AccountId: 011433970860
ContactId: cba7a1a4-5455-4010-8799-9f1c29b2ac76
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 484549 ms
Total Talk Time (AGENT): 148418 ms
Total Talk Time (CUSTOMER): 149049 ms
Interruptions: 3
Overall Sentiment: AGENT=1.8, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/cba7a1a4-5455-4010-8799-9f1c29b2ac76_20250305T15:17_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. How are you? This is [PII].
[AGENT][POSITIVE] I'm good thanks how are you?
[CUSTOMER][NEUTRAL] I'm good. Um, I have a Spanish call, so I just need to tell you.
[CUSTOMER][NEGATIVE] And I need to tell them in Spanish because they don't, they don't speak English.
[CUSTOMER][NEUTRAL] Um, but I have a situation and I explained to them, as this is my knowledge of what we need and what we have, and they keep saying, you can use that, you can use that, you can use that. So let me give you the policy number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That is 257-096-3.
[AGENT][NEUTRAL] OK, and the insured's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and it's the claim that was just sent yesterday?
[AGENT][NEUTRAL] Or completed yesterday?
[CUSTOMER][NEUTRAL] On the, yes, the one that it was completed yesterday. Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then I guess what was their question?
[CUSTOMER][NEUTRAL] OK, so it looks like we're asking for itemized bill for the surgeon and the anesthesiologist and the hospital stay and all that.
[CUSTOMER][NEUTRAL] OK, so they think that what they send, um, from, um, and I'm looking at the documents uh from you Health University of Miami Miami Health System should be sufficient.
[CUSTOMER][NEUTRAL] Um, which I explained to them over and over that this is not an itemized me, but they keep saying that it is, so I don't know if you can see that and.
[CUSTOMER][NEUTRAL] What else do we need, basically, um, is this sufficient? Yes or no?
[AGENT][NEUTRAL] OK, uh, give me just a second, take a look here.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK. So is there a way I can put you on hold for a moment?
[CUSTOMER][NEUTRAL] OK. Mhm, yes.
[AGENT][NEUTRAL] I'm just gonna check with that adjuster.
[CUSTOMER][NEUTRAL] OK, yes.
[AGENT][POSITIVE] OK, thanks.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Hi there, good morning.
[AGENT][NEUTRAL] Um, can you see my screen?
[AGENT][NEUTRAL] OK, so, um, it looks like so I'm looking, we got a call on this policy, um, do you remember doing this one yesterday?
[AGENT][NEUTRAL] OK, we asked for it looks like the surgery bill, you know, for the anesthesia and the facility bill.
[AGENT][NEUTRAL] And so I went through and I look and it looks like.
[AGENT][NEUTRAL] We were asking for it for.
[AGENT][NEUTRAL] I guess this date, the [PII].
[AGENT][NEUTRAL] The [PII], but I see we have these codes. So, uh, why were we needing the surgery bill?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, OK, so they told me that this was the estimate of charges, not the actual itemized bill.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, well I'll let them know thank you.
[AGENT][POSITIVE] Good bye bye.
[AGENT][POSITIVE] OK, so sorry about that. Are you still there?
[CUSTOMER][NEUTRAL] Yeah, yeah, it's OK. Uh-huh.
[AGENT][NEUTRAL] OK, so yes, this does have the um the codes on it. however, the reason why we asked for the itemized bill is because this is like the estimate. So before they had their procedure done, they provided them with this estimate of charges, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh, so this was prior. OK. Gotcha. OK. Gotcha. OK.
[AGENT][NEUTRAL] This was prior to the procedure even happening, so we're not sure that they would have even stuck with the charges or how they would have billed and so we would just need to explain to them, we need your itemized bill after your procedure. We can't do the one before because technically we don't even know if you even had this procedure done.
[CUSTOMER][NEUTRAL] Do.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] If you, if you had the surgery, yes, OK, there you go. OK. So, yes, that's what I was confused because I did see where it says in Spanish that it's an estimation. So I, I got confused with that word too. I'm like an estimation, what do they mean?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, so this is like they like their insurance, you know, when they, you know, they, they estimate what their insurance, hey, we, we need to have a procedure done. This is the estimate of the costs and whatever, whatever, and then they agree and then they'll do the procedure or not, you know, I mean, you don't have, you know, they're not forcing you like so we don't know until after you get that bill after you've already had the procedure done.
[CUSTOMER][NEUTRAL] But OK.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] OK, and they did pay which it does show that they pay on the last, which is the receipt, but we still, we still need the itemized bill after. OK, I'll go ahead and ask them. Yeah, yeah.
[AGENT][NEUTRAL] Right, so this receipt, yeah, needs to be, you know, the, uh, we still need the itemized bill from the provider, from the services, and I would ask them too to get the hospital bill as well, um, because they have a facility benefit and so yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Uh-huh.
[CUSTOMER][NEUTRAL] Mhm. Yeah, I do.
[CUSTOMER][NEUTRAL] Mhm. Yeah. I asked them for the, um, I said that you need to get the 3 of them, like the hospital, the surgeon, and the um anesthesiologist. So it's 3.
[CUSTOMER][POSITIVE] So, OK, uh, OK, I'll go ahead and let him know why we're asking. OK, now I got it clear. OK, thank you so much. Have a good day. Bye.
[AGENT][NEUTRAL] Yeah, mhm.
[AGENT][POSITIVE] Yeah, sure, you're welcome you too bye bye.
[CUSTOMER][NEUTRAL] No.