AccountId: 011433970860
ContactId: ae5b74b5-268c-446f-b965-76a9d423508e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 777719 ms
Total Talk Time (AGENT): 318062 ms
Total Talk Time (CUSTOMER): 193760 ms
Interruptions: 7
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/ae5b74b5-268c-446f-b965-76a9d423508e_20250228T14:15_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Um, I actually just had a, well, a couple of questions. My husband has had benefits, um, the hospital hospital indemnity for the last however long, we just found out that he had it and he's been in the hospital a lot the last couple of years. How far back can you file a claim?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Depends on the effective date, but I can check on that. Um, may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh. [PII] telephone number [PII].
[AGENT][NEUTRAL] Mm, thank you. And Ms. [PII], um, are you listed on the policy?
[CUSTOMER][NEUTRAL] I am not. We didn't like I said, we didn't even know that he had it. The doc, the his, we just found out when he was doing his enrollment for benefits for this year, but when I logged into the APL system, it shows that his benefits have been effective since [PII].
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] Oh, OK. All right. Um, and he's not, he's not, um, they're available for me to get permission. This, oh, perfect then, yeah, let's do this. OK.
[CUSTOMER][NEUTRAL] Yeah, he's here. Uh-huh, yeah, and then, uh-huh, just, I just have to give me just a second. Yeah, I was just, I didn't know if I needed, if he needed to or if you just could give just generic general information, but hold on for a second.
[AGENT][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] No, OK, thank you.
[CUSTOMER][NEUTRAL] Mm mhm.
[CUSTOMER][NEUTRAL] Can you give her permission to talk to me.
[CUSTOMER][NEUTRAL] Hello ma'am.
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Good morning. This is [PII].
[CUSTOMER][POSITIVE] Good morning.
[AGENT][NEUTRAL] Morning, um, I need um your name and date of birth for verification.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. And do you have the policy number, the policy number by any chance?
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK. Uh, let me get it, let me pull it up. Oh yeah, give me just a second. I get it.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Sure, yes, yes. Take your time.
[CUSTOMER][NEUTRAL] 023-332-13.
[AGENT][NEUTRAL] OK, thank you. And may I have the mailing address and email address on file, Mr. [PII]?
[CUSTOMER][NEUTRAL] Uh, [PII], um, you may have [PII] or you may have [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK. And may I, um, may I get your permission, Mr. [PII] to release information to your wife?
[CUSTOMER][NEUTRAL] Yes, ma'am, please.
[AGENT][NEUTRAL] OK, thank you. All right, Ms. [PII]. So, um, the address that was [PII], is that correct?
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] OK, let me make sure I got that correct.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] So let me go
[AGENT][NEUTRAL] OK. So, um, by reviewing this information, it looks like the policy was effective [PII] with us. It was [PII]. Mhm. Yes. So you can go back as far as [PII] to submit any claims.
[CUSTOMER][NEUTRAL] The [PII], OK.
[CUSTOMER][NEUTRAL] OK, I can't remember. I did something yesterday.
[CUSTOMER][NEUTRAL] Um, I did, I think I went back to [PII].
[CUSTOMER][NEUTRAL] Uh, yesterday I uploaded, so all that I need to do is the claim form, the explanation of benefits.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] If I have it or the, the detailed thing from the hospital.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, for this type of product, all you need is an itemized bill. Itemized bill needs to have the diagnosis codes and procedure codes and the claim form. Those are the two documents that you need. For this one, we don't need uh the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] OK, so can you see and make sure that I just uploaded what was the correct information?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm I did do the explanation of benefits, but I downloaded the thing from the bill from the hospital. I just wanna make sure that that's the right thing.
[AGENT][NEUTRAL] OK, I see.
[AGENT][NEUTRAL] One moment because it's several submissions. Um, do you mind holding for me? I'll have to open each one of them.
[CUSTOMER][NEUTRAL] OK, well, they're about the same if you open one, that'll.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] about the same.
[CUSTOMER][NEUTRAL] Cause I downloaded it from the same place.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK. All right. Let me put you on a brief hold. I'm just gonna go ahead and open the documents, OK?
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding and being patient for you Miss [PII]. OK, so, um, after reviewing the document, if they're all the same, they're all gonna be missing one thing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] The diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The diagnosis code um is the one, is the one that indicates the reason why he had to go to the emergency room. Um, the CPT codes is just telling us what they did. So, um, those codes, yeah.
[CUSTOMER][NEUTRAL] I get that.
[CUSTOMER][NEUTRAL] I, I will have to get that. How do I get that from? Where do I get that from?
[AGENT][NEUTRAL] You call Texas Health and let them know that you need um a fully itemized bill with the diagnosis codes.
[AGENT][NEUTRAL] And they can either um can send one to you or tell you how to get one either by online or either by picking them up. I'm not really sure how they handle that. But yeah, you can just let them know that you need a fully itemized bill that you can see your bill and you got that information, but you need one with the diagnosis codes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, because the, the ones that have 3 documents have the explanation of benefits, would that have the diagnosis code on it?
[AGENT][NEUTRAL] Um, let me check, um, let me see if I can find an open one that has that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK um
[AGENT][NEUTRAL] Let me try this one.
[CUSTOMER][NEUTRAL] There you go.
[CUSTOMER][NEUTRAL] There
[AGENT][NEUTRAL] And for future, um, whenever you submit a claim, we just need one claim form, um, just one time and just the documents uploaded, OK? You don't have to do it for each.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so I don't need to submit another claim form anymore.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, unless you're doing another one, but not right now, like, let's say you try to submit a claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 3 months from now, 6 months from now, yeah, yeah, if it's, yeah, like today, tomorrow, the next day, uh no, because, yeah, we have all the information.
[CUSTOMER][NEUTRAL] If I need a time today then OK, then I would need to do.
[CUSTOMER][NEUTRAL] OK, so I thought each, each occurrence was a different claim form, OK.
[AGENT][NEUTRAL] Oh no, no, the claim form is just to give us permission just in case we need to um.
[AGENT][POSITIVE] Get additional information and we already got that information recently, so you don't have to submit it, um.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Again, OK.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This one has a little bit more information so let me see.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, yeah, I think they have the diagnosis there.
[CUSTOMER][NEUTRAL] So with those it it does.
[AGENT][NEUTRAL] Mhm. Yeah, I mean is um.
[AGENT][NEUTRAL] It's one of the little ones that doesn't have um diagnosis codes on their explanation of benefits. Um, yeah, this one doesn't, no, it doesn't have the information. So, yeah, we still need that information, OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I wait and I will start working on that. And then how long does it normally take as far as filing the claim or processing.
[AGENT][NEUTRAL] The normal processing time is 7 to 10 business days.
[AGENT][NEUTRAL] Um, if we don't have all the information we need by the 10 date and we process, we're just gonna.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Go ahead and send you an explanation of benefits indicating what we need and once we get that information, we will reprocess. Once we receive the additional information, it goes back to the line so it starts basically all over again. So it's again 7 to 10 business days. So yeah, if you can get that before the, the 7, yes, that will be great. So you don't have to wait that 7 to 10 business days again, OK.
[CUSTOMER][NEUTRAL] That's older. OK.
[CUSTOMER][NEUTRAL] OK, so if I can get it today.
[CUSTOMER][POSITIVE] Alrighty, I'll start working on it.
[AGENT][NEUTRAL] Alright, is there anything else I may help you today, Miss [PII]?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] That is it. I appreciate your help.
[AGENT][POSITIVE] Uh, you're welcome and thank you for calling ATO. Have a good day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you