AccountId: 011433970860
ContactId: d37a05a9-cdbb-4a5d-adff-cf1c5c6167fd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 244009 ms
Total Talk Time (AGENT): 100861 ms
Total Talk Time (CUSTOMER): 96469 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/d37a05a9-cdbb-4a5d-adff-cf1c5c6167fd_20250611T14:09_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] in [PII]. How are you doing?
[AGENT][NEUTRAL] I'm fine, Mr. [PII]. How are you?
[CUSTOMER][POSITIVE] Doing great, doing great. I um just trying to double check on a claim for one of our customers if you don't mind.
[AGENT][NEUTRAL] OK, uh, what's that policy number, please?
[CUSTOMER][NEUTRAL] The policy number is 261-787-3.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And our our OSC is is acting up a little bit so I can give you the claim number um.
[CUSTOMER][NEUTRAL] If that'll help you. I know it's on his wife [PII], and it's a hospital claim.
[AGENT][NEUTRAL] OK, and what is that claim number?
[CUSTOMER][NEUTRAL] It is 3609223.
[AGENT][NEUTRAL] OK, thank you. And Mr. [PII], what's your callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you, let's see.
[AGENT][NEUTRAL] For Ms. [PII].
[CUSTOMER][NEUTRAL] Right, yeah, she had a hospital stay that was for, I think 55 days, and she had to have a surgery, um.
[CUSTOMER][NEUTRAL] And it when I got the EOB back this morning, it said 0 so I was trying to figure out, I know it was clean, so I was trying to figure out what happened.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Uh, it looks like it was processed as the loss, uh, was incurred prior to the patient's effective date of coverage.
[CUSTOMER][NEUTRAL] Let me see the effective date. I wrote it down. I think the effective date was [PII]. Is that right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the date of service was [PII].
[CUSTOMER][NEUTRAL] Let me go look at this.
[CUSTOMER][NEGATIVE] [PII], the luck I have lately is, is unreal. Um, the, it's crazy, it's so crazy. Well, let me ask you this. This is the first time I've incurred something like this where it's right before the effective date.
[AGENT][POSITIVE] bless
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah, yeah, I know it started on [PII], but all the days that were after the effective date, wouldn't they process those?
[AGENT][NEUTRAL] Not unless it was separate. Like if it's starting from the date of first date of confinement is [PII] and then it looks like that she was confined until [PII]. If, for instance, they had a claim for [PII], that would be covered since it was after effective, but since the
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] The date of service was [PII], it wouldn't cover. Or like if she had the surgery on [PII] or a different date after um after the [PII] would have been covered, but not when the actual hospital charges start from [PII].
[CUSTOMER][NEUTRAL] OK, it looks like she had a surgery on [PII], um, on the bill it's like 13,000 anesthesia was like 3000.
[AGENT][NEUTRAL] Yes, sir, they won't separate it from the actual hospital charges. It wouldn't like start, OK, since she wasn't covered on the [PII], they start on the [PII], they wouldn't do that. It would start from.
[AGENT][NEUTRAL] The first day she was confined.
[AGENT][NEUTRAL] And as far as the surgery, if there was a separate bill from the surgeon, like showing that uh the data service was the [PII], then that would be a consideration, but not for.
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEUTRAL] Just because it was in the hospital bill and shows she had surgery.
[CUSTOMER][NEUTRAL] OK, so if I would get an operative report in a separate surgeon bill that shows the date of the surgery [PII], you think they would readdress it?
[AGENT][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'll see what I can do here. I appreciate your help this morning.
[AGENT][POSITIVE] Uh, yes, sir, and thank you for calling APO Mr. [PII]. Have a great day.
[CUSTOMER][POSITIVE] Thank thank you you too bye bye.
[AGENT][NEUTRAL] Bye bye.