AccountId: 011433970860
ContactId: cc829bb7-d0be-447c-aa80-d057effd05a8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1194989 ms
Total Talk Time (AGENT): 310921 ms
Total Talk Time (CUSTOMER): 451810 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/cc829bb7-d0be-447c-aa80-d057effd05a8_20250422T19:57_UTC.wav
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[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] Thank you. Yeah, my name is An[PII]How may I help you?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Um, yes, I am calling. Um, I recently, um, put in, um, a claim for, um, an accident that I had. I fell on my stairs at my apartment and went to the emergency room and ended up having to have surgery. So, um, this happened back in January and so I put in the.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know what the hospital gave me and then they sent me a thing saying it needed to be have ICD 9 codes and whatever so then I contacted the hospital. They sent me the information. I resubmitted it and then and now I got one saying that they needed um the enclosed claim form completed by the insured giving detailed description of the accident or diagnosis of sickness.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Now the, the first one I put in was from the ER where said I fractured, you know, my foot and all that kind of stuff. I just, I don't, I, I don't know what else they want from me.
[AGENT][NEUTRAL] OK. Well, that, no, it's OK.
[CUSTOMER][NEUTRAL] Sorry, it's my class.
[AGENT][NEUTRAL] It's OK. Um, well, let me do this. Let me go ahead and pull up your policy. I'll look at the um the claim and what they're asking for and what was submitted, and then I'll be able to help you better.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And may I have your name and a good contact number just in case we're disconnected?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, my name is Sh[PII]The last name is Ec[PII]nd my cell phone number is 81[PII].
[CUSTOMER][NEUTRAL] 48[PII]
[AGENT][NEUTRAL] [PII]hank you for that, Ms. Sh[PII]May I have your policy number?
[CUSTOMER][NEUTRAL] Um, yes, it's 02.
[CUSTOMER][NEUTRAL] 541,500.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so I have you here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] OK. Date of birth is 5-[PII]Mailing address is 17[PII].
[CUSTOMER][NEUTRAL] And my email address is S [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And Ms. Sh[PII]do you mind if I place you on just a brief hold so I can look at everything?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK. Hello, Ms. Sh[PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] All right, thank you so much for holding. I apologize for that wait. So, I think I'm caught up. So what's happening is
[AGENT][NEUTRAL] So you did submit an itemized bill.
[AGENT][NEUTRAL] But you submitted like the patient version of the itemized bill. So on this bill, it only shows the procedure codes. Basically, it shows us what treatment and medication you received and how much you paid for it, but we're wanting to know why. That's on the
[CUSTOMER][NEUTRAL] Yes, OK.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] There's like a hospital version of the bill that your version is taken from. So we would either, if this is a hospital, we would need to ask them for the universal bill, like a UBO4 form that has the diagnosis codes, the procedure codes, and all the charges, um.
[CUSTOMER][NEUTRAL] OK, so I need to ask for what? a UB?
[AGENT][NEUTRAL] So it's called a UBO4, like Universal bill and then 04.
[CUSTOMER][NEUTRAL] Sorry
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so the first, OK, and the first claim that I sent through, that doesn't do it where they have the explanation on there that I fell and broke my foot.
[AGENT][NEUTRAL] Let me look back at that one. Hold on one second.
[CUSTOMER][NEUTRAL] Because I had to
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No, go ahead, I can hear you.
[CUSTOMER][NEUTRAL] No, I just, I, so I submitted that one and then that's when they said no, that one wasn't enough. I had to do this other one.
[AGENT][NEUTRAL] Let me see what came in on that one.
[CUSTOMER][NEUTRAL] And so
[AGENT][NEUTRAL] Hold on, it's coming up now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So, these are clinical notes. Where's the bill? Hold on one second.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, the first one I didn't, the very first time I didn't do, I didn't put the, I don't think I sent the money part, you know what I'm saying?
[AGENT][NEUTRAL] This is just a description of what's going on or what happened.
[CUSTOMER][NEUTRAL] The bill part.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] To see if that would suffice for the description.
[CUSTOMER][NEUTRAL] And then they were like, oh well, you need the bill too. So then I sent the bill or whatever, 2, but I didn't send the first one, you know what I'm saying?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then what was the 2nd 1? Hold on 1 2nd. I'm just flipping through. Hold on one moment.
[CUSTOMER][NEUTRAL] Oh, you're.
[AGENT][NEUTRAL] DA not that one.
[AGENT][NEUTRAL] The 2nd 1.
[AGENT][NEUTRAL] Let me do this. If you don't mind, I'm gonna place you on a brief hold and I'm going to call um claims on the other line because the, OK, so the first one was denied asking for the bill, and then the second one was denied asking for the description. So I'm wondering if the documents from the first one can be used for the description and then
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh wait a minute. Claims are completed by the insurer given a detailed description, or yeah, so they're still wanting the diagnosis. OK, so I don't have to get the claims. I, I read the whole thing through. So yeah, we're gonna need the itemized bill. There's a number here. I'm sorry.
[CUSTOMER][NEUTRAL] OK, so I.
[CUSTOMER][NEUTRAL] No, go ahead.
[AGENT][NEUTRAL] There's a number here. Did you want me to try to give them a call?
[AGENT][NEUTRAL] To let them know what's needed, are you OK?
[CUSTOMER][NEUTRAL] I can't.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I'm, I would love for you to because when I called them and told them I was like, I need an itemized bill with the ICD 9 codes, all that stuff, that's what they sent me, you know, what I just sent in. And so they were like, this has everything on it that they would need. And so I'm like, OK, so they had to, you know, send that to me.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] They always do that.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes, uh-huh, go ahead.
[AGENT][NEUTRAL] I was saying they always, they always say that like once we we say what we need and then they're like, this is what they should need.
[CUSTOMER][NEUTRAL] Yes, that's exactly what they said and I was like, OK. And I'm like, I don't, I mean, of course, I don't know. I mean, and then they were like, I, and I even asked them, I said, well, can I, I just want access to my patient records, which I have, but that particular form was not in there, so that's why I had to call and I said, how can I have access to this form? They were like, well, we have to, we have to mail it to you. And I was like, OK, well, I need it mailed to me so I can mail it to them.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so let me do this. I'm gonna place you on a brief hold. I see this 817 number here and it's we're reaching Medical City Healthcare, right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I'll go ahead and call them on the other line and then I'll patch you in with us, OK?
[CUSTOMER][POSITIVE] Oh perfect.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Doctor O'[PII] office.
[AGENT][NEUTRAL] Hi, my name is An[PII]I'm calling from American Public Life. Um, we have a mutual patient and I'm trying to help her, um, with the documents that we're needing to process the claim. Is this the correct department to speak with?
[CUSTOMER][NEUTRAL] OK, who's the patient?
[AGENT][NEUTRAL] Um, her name is
[CUSTOMER][NEUTRAL] My name is Sh[PII].
[CUSTOMER][NEUTRAL] EI
[CUSTOMER][NEUTRAL] Um, no, it's I [PII].
[CUSTOMER][NEUTRAL] [PII]m
[CUSTOMER][NEUTRAL] OK, what who are you trying to call?
[CUSTOMER][NEUTRAL] Um, we're um.
[AGENT][NEUTRAL] So this is the phone number that's on their records. We're just trying, I'm just trying to get a UBO4 form, whoever I need to speak with for that.
[CUSTOMER][NEUTRAL] Well, I don't have an answer. That's why I'm trying to see if you're trying to call a different office.
[AGENT][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] Um, OK, I'm a patient.
[CUSTOMER][NEGATIVE] I know and I don't see it's IKERD.
[AGENT][NEUTRAL] Do you need an account number?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, what's the date of birth?
[AGENT][NEUTRAL] Would that help?
[CUSTOMER][NEUTRAL] Date of birth is 5-[PII].
[CUSTOMER][NEUTRAL] I don't have you in my system, so that's why I'm trying to figure out.
[CUSTOMER][NEUTRAL] So you're trying to call Doctor Am[PII] office.
[CUSTOMER][NEUTRAL] No, I'm trying to call medical uh medical records for Medical City. Oh, you're calling the doc you're calling Doctor On's office. You're calling the wrong number.
[AGENT][NEUTRAL] OK, this is the number that's on the, the physician is saying Doctor Ke[PII]but I'm sorry, this is the phone number that's listed. Is there a better phone number? I don't need medical records. I need billing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I, I don't know that number.
[AGENT][POSITIVE] OK, so I'll try something else. Thank you.
[CUSTOMER][NEUTRAL] OK. OK, I'm sorry, uh huh bye bye.
[CUSTOMER][NEUTRAL] OK, so let me, let me try and you're saying billing I need to talk to someone in billing.
[AGENT][POSITIVE] Yes, ma'am, definitely billing.
[CUSTOMER][NEUTRAL] OK, and UB 04.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, let me see what I can do. You don't have a direct line that I can call you back, do you?
[AGENT][NEUTRAL] I don't have a direct line, but I am the only An[PII]ere, so it won't be hard to get me.
[CUSTOMER][NEUTRAL] An[PII]OK. All right, I'll say An[PII]I'll ask for An[PII]OK, let me, um, look through and see what I can figure out, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] See if I can't find something and then I will, um.
[CUSTOMER][NEUTRAL] Let me, let me see, I was trying to see if I had any anything.
[AGENT][NEUTRAL] If you get somebody on the phone, tell them you need you need the UBO4 for Ja[PII].
[CUSTOMER][POSITIVE] OK. Ja[PII]OK. Well, I appreciate your help and I will, um,
[CUSTOMER][NEUTRAL] Do some more, see what I can figure out here.
[AGENT][POSITIVE] Alrighty, well, you're very welcome, Ms. Sh[PII]Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] By any chance, does it have my account number on there?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] What is my account number?
[AGENT][NEUTRAL] So it's M as in Mary, you mean for Medical City, right?
[CUSTOMER][NEUTRAL] Yes, uh-huh.
[AGENT][NEUTRAL] OK, so it's M as in Mary.
[AGENT][NEUTRAL] 000.
[AGENT][NEUTRAL] 270.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 223.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 42.
[CUSTOMER][NEUTRAL] 402
[AGENT][NEUTRAL] No, ma'am. 42.
[CUSTOMER][NEUTRAL] What were the last 3 numbers?
[AGENT][NEUTRAL] 342
[CUSTOMER][NEUTRAL] OK, 342. OK. Um, OK, because I have, see, I have this, um, they sent me this thing, it has the same account number that y'all put on here for me provider provider Provider Medical City, and it's a thing saying, you know, pay my bill.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then um.
[CUSTOMER][NEUTRAL] But it has this, the account number you and I both have the 270022. 0, that is it. The, OK. Let me see what this is. Hang on, they just sent me something um just
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] No way, OK, alright, so I did get in, right, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] See home. OK, so I'm in there this pay their payment system.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it says home. OK, that's that. It gives me a statement. OK. Payment methods make it, yeah, see, you won't give me anything else.
[CUSTOMER][NEUTRAL] Gives me
[AGENT][NEUTRAL] You mean like documents or a way to contact them?
[CUSTOMER][NEUTRAL] Well, um, see, Medical City, uh, Na[PII]OK, this, um, account balance is a respo may pay.
[CUSTOMER][NEUTRAL] And the balance in full, please contact us at this 18[PII]f you've already sent payment.
[AGENT][NEUTRAL] OK, that one, that number.
[CUSTOMER][NEUTRAL] OK, call that number you think?
[AGENT][NEUTRAL] Mhm, because that's, you're in the bill, you're in like the billing area, right?
[AGENT][NEUTRAL] Yeah, because they were talking about payment.
[CUSTOMER][NEUTRAL] Well yeah, this is on the bill.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, call that number.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK, I will do that.
[AGENT][POSITIVE] OK, well, if you need anything, I'm the only An[PII]ere, but any one of us will be more than happy to help you, OK?
[CUSTOMER][POSITIVE] OK, thank you, An[PII].
[AGENT][POSITIVE] You're very welcome, Ms. Sh[PII]and thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.