AccountId: 011433970860
ContactId: d4d76091-fa44-455e-916a-773bb407bfa5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 390779 ms
Total Talk Time (AGENT): 89796 ms
Total Talk Time (CUSTOMER): 178110 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/d4d76091-fa44-455e-916a-773bb407bfa5_20250409T22:09_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Number 358-1301.
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Miss [PII], can you hear me?
[AGENT][NEUTRAL] Uh, I can now.
[CUSTOMER][NEUTRAL] OK, good. OK, I've got insured on the phone, um, policy number is 252-7615.
[CUSTOMER][NEUTRAL] She is calling about claim number 3581301.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it is requesting a uh additional information and she has.
[CUSTOMER][NEUTRAL] She that guy with the remarks on the client.
[AGENT][NEUTRAL] One second, let me see
[CUSTOMER][NEUTRAL] Can you hear me?
[AGENT][NEUTRAL] It's going in and out. Give me one second to pull it up. Let me see if I can.
[CUSTOMER][NEUTRAL] Miss [PII], can you hear me, ma'am?
[AGENT][NEUTRAL] I can, it's off and on. I can hear you off and on. Give me one second.
[CUSTOMER][POSITIVE] Oh I'm so sorry. I'm gonna, OK, yeah, my.
[CUSTOMER][NEUTRAL] You just let me know when it's OK to relay.
[AGENT][NEUTRAL] OK, you can send her over.
[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes, um, my name is [PII] about it. I was calling in regards to my claim. Um, they were asking for additional information for my claim, and I needed just to verify that information.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it looks like there was an additional note on the claim uh they were asking for the hospital admission and discharge summary.
[AGENT][NEUTRAL] And they were needed the hospital uh history and physical.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, the itemized hospital bill with procedure codes.
[AGENT][NEUTRAL] Uh, the dates of service and the charge amounts.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, so I have all that. Oh, I have all that paperwork and then I have a summary, but I don't think there's any codes on here.
[AGENT][NEUTRAL] And go ahead.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, anything else but the discharge, uh, but they don't have an itemized of all the tests that they ran like MRIs, cas, uh, head scans, um, X-rays.
[CUSTOMER][NEUTRAL] That's the only thing I don't have.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] But that's what they're needing a copy of the summary instructions and stuff, right.
[AGENT][NEUTRAL] Mhm um do you have a copy of the explanation of benefits that came?
[AGENT][NEUTRAL] From [PII] from APL.
[CUSTOMER][NEUTRAL] Um, uh, the form that explanation of benefits, yes.
[AGENT][NEUTRAL] OK, and so on page 2 there should be an additional note.
[AGENT][NEUTRAL] With all the information that I'm reading off to you.
[CUSTOMER][NEUTRAL] Oh yes, OK, um, the notes that we have received your claim for review, however, we need additional information.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, hospital admission and discharge summary. I have a hospital history and physical and autoized hospital bill with procedure code states of service.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, I just printed everything that they have put under my chart where I could print those out.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that's what y'all are needing.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So I guess I'll submit this, uh, I just don't have an itemized bill.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm, is there any way you can contact the hospital to see if they will send you one?
[CUSTOMER][NEUTRAL] Of everything that was actually done.
[CUSTOMER][NEUTRAL] Yeah, I can, I can contact them and uh see if they can send me that particular page.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so when do I have to submit this? I have 180 days from the day that I was in the hospital or released?
[AGENT][NEUTRAL] Um, I don't think there is a time limit on it.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Um, it said
[CUSTOMER][NEUTRAL] Your written appeal, OK, it says 180 days, but that's for an appeal, but I can just submit this at any time. OK.
[AGENT][NEUTRAL] Yes ma'am, that's correct. And did you also see that they're needing the results from your EKGs, ECGs, CTs, labs and MRI's and the cardiologist notes?
[CUSTOMER][NEUTRAL] Yes, I've got that.
[AGENT][NEUTRAL] You already got that?
[CUSTOMER][NEUTRAL] I've got everything printed. Uh-huh, I got all that printed and whatever they have on here as far as what they did.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes. OK, so, um, I will.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Look this over and then I'll just go ahead and send it in. OK, thank you.
[AGENT][NEUTRAL] OK, and Ms. [PII], was there anything else I can help you with on today?
[CUSTOMER][POSITIVE] No, that was it. Thank you so much. I appreciate it.
[AGENT][POSITIVE] OK, you have a great rest of your evening and thanks for calling APO.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Alright bye bye.