMER][NEGATIVE] Yeah, they did, and they said that that would have to be mailed to me, which this is 2 months and it's never been mailed. And so I've called 3 times. And so then they said, well, we can, I don't have a fax here. And they said, or we can fax it directly to the insurance company. And I said, well, are you really sure you can do it since you haven't done it? I mean, I don't understand what
[AGENT][POSITIVE] 00 bless it.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] I don't understand what it is that you can't do now that you know, you could do then. So, um,
[AGENT][NEUTRAL] Yes, I understand.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I guess she said, well, I need to know exactly what you need. And I said, well, I know I have to have an itemized statement with procedure codes and diagnosis codes. And then, but she wouldn't tell me which one it was, which, if it was that UB.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] You know, so I, I, I, so I, I'm calling you, and I don't know whether, I mean, I kind of would like to have it myself, but she said I can fax it directly to the insurance company.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. OK. Um, do you have our fax number?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] Let me give that to you and
[CUSTOMER][NEUTRAL] Not unless it might be back on the web, OK, it might be back on the website somewhere and I haven't been back on that. I was just calling them back, you know, so, OK.
[AGENT][NEUTRAL] Yes ma'am, let me give you um the fax number and then I'm also going to give you a payer ID number so if they wanna send it electronically they can do it that way also.
[AGENT][NEUTRAL] OK, um, that's two ways that they can, they can utilize the, the services. Um, the fax number is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 942 [PII].
[CUSTOMER][NEUTRAL] OK [PII]
[AGENT][NEUTRAL] Yes ma'am, that is the um fax number and then the claims payer ID number for them to send it electronically which may be easier for them because it's right there on the computer is 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 6001
[AGENT][NEUTRAL] No, no, 60, 6801.
[CUSTOMER][NEUTRAL] Four digits
[CUSTOMER][NEUTRAL] 6801. OK.
[AGENT][NEUTRAL] No, 60801.
[CUSTOMER][NEUTRAL] I'm sorry, 60801 5 digits.
[AGENT][NEUTRAL] That's OK.
[AGENT][POSITIVE] Yes, that's right. That's correct.
[CUSTOMER][NEUTRAL] 60801. I think on my phone might have cut out a little bit there. OK, 608, and that's your payer ID if they want to do electronically. OK. But what you do need is this UBO4.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] That's
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, the facility form that has all the charges on it.
[AGENT][NEUTRAL] That, um, let me read it again. It says in order to give consideration to this state of service, we will need a fully itemized hospital facility.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hospital slash facility billing with charges fully identified.
[AGENT][NEUTRAL] And that's the UBO4 facility form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, just so you know, if you have any um
[CUSTOMER][NEUTRAL] OK, so if they
[AGENT][NEUTRAL] Anything from a physician that needs to be sent in as far as um billing information like this is requesting from the facility which is the hospital uh and if you ever need to send anything from the physician, that's a different form and if you wanna write it down just for your notes.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's a hifa, H I F A.
[AGENT][NEUTRAL] 1500 standard form. So that comes from the physician and the UBO4 comes from the hospital.
[CUSTOMER][NEUTRAL] OK, so when the part where you determine.
[CUSTOMER][NEUTRAL] When he had a heart attack or when that happened.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I mean, is that going to need to come from uh his personal physician? I mean, you know, he had a personal physician, and then he had the ones that were in the hospital, which some of them sometimes they overlapped. He was there for a week. So,
[CUSTOMER][NEUTRAL] What, where is that gonna come from? Is that going to.
[CUSTOMER][NEUTRAL] Say, I mean, I, I don't, I don't understand how I'm going to get that because they did say he must have had a heart attack, you know, and then all these other things happened. But how do I prove that? Who does that come from? The heart attack part?
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] That's gonna come from the initial.
[AGENT][NEUTRAL] Do that said or
[AGENT][NEUTRAL] Whether it be in the hospital or in the physician's office, the initial diagnosis of heart attack would come from
[AGENT][NEUTRAL] The doctor that initially diagnosed him with a heart attack.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, because
[CUSTOMER][NEUTRAL] He went.
[CUSTOMER][NEUTRAL] To the doctor.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And they went ahead and sent him to the hospital at from the doctor's office.
[CUSTOMER][NEUTRAL] And so,
[CUSTOMER][NEUTRAL] You know, then at some point after they had him and started running tests, is when they said, after a couple of days, you, you've had a heart attack. And they didn't say that on the way to the hospital, but I don't know, I guess, how I'm gonna get that, which, I mean, there were like 20 doctors that saw him. So maybe go back to his cardiologist.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Or um
[AGENT][NEUTRAL] or if you go to the hospital, they may have his medical records that shows the initial diagnosis at the medical records department.
[AGENT][NEUTRAL] And his cardiologist, OK, so if they initially diagnosed him at the hospital, then they would have referred him to the cardiologist, is that correct? Is that what happened?
[CUSTOMER][NEGATIVE] No, he did not come home. He passed away in the hospital.
[AGENT][POSITIVE] Oh blessed. OK. So yes. So the doctor.
[CUSTOMER][NEUTRAL] Yeah. So he has, he passed away. And, I mean, he, he had had open heart surgery 10 years ago, but he has never, no one had ever said he had a heart attack. He's never, this was the very first time they said he actually had a heart attack. And I mean, it's like, cause I know they say, oh, it's the first time. Well, you know, he had heart problems, but he, I mean, he was always thankful he'd never had a heart attack. And so, uh,
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] We don't, we, it's kind of hard to say it happened at [PII] on this day in the hospital. And so I, I
[CUSTOMER][NEUTRAL] You know, the doctor came in and said, well, he's, he's had a heart attack, and that's why his heart went down this much. So I, I don't, I don't even know where to begin to, to try to file that type of a claim. I don't think I have, I don't think I have tried to file that yet.
[AGENT][NEUTRAL] I would
[AGENT][NEUTRAL] OK, I would start with his cardiologist.
[CUSTOMER][NEUTRAL] On the, uh
[AGENT][NEUTRAL] That he saw in the, in the hospital.
[AGENT][NEUTRAL] Because
[AGENT][NEUTRAL] That would be, you know, if anybody has actually diagnosed him with, with a heart attack, it would be the cardiologist.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right. So if he saw 2 or 3 in the hospital, one of the ones was his main one, you know how they're on call. So probably maybe just contact his main cardiologist at the office and say,
[AGENT][NEUTRAL] Yes,
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] This is what they need and then ask him if he can do this HIA 1500. Is that what he would do it, that standard form? OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And would that need to come directly to y'all?
[CUSTOMER][NEUTRAL] Again at this fax number.
[AGENT][NEUTRAL] Yes, that
[AGENT][NEUTRAL] Yes, ma'am. Or at the, or at the payer ID.
[CUSTOMER][NEUTRAL] OK, and even if you get it before.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEGATIVE] OK. Well, maybe I can get somewhere with this. I don't know. I've, I've, I've had to, you know, you wait and wait and wait, wait 10 days if you get in the mail. And after 2 months, I'm going, I don't understand. And then they say, well, this person, we look back and it says they couldn't get in because he passed away. And I went, I don't understand. I mean, I'm, you know, it's hard enough to go through the stuff that you're going through all this paperwork that
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] Does not make any sense. Like they just don't want to do it. And I know that that's probably not true. It's just, I don't know. So, um, anyway, I'm gonna try to call them back and tell them that's what I need. And then I don't know how long it normally takes them to fax it, but then I will check back I guess to see if y'all get it. I, I mean, I have no idea the time length for y'all to get faxes or.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Um, allow a couple of days or just kind of.
[AGENT][NEUTRAL] Yes, allow 3 days for them to get the fax and process it to where we could actually see it in the computer, um.
[CUSTOMER][NEUTRAL] I guess I'd have to ask them.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And so I will, I will try to see what I can do with this, and then I will call y'all back and if you if they say yes we're gonna fax it, I'll call you back in a couple in 2 to 3 days to see if you actually got the fax.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am, and we, we can do that. And then Miss [PII], if there's anything else that um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They're, they're requesting or need.
[AGENT][POSITIVE] And you have sent it if you wanted to call and check up on it as you know it takes 7 to 10 days and if we need to get further help and go to a claims specialist at any point in time we can do that too.
[AGENT][NEUTRAL] To help you.
[CUSTOMER][NEUTRAL] OK, what's a claims specialist?
[AGENT][NEUTRAL] That's gonna be the person who actually.
[CUSTOMER][NEUTRAL] You mean at the hospital or with you?
[AGENT][NEUTRAL] With us. That's the person who actually processes your claim.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Once we receive all the information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so you're just an intake person, right?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Is that is that what you're saying you just take the information?
[AGENT][POSITIVE] Right, I'm in the right, I'm in the care team we're the first point of contact.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And then we help as much as we can and then if it's something that we can't help with then we'll transfer you to a claims specialist but they're always available to help at any time too so we wanna just make sure that you know that you're getting all the help that you need.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I know they tell me that they know they told me that there's no time limit, but I'm also like at some point you want things.
[CUSTOMER][NEUTRAL] Just finished, you know.
[AGENT][NEUTRAL] Right. Right. Right. That's true. And that, that's also said because there's a lot of places, a lot of insurance companies that if you don't file your claim within 90 days or they'll have a day limit on it, then you can't file it at all. So, we're not like that.
[CUSTOMER][NEUTRAL] So anyway,
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Oh, no, I know. I mean, I'm very grateful for that because I'm like, you know, cause you couldn't even get a bill for 90 days. I mean, you know, it's just crazy. So, OK. Well, I appreciate your help and I, I will try to, to work on this again and kind of, you kind of get away from, you wait for 10 days and you kind of get away from it, and then you go, OK, nothing's moving. I mean, I've had this, it's, it's kind of weird how some of this stuff works. So,
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right. Yes, yes, ma'am.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] I appreciate your help, [PII], and I will see what I can get through to them now. OK, thank you so much.
[AGENT][POSITIVE] You're very welcome, Miss [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're very welcome. You have a blessed rest of your week and thanks for calling APL. Bye bye ma'am.
[CUSTOMER][NEUTRAL] OK. Uh-huh. Bye-bye.
[CUSTOMER][NEUTRAL] OK. OK.