AccountId: 011433970860
ContactId: deff3441-8eeb-41e0-9235-60a6fec37594
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 605710 ms
Total Talk Time (AGENT): 279602 ms
Total Talk Time (CUSTOMER): 247682 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/deff3441-8eeb-41e0-9235-60a6fec37594_20250520T21:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII].
[CUSTOMER][NEUTRAL] Take care, it's, it's my newborn. Please, please ignore the noises. I'm sorry.
[AGENT][POSITIVE] I hear no, no, that is perfectly fine, been there.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] So, uh, what can I get for it? What can I get started for you?
[AGENT][NEUTRAL] OK, um, what was your name please?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, what can we help you with today, [PII]?
[CUSTOMER][NEUTRAL] OK, I have a claim that I filed, um, and I filed with my, I was filing for my hospital admission benefit because I believe I have a couple on my policy. One of them I have filed and received. Um, I had another hospital admission on [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] And I submitted my itemized bill and I called because that wasn't given the benefit and they said submit the uh discharge paperwork. So I submitted that and it still didn't pay out on it. So I just wanted to call and see what was going on.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Absolutely I can check on that claim for you uh [PII] can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yes ma'am. It is 255.
[CUSTOMER][NEUTRAL] 2172
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Alright, just gonna verify some information really quick. Uh, can I get your date of birth please?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. The last thing I need is the email address we've got on file for you. Uh, looks like it is through an organization.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][POSITIVE] Awesome, OK, thank you for verifying all of that. OK, and so you did say this date of service was [PII] of this year, correct?
[CUSTOMER][NEUTRAL] Yes. Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Bear with me just a moment, let me take a look.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, was this, uh, is it Lovelace Reg Regional Hospital?
[CUSTOMER][NEUTRAL] Yes, ma'am, mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, well, according to this, let me see when this information was received because all I'm seeing is that we are missing the itemized bill with the admission and discharge dates and times um when did you send that information to us?
[CUSTOMER][NEUTRAL] That one, hold on just one second because I have it here in front of me.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] Um, OK, date received, it should have been [PII].
[AGENT][NEUTRAL] [PII]. OK, let's see.
[AGENT][NEUTRAL] Did you send it, was it through our uh online portal?
[AGENT][NEUTRAL] Or was it through fax? OK, it was through the portal. OK, let's see.
[CUSTOMER][NEUTRAL] Yes, ma'am. Mhm.
[CUSTOMER][NEUTRAL] So, and I will say the one.
[AGENT][NEUTRAL] I'm not showing
[AGENT][NEUTRAL] Uh-huh. Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] So my uh my, no, no, you're fine. The other claim that did get paid out on I did fill out like the claim form and everything. This one I did not fill out a claim form for specifically do I need, should I do that? Um.
[AGENT][POSITIVE] I would say yes.
[CUSTOMER][NEUTRAL] Or is it OK to not.
[AGENT][NEUTRAL] I would say yes just going forward um it didn't ask for that information generally it would list out everything that was um if there was any information missing it would say and as far as this is concerned this does appear to be.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The last information we received, which was I don't show anything from the [PII] this was um [PII].
[AGENT][NEUTRAL] Was when this last one was received um.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] And this was uh was it for 2.
[CUSTOMER][NEUTRAL] So you don't see the name.
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] No, no, no, you're fine.
[CUSTOMER][NEUTRAL] I was just gonna say you don't see the May, the [PII] I did submit an itemized bill and it says that the date completed is [PII] and I can give you the um confirmation number if that helps.
[AGENT][NEUTRAL] OK, I do see that one that one is showing something different, um, so.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] One is saying it's for a clinic, the other is saying it's for a different kind of facility, um, was it for $2,472?
[CUSTOMER][NEUTRAL] Uh, you, let me, let me look because.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This, this is what they gave to me. Like at the, do you see at the top it says Lovelace Health System.
[AGENT][NEUTRAL] Health system.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And then it has the admission date and the discharge date on that on that one because that's whenever I called and asked for the itemized bill that's what they sent to me and it does say the total charges is 2,472. I do see that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That that is what it says. OK, so I do see two instances of receiving claim information for that amount for that data service. Um, however, it is saying different.
[AGENT][NEUTRAL] Things so here's what I'm going to do, [PII], I just.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I see like kind of surface level so if you don't mind I'm gonna put you on a brief hold and reach out to our claims specialists so that they can review what was submitted um because it's possible that there might be some confusion if there wasn't a claim form that they might be registering as two separate claims and there might be some, you know, trouble linking them you know what I mean? um so give me just a moment I'll get right back with you OK?
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Of course one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII] on the care team. How's it going today?
[CUSTOMER][NEUTRAL] Good [PII] how are you?
[AGENT][NEUTRAL] Alright, thank you. I've got a member on the line who has an HI policy, and I think there's just a bit of confusion as to what she submitted for this claim. She was trying to get the benefit for just hospital admission. Um, I do see when she gave me the data service, I do see two claims for the same amount. However, both denial reasons are saying something different. She said that she did send um.
[AGENT][NEUTRAL] The uh itemized statement that shows the admission and discharge time so I'm not quite sure if maybe there's just some missing information that it we're just not seeing.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Sure, what's the policy number? I think it's the claim I might have.
[AGENT][NEUTRAL] That is 25
[AGENT][NEUTRAL] She did mention she didn't fill out a claim form, um, so that's why I wasn't sure if maybe there's just some trouble linking, um, it is 2552172.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] For uh [PII].
[CUSTOMER][NEUTRAL] Yeah, that's the that's the claim I just processed.
[AGENT][NEUTRAL] I say it looks like they were just today.
[AGENT][NEUTRAL] So there were uh two for this state of service um for the [PII] or excuse me, [PII] um both are the same amount but they do look different so I'm not sure what was submitted. She said that she sent in the itemized statement with those admission and discharge times on the [PII].
[CUSTOMER][NEUTRAL] Yeah, um.
[AGENT][NEUTRAL] However, the one that I see on.
[AGENT][NEUTRAL] What was that one on the [PII] I think.
[AGENT][NEUTRAL] The [PII], um, that one sta stating that we need that information.
[CUSTOMER][NEUTRAL] Right, because I see that there was a note in there. I did read the notes, so the first one she sent in on the [PII] was the itemized statement, but it just shows that there's no room and board charges, and it shows a clinic charge. The reason why it looks different is the previous adjuster keyed it under clinic. I keyed it under facility because she was at the hospital and that's.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What that procedure means, um, if we don't usually if it's outpatient hospital it's supposed to be under the facility, um, but because that previous adjuster she saw the 510 revenue code on the itemized bill she put it under clinic because that 510 revenue code that's what it states on the actual um billing that she sent in.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So she did send in um an additional page from her um and it just kind of like an aftercare summary however it doesn't give us any uh time doesn't give us any time so what I'm asking for is the um admit and discharge date and time, but I'll be happy to speak with her and explain that to her.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah well I I appreciate you explaining that to me. I was a bit confused on that, so thank you um OK yeah I can go ahead and send her to you if you're ready.
[CUSTOMER][NEUTRAL] OK, she's been verified?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And that's her number on the screen there, the [PII]? OK.
[AGENT][NEUTRAL] Yeah, the, mhm.
[AGENT][NEUTRAL] [PII]. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, you can go ahead and send it through when you're ready.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] I appreciate your help thank you bye bye.
[CUSTOMER][POSITIVE] No problem you're welcome thanks.