AccountId: 011433970860
ContactId: aead203b-5a3a-46d2-8dfe-ba04e64fe82f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 662119 ms
Total Talk Time (AGENT): 155018 ms
Total Talk Time (CUSTOMER): 415861 ms
Interruptions: 3
Overall Sentiment: AGENT=1.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/aead203b-5a3a-46d2-8dfe-ba04e64fe82f_20250219T20:31_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Hi, [PII], I have a quick question regarding uh a claim on my gap insurance.
[AGENT][POSITIVE] I'll be happy to assist with the claim. May I have your first name please?
[CUSTOMER][NEUTRAL] Yes, my first name is [PII].
[AGENT][POSITIVE] And [PII], if I can get a good callback number for you.
[CUSTOMER][NEUTRAL] Yeah it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] My policy number is 02496462ML7.
[AGENT][NEUTRAL] OK, and if you can verify your last name, date of birth, and email address.
[CUSTOMER][NEUTRAL] Yes, my last name is [PII]. My date of birth is [PII], and you said email address?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] Thank you for that and what's the date of service for the claim?
[CUSTOMER][NEUTRAL] Uh, the, the date of service was, I believe the [PII], no, the date of service was.
[CUSTOMER][NEUTRAL] I don't remember. I have the claim number on me. Will that help?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I have 356-561-1.
[AGENT][NEUTRAL] I'm showing that data service [PII].
[CUSTOMER][POSITIVE] Yes, that that sounds correct.
[CUSTOMER][NEUTRAL] That is uh my, the, the thyroid surgery, the thyroid removal.
[CUSTOMER][NEUTRAL] what it should be.
[AGENT][NEUTRAL] OK, so I'm showing that um.
[AGENT][NEUTRAL] We requested we can't tell whether or not this should be processed under your inpatient or outpatient benefit so we requested the itemized hospital bill that shows um the dates and time of the admin and discharge.
[CUSTOMER][NEUTRAL] OK, so, so, uh, uh, two things that I wanted to ask because, uh, for starters just to get full clarity as far as what I submitted originally I'm assuming that that is perfect as long as it has the diagnosis code, the procedure code, and then the EOB, which is what you guys see there, which is what I provided on the screen. You guys were able to see that there was a co-pay amount and that there was a patient responsibility amount. So on as far as that's concerned, that's correct.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Now, uh, but for, for situations specific to this one like surgery and stuff like that, the reason why the claim hasn't been approved is because it needs what you just said, which is, uh, the to define whether it's outpatient or inpatient based on the, the, the discharge, right, like the overall time of stay at the hospital, correct?
[AGENT][NEUTRAL] Right, we don't wanna underpay the claim because if you were under observation for more than 18 hours, that would be considered, um.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] A thou uh inpatient and we would have to process it under your $2000 benefit versus just your $750 benefit.
[CUSTOMER][NEUTRAL] I understand.
[CUSTOMER][NEUTRAL] I understand so so it doesn't mean that you guys aren't approving it it just means that if it were to get approved, you guys wanna make sure that you guys have the right time to to approve it under the right, I guess, um.
[CUSTOMER][NEUTRAL] Whether it's outpatient or inpatient, I understand that makes a lot of sense. OK, now I, I, I guess I don't know if you have guidance on this, but how would I be able to, because on my discharge papers, it doesn't a I would have to take a picture of them and submit them as separate claims the file is gonna be too big, um.
[CUSTOMER][NEUTRAL] What have you seen patients do as far as getting that number? I also have my wife is a nurse at Jackson. She has colleagues that, that, that were working under my case and I was able to get one sheet of paper that has my discharge, uh, my, my information, my time in versus my time out, which, if I'm not mistaken, is equivalent to about 19 hours, um.
[CUSTOMER][NEUTRAL] But I don't know if that's enough to submit. I guess like what would be the document that I would have to request from the hospital? Would it just be simply the discharge paper on a on a PDF file?
[AGENT][NEUTRAL] So you said you have something that says when, what time you were admitted and what time you were discharged?
[CUSTOMER][NEUTRAL] I do, but I don't know. The problem is, is I don't know how clear it is. Look, I have it with me and I can maybe relay it to you and you can give me some guidance, but.
[CUSTOMER][NEUTRAL] One second here.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So it doesn't, it doesn't, and the problem, yeah, you see, the problem is it doesn't necessarily have
[CUSTOMER][NEUTRAL] The first page of the document does have my name. It has [PII]. It has my information, and then on the back of that same document there is the visit type and then it says here um.
[CUSTOMER][NEUTRAL] It has like all the information as far as like the location and then the day of admission and the day of release.
[CUSTOMER][NEUTRAL] Um, so for example, for, for the sake of this, for, for this, uh.
[CUSTOMER][NEUTRAL] For this
[CUSTOMER][NEUTRAL] Removal, uh, I was under observation, uh, on [PII].
[CUSTOMER][NEUTRAL] At [PII] was when I started and I was discharged at [PII] at [PII].
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEGATIVE] The prob[PII] is, is I don't know how clear that is for you guys and the and the last thing I wanna do is go through this again where I have to wait longer because the problem is is I'm, I'm, you know, I'm getting calls from [PII] and they're asking me, hey, uh, when are you gonna be able to pay this? and then it's like, hey.
[CUSTOMER][NEUTRAL] Guys, I gotta hold off because I'm working on getting my gap insurance to see how much I, I get covered to be able to know what the difference is, uh, but I don't wanna keep prolonging it, so I guess I wanna figure out exactly what documentation I need to be able to submit to make sure I have everything accurate.
[AGENT][NEUTRAL] What you just read to me.
[AGENT][NEUTRAL] Is what we need is what we're asking for. Do you mean not clear like.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Like we wouldn't be able to see it because it's like great, it's not dark enough or.
[CUSTOMER][NEUTRAL] I guess, I guess from clarity what I mean is it's, it would be, so I try to.
[CUSTOMER][NEUTRAL] I tried to submit this earlier, right, uh, as a new claim, and I guess I'm gonna have to, so I guess my question is when I submit this, I'm gonna obviously have to submit this as a completely new claim, uh, but with that being said is when I try and submit as a new claim, the issue that happens is I guess the, the capacity of files or like the file storage that a claim can can take is kind of exceeded, uh, so I don't know if I have to commit.
[AGENT][NEUTRAL] How many pages is it? It should just be, we just need the one page that shows your admin and discharge. We don't need all the other stuff.
[CUSTOMER][NEGATIVE] I mean, uh, technically I could submit the one page. The the only fear that I have is that it's not descriptive enough because the one page, the one page that I'm telling you has, um, it only has like it's like, uh, it all it has is like visit type, but it has none of my information on it.
[AGENT][NEUTRAL] Oh, OK. Yeah. It, it needs to have your personal, OK, OK, OK.
[CUSTOMER][POSITIVE] Yeah, you got, right.
[CUSTOMER][NEUTRAL] Yeah, that's what, that's what I mean, uh, you know, of course.
[AGENT][NEUTRAL] OK, we'll call [PII].
[AGENT][NEGATIVE] And let them know since they want their money and they're bothering you, say, well, listen, send me medical documentation stating my admin and discharge time.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So that I can finish completing filing my claim that just go straight to the source, tell them that's what you need if they want their money and they know what you need because it's the same information they send us when they want money.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, um.
[CUSTOMER][NEUTRAL] OK perfect so I'll do that and then with that being said, when I, when I resubmit this claim and I and I upload a new claim, um, what I'm gonna run into, I already know I'm gonna run into this issue is is when I submit that same EOB that I have on that claim that we were just talking about, it's, it's not gonna, it the storage is not gonna be enough for that, that document. Let's say they do give me a one pager with the information we're talking about.
[AGENT][NEUTRAL] How many
[CUSTOMER][NEUTRAL] The one page. It really is just one page. I, I don't know, it's very for me, for me in my opinion.
[CUSTOMER][NEGATIVE] Uh, the APL system, however it is here, it's, it's, it's kind of, yeah, like, like, uh, very limited on storage capacity, um, because it's literally 2 pages max, but, but it's giving me an issue.
[AGENT][NEUTRAL] You don't need to send us the EOB the own.
[AGENT][NEUTRAL] The only thing we need is what time you checked in the hospital and what time you checked out. We don't need the EOB. We don't need a diagnosis. We already have that. So just send us what we're asking for. You don't need to send anything else extra cause we already have that.
[CUSTOMER][NEUTRAL] OK, so I just need to OK.
[CUSTOMER][NEGATIVE] I don't got it.
[CUSTOMER][NEUTRAL] So I don't need to redo it. OK, the lady on the last time I called said I needed to do the whole thing over again. That's why I was under that impression. So I don't need to do that. I just need to, uh, submit the, the, the paperwork that is in line with the same date of what we're talking about.
[AGENT][NEUTRAL] That's correct and just put the claim number that you gave me just reference the claim number then we'll know OK this information goes with this claim and he's sending us what we asked for.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right
[AGENT][NEUTRAL] OK, was there anything else I could assist with today?
[CUSTOMER][POSITIVE] No, uh, you've been a great help. I'll, I'll see, uh, I'll get to the bottom of this, alright.
[CUSTOMER][NEUTRAL] Um
[AGENT][POSITIVE] OK, well thank you for choosing APL and you have a good day.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Alrighty, likewise, thank you so much.
[AGENT][POSITIVE] Alrighty bye bye.
[CUSTOMER][NEUTRAL] Bye.