AccountId: 011433970860
ContactId: bf9b159a-65ba-4636-8898-05107845b685
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1615540 ms
Total Talk Time (AGENT): 488604 ms
Total Talk Time (CUSTOMER): 497739 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/bf9b159a-65ba-4636-8898-05107845b685_20250515T13:14_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling ATL. My name is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Hi [PII], how are you? My name is [PII]. I'm calling to see if there's any way that you could help me. I was just on the phone with a lovely lady because I've done a bunch of claims.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I think I sent the right information that we're looking for now. Can I just give you my name and my phone number or what informa you need my policy number?
[AGENT][NEUTRAL] OK, hold on. So that you sent in claims documents and you're just wanting to make sure we received them?
[CUSTOMER][NEGATIVE] Well, I just wanna make sure that it's what you guys were needing because honestly I've been doing this since [PII] and I'm really not getting an answer like it's just, it's just a little hot mess.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, so I can definitely help you with your claims. May I have, um, well, you already gave me your name. May I have a good contact number in case we're disconnected and your policy number?
[CUSTOMER][NEUTRAL] OK, my policy number is 02111201. My number is [PII]. My name is [PII] and my address is [PII].
[AGENT][NEUTRAL] OK, and can you verify your date of birth and your email address?
[CUSTOMER][NEUTRAL] Oh my [PII], [PII] [PII].
[AGENT][NEUTRAL] Thank you for that, and all your information provided is a verification of benefits, not a guarantee of payment. So the 3, the two that came in on today, you're wanting to
[AGENT][NEUTRAL] See if it's what's being asked for in these denied claims previously here.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK. Do you mind if I place you on just a brief hold while I look at the documents and what's being asked for?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] 360345.
[AGENT][NEUTRAL] And that's a do something or for.
[AGENT][NEUTRAL] What just happened?
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] That's a dupe.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] And the office visits aren't covered, OK.
[AGENT][NEUTRAL] T
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm mm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And times.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] It's the time she printed it out, but that's not the.
[AGENT][NEUTRAL] No, OK, this is not it. And that's the next thing.
[AGENT][NEGATIVE] Dang, she already frustrated.
[AGENT][NEUTRAL] Mm mm.
[AGENT][NEUTRAL] Hello [PII].
[AGENT][NEUTRAL] Hello [PII]?
[CUSTOMER][NEUTRAL] Oh, I'm sorry, yeah, yeah.
[AGENT][POSITIVE] It's OK. Hey, thanks so much for holding. I apologize for that wait. OK, so I see everything that's being asked for and I saw um all the documents that you submitted.
[AGENT][NEUTRAL] OK, so if when you went to the hospital, did you give them the secondary insurance card?
[CUSTOMER][NEUTRAL] No, I did not.
[AGENT][NEUTRAL] OK. The
[CUSTOMER][NEUTRAL] Cause I did, I didn't have him with me. It was an emergency.
[AGENT][NEUTRAL] OK, the reason I'm asking is because all this work that you're doing, they should be doing, which is why the information is not being sent in correctly because the patient wouldn't know. So I'm just asking so I know how to help you. So, the documents that you're welcome, the documents that you sent in are your patient copies of what we're asking for. So it does show the admission dates and the discharge dates, but this coding here, this is
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Basically, this shows what you received as in treatment and how much you paid for it, but what we're asking for is why, because that's how we prove medical necessity in case we're audited. They'll know the doctor said this is what happened, this is why she received this treatment and this is why this was paid.
[AGENT][NEUTRAL] So, do you, you have two options. Um, if you wanted to call the hospital and say, hey, I have a secondary insurance, here's my policy number, y'all bill them and have them bill us for I can give you these dates of service and then they'll send everything into us or um I don't know if you want me to call with you or if you want to give them a call and ask for the information that's needed, but um,
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Basically, what we're asking for is their versions of the billing, which has the dates, the times, all the coding, it's all on one document. Um, so whichever of the two options, I'll be more than happy to help, um, but yeah, this is anytime, well, this was an emergency, so that's different, but typically anytime you give your your your major medical, just go ahead and give us, but of course this was an emergency. So you still can let them know, but it's up to you.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] I mean, uh, to be honest, I just want this resolved. I've been going back and forth since [PII] with this, like you see, I mean, Memorial Hospital doesn't send me a bill. I saw this all through my chart. It's on an app, so I, I figured that this is what you guys need to see, you know what I mean? like.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, and so
[CUSTOMER][NEUTRAL] I really don't know because this is my first time ever.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And so the patient like that does look like itemized bill, you know, you see the codes there, there, you're not sure what it is, you just see a code. So I mean, I definitely understand. I just, um, it's up to you if you want them to to file it or if you want me to tell you how to tell them what's needed, because it's gonna, you're gonna have to talk to them regardless because we need their document. So however you want.
[AGENT][POSITIVE] Handle it, I can help.
[CUSTOMER][NEUTRAL] OK, so you, you, you suggest that I call Memorial, you said?
[AGENT][NEUTRAL] Yes, you're gonna have to call Memorial and speak to their billing department, and I'm gonna, um, I'm gonna go through these claims and get all the dates of service. So basically you're just gonna call and say I need an itemized bill that has diagnosis codes.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Procedure codes.
[AGENT][POSITIVE] And all of the charges for the dates of service. I'm getting ready to look up for you.
[CUSTOMER][NEUTRAL] I, I, I don't bill by procedure. Do you want me to call Memorial through it with you?
[AGENT][NEUTRAL] I can if you like
[CUSTOMER][NEUTRAL] Because there
[CUSTOMER][NEUTRAL] But they're gonna have to email it to me, and they're not gonna email it to you, right?
[AGENT][NEUTRAL] It depends. Um, sometimes with the patient on the phone, they'll go ahead and fax it over to us, sometimes they'll say they have to send it to the patient. It depends on the facility. They all have their own rules.
[AGENT][NEUTRAL] But I don't mind if you want to call them, we can call them.
[CUSTOMER][NEUTRAL] OK let me.
[CUSTOMER][NEUTRAL] Yeah, I mean, let me try calling them. I, I think I could do this. Give me one second.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Calling Memorial Health Care Systems Patient Financial Services espanolavor precinco. If this is a life-threatening emergency, please hang up and dial [PII].
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] To self-pay your bill via our automated phone system, please press 1. For financial eligibility, please press 2. To speak to hospital billing representative, please press 3. If you are calling.
[CUSTOMER][NEUTRAL] In order for us to serve you better, please provide your date of birth by entering 2 digits for the month, 2 digits for the day, and 4 digits for the year.
[CUSTOMER][NEUTRAL] All calls are recorded for quality assurance and training. Please hold for our next available agent.
[CUSTOMER][NEUTRAL] Your estimated wait time is less than 5 minutes.
[CUSTOMER][NEGATIVE] It's not good because you're getting.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] In order to serve you better, if you would like us to call you back without losing your place in line, please press 1. Otherwise, you can continue to hold, and we will be with you momentarily.
[CUSTOMER][NEUTRAL] Good Morning. Thank you for calling Memorial Patient Financial Services. This is [PII] speaking. How may I help you? Hi, [PII], how are you? My name is [PII]. How are you?
[AGENT][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] Good and yourself? Good. I'm calling on 3 way with my um uh my gap insurance that I have as well. The reason why I'm calling is I was in your facility [PII] and
[CUSTOMER][NEGATIVE] It was not a good experience, but that's, that's beyond the point. And then I was sent home and then they sent me back to the hospital on [PII] and I was released on [PII] and I had to have surgery and I'm just going back and forth and my gap insurance needs some information from you guys on the bill.
[CUSTOMER][NEUTRAL] And I was calling to see if there's any way that if you could speak with her, she's on 3 way.
[CUSTOMER][NEUTRAL] So we don't provide information on the phone with the gap insurance depending on what they're asking. Um, if not, there's certain documentation that we can provide you and then that you would have to provide to them. um, I can think to you at least what we need to see if you could just in person to me.
[CUSTOMER][NEUTRAL] Yeah, of course, um, can you confirm with me your name and date of birth? [PII].
[CUSTOMER][NEUTRAL] Hello, ma'am?
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] And then what
[CUSTOMER][NEUTRAL] I think she's not there anymore.
[AGENT][NEUTRAL] I'm here.
[CUSTOMER][NEUTRAL] No, I heard her on the back line. Oh, OK, I was like, what you hear. Um, what, what else do you need? I'm sorry?
[CUSTOMER][NEUTRAL] Um, if you can also just confirm your home address and phone number on file, [PII].
[CUSTOMER][NEUTRAL] OK, thank you and then your phone number? [PII].
[CUSTOMER][POSITIVE] OK, thank you so much, thank you.
[CUSTOMER][NEUTRAL] OK, and then, so is it for both dates of services or just the one on the [PII]? Both of them, I guess at this point. I just wanna make sure everything's together, OK.
[AGENT][NEUTRAL] OK, hold on, hold on, hold on. I'm sorry, wait, hold on. So, you said that there's only certain information that you can give us. Can I give you her she never, she never gave our, it was an emergency, so she didn't provide our cards, so we weren't billed. So we're asking for like itemized bills and like diagnosis codes so we can process. Do I need to just give you her information so y'all can bill us?
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] Since you can't give me any information, or can I tell you what I need and get it sent to us?
[CUSTOMER][NEUTRAL] Right, so all we would do is just bill you guys for the date of service, um, if you needed like diagnosis codes that would be after a claim gets sent to you she can request the UB 04, um, but uh on the bill it's gonna have like on the claim that we submit it's gonna have the coding on there as well.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So she's already submitted the claims because they, the, the card wasn't submitted to y'all to bill to us, so we already know what we need. Does she need to ask, do I need to tell her what to ask you since you can't tell me or I just need itemized bills, you be for?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's all we need, because she's already.
[CUSTOMER][NEUTRAL] So UBO4 we submitted it to her primary insurance, is that what you need?
[AGENT][NEUTRAL] Right, that's what I'm saying. She has a secondary insurance, so it wasn't provided to you. So you, you all did not bill us. So yes, that's what we need.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, so what you want is the UB 04 from the primary or you want us to send the claim over to you guys and bill you guys as secondary?
[AGENT][NEUTRAL] It doesn't have to be from primary, it just needs to be the item, the UBO4 from the provider, whether it's primary's copies or yours. We just need the UBO4 with the itemized billing.
[AGENT][NEUTRAL] And the codes.
[CUSTOMER][NEUTRAL] OK, and what's her gap insurance?
[AGENT][NEUTRAL] We are APL American Public Life.
[AGENT][NEUTRAL] It's a Medlink policy.
[CUSTOMER][NEUTRAL] [PII] you stated.
[AGENT][NEUTRAL] Yes, it's a meddling supplemental gap insurance policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or second to her UnitedHealthcare.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] She
[CUSTOMER][NEUTRAL] Bear with me one moment, OK?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is the [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Can you confirm with me her um.
[CUSTOMER][NEUTRAL] ID number?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] With us is 211.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 1201.
[CUSTOMER][NEUTRAL] OK, bear with me.
[CUSTOMER][NEUTRAL] OK, so I'm gonna update both accounts, um, to go ahead and bill you guys a secondary insurance.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I can send her the UBO4 that we submitted to United Healthcare.
[CUSTOMER][NEUTRAL] Can you please
[AGENT][NEUTRAL] And it has all of the coding.
[CUSTOMER][NEUTRAL] Of course what's your email address?
[AGENT][NEUTRAL] Hold on, please. It has all of the clothing along.
[CUSTOMER][NEUTRAL] It's gonna have the diagnosis code.
[AGENT][NEUTRAL] OK. Along with the admission dates and the discharge dates, or do you have a different document for that and time? I'm asking because it's already been denied and that's what they're asking for. OK, thank you.
[CUSTOMER][POSITIVE] Correct, it's gonna have that as well.
[CUSTOMER][NEUTRAL] Mhm. Of course. Is there any way that you could email it to me?
[CUSTOMER][NEUTRAL] Yeah, of course, what is your email address?
[CUSTOMER][NEUTRAL] Um, you can send it to my job, it's easier. [PII].
[CUSTOMER][NEUTRAL] So [PII].
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][POSITIVE] OK, so I'll submit it over to you um within a few minutes.
[CUSTOMER][POSITIVE] OK, no problem. Thank you so much.
[CUSTOMER][NEUTRAL] Of course. Was there anything else I can do to assist with? No, that's it.
[CUSTOMER][POSITIVE] If you don't mind hanging, I'll stay talking with the other lady. Thank you so much for your help.
[CUSTOMER][POSITIVE] Of course any time have a great rest of your day you too bye bye.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I hope she had not
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] OK, so when she sends me that I should go into the website and attach it to, or no?
[AGENT][NEUTRAL] Hey, OK.
[AGENT][NEUTRAL] Yes, when she sends you the um
[AGENT][NEUTRAL] When she sends you the UBO4.
[CUSTOMER][POSITIVE] I'm so sorry. Thank you so much.
[AGENT][NEUTRAL] You're welcome. I, I was trying to get, I wanted to give her the date, we have particular dates of service on these claims. I don't know what she's sending over, but whatever you um you be for, she sends over, yeah, go ahead and upload them to the online service center and we'll go ahead and look through them.
[AGENT][NEUTRAL] And get it processed.
[CUSTOMER][POSITIVE] Alright, thank you so much.
[AGENT][POSITIVE] You're welcome. Um, also,
[CUSTOMER][NEUTRAL] I was just trying to see yeah mhm.
[AGENT][NEUTRAL] If they um
[AGENT][NEUTRAL] When you get them, we're looking for [PII].
[CUSTOMER][NEUTRAL] And on April.
[CUSTOMER][NEUTRAL] [PII], uh-huh.
[AGENT][NEUTRAL] Um, then [PII].
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Those are all the same dates.
[AGENT][NEUTRAL] Well, the [PII], it, it, I'm giving you the date, date, go ahead.
[CUSTOMER][NEUTRAL] Because I
[CUSTOMER][NEUTRAL] Yeah, I was, I'm.
[CUSTOMER][NEUTRAL] OK, no, no, no, because I was admitted on the [PII], but I went to the hospital on the [PII], I should say, but I got admitted on the [PII]. So by memorial's paperwork, it looks like I went on the hospital on the [PII] because I was admitted on the [PII]. I got to the hospital on [PII] at [PII], I mean in the afternoon.
[CUSTOMER][NEUTRAL] But they didn't put me in a room until [PII]. So to them, I checked in on the [PII].
[AGENT][NEUTRAL] Right, the dates that I'm giving you may overlap. I'm just giving you the dates based on each claim we went through. So when you get the paperwork, you can go through the dates. I'm just, I just want you to have all of them, that's all.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Did you need the rest?
[CUSTOMER][NEUTRAL] Yeah, I mean, sure.
[AGENT][NEUTRAL] No, if you need to ask them for more.
[CUSTOMER][NEGATIVE] No, I think that's all. I mean, I got different bills, but I don't even know what to do with them. Like, I'm getting a bill for $424 for supposedly something that they did to me in Memorial Hospital and that the insurance was denied.
[AGENT][NEUTRAL] Right, so what I'm saying to you is from the claims that we've received, I've went through each of them, so I have the dates. So the paperwork that she's sending you, if the dates that I'm giving you is not on here, it needs to be requested.
[AGENT][NEUTRAL] That's all I'm saying, because she didn't ask for dates, so I'm not sure what she's sending.
[CUSTOMER][NEUTRAL] OK, I'll call them back. OK.
[CUSTOMER][POSITIVE] Yeah, no problem. I'll, I hopefully I'll get that as soon as possible and then I'll see what the dates are and if not, I'll call them again.
[CUSTOMER][NEUTRAL] And I'll submit it again to you guys. And when I submit it to you guys, should I call like I just did right now?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Well, you don't have to. I mean, you can if you like, but you don't have to. Once you submit it, it automatically like pops in our system and then they'll upload the documents and that once the documents are uploaded, claims can see it and they'll start processing. But as soon as you get that confirmation number, it pops in our system. It just has zeros until the claim number pops, you know, it's populated.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, well, was there any
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's it. Thank you so much. You're so kind.
[AGENT][POSITIVE] Thank you. I'm glad I could assist you and thanks for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too, bye bye.
[AGENT][NEUTRAL] Bye bye