AccountId: 011433970860
ContactId: e0889f7f-60a2-4885-9952-b0c62c041259
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 854650 ms
Total Talk Time (AGENT): 341424 ms
Total Talk Time (CUSTOMER): 335552 ms
Interruptions: 4
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/e0889f7f-60a2-4885-9952-b0c62c041259_20250507T17:08_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, ma'am, um, the reason that I'm uh calling is because I have, um, some claims that, um, they keep sending me the, um, what I need in order for you all to continue to process the claim, and I have requested those documents to the hospital and every time uh they send me those, I send them to you, but uh.
[CUSTOMER][NEUTRAL] I believe they said they did not, don't, you know, did not receive what I requested. So, um, last time that I called, um, to, to y'all is to see if somebody was gonna call me back because I wanted to see if you can request those documents about um my son's surgeries and uh the procedure codes and the anesthesia, uh, with those uh surgeries.
[AGENT][NEUTRAL] OK, so you're needing to find out if we can request the information from the provider?
[CUSTOMER][NEGATIVE] Right, right, right, because some of other insurance that I uh have they been doing that and um you're the only ones that asking me to do it and, and uh uh like I said, I did it several times, but every time I send something to y'all, uh, uh, I keep receiving the letter saying that they still need that information.
[AGENT][NEUTRAL] OK. So, yes, ma'am. I can try and help you with this as far as what we could possibly do to assist you. Um, first, I need to pull up your policy information, verify some things with you for security purposes, and then we can go from there.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so first off, who am I speaking with please?
[CUSTOMER][NEUTRAL] Yes ma'am. My name is [PII].
[AGENT][NEUTRAL] OK, and Miss [PII], I'm sorry, but I'm having some trouble hearing you. You, your voice sounds like it's far away from the phone.
[CUSTOMER][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] Can you hear me better now?
[AGENT][NEUTRAL] Not really. To be honest, it sounds like we're on speaker or something. I don't know, there's an echo, a little bit of an echo on the call.
[CUSTOMER][NEUTRAL] Not really? OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, hold on, let me try something.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Yes, ma'am. I can hear you much better.
[CUSTOMER][POSITIVE] OK, good. Mhm.
[AGENT][NEUTRAL] OK. So, um, what is your last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you and Ms. [PII], what is your callback number, your phone number?
[CUSTOMER][NEUTRAL] Yes, ma'am. It's [PII].
[AGENT][POSITIVE] Thank you. And the policy number, please.
[CUSTOMER][NEUTRAL] Uh, yes, ma'am. The policy number is 0291331.
[AGENT][NEUTRAL] OK, that was 0291331. Is that correct?
[AGENT][NEUTRAL] We're missing in them, yeah.
[CUSTOMER][NEUTRAL] I'm sorry, 20.
[AGENT][NEUTRAL] OK, so start over. Mhm.
[CUSTOMER][NEUTRAL] Oh yeah, yeah, we're missing a number, OK.
[CUSTOMER][NEUTRAL] Uh-huh. 02.
[CUSTOMER][NEUTRAL] 09
[CUSTOMER][NEUTRAL] 1331.
[AGENT][NEUTRAL] OK, thank you. So one moment please while I get your information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and this I guess any information that is provided today would be a verification of benefits and not a guarantee of payment. I will need to verify several things first, as I stated for security. So first off, if you'll please verify your date of birth and then your child's name and date of birth that the claim is for.
[CUSTOMER][NEUTRAL] Yes, ma'am. My date of birth is [PII], and my son [PII], uh, his date of birth is [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Also your home mailing address, please.
[CUSTOMER][NEUTRAL] Yes, ma'am, it's [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you provided for me, so that is your best contact number. Is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Thank you. And lastly, your email address?
[CUSTOMER][NEUTRAL] Mm, yes, ma'am. Uh, I have to, um, I don't remember which one, but I think it's [PII].
[CUSTOMER][NEUTRAL] At [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the date of service, Ms. [PII], that you're calling about for your son for [PII]?
[CUSTOMER][NEUTRAL] OK, I have, um, there's, uh, let me see, it's for his surgeries and I have, let me tell you.
[AGENT][NEUTRAL] I need the dates. Mhm.
[CUSTOMER][NEUTRAL] Yes, ma'am, I have [PII], [PII]. So, the first one.
[AGENT][NEUTRAL] 9 surgeries?
[CUSTOMER][NEUTRAL] Yes, ma'am. Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, the first one, it'll be um
[CUSTOMER][NEUTRAL] It'll be [PII], I mean, yes, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Let me locate that data service first off.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This was for Texas Children's Hospital. Is that correct?
[CUSTOMER][POSITIVE] Yes, ma'am. Mhm, correct.
[AGENT][NEUTRAL] OK, let me look at the denial remarks.
[AGENT][NEUTRAL] OK, so now I do see that this says
[AGENT][NEUTRAL] This was the most recent thing that was received and that's been back several months ago. That was back in December actually that we've received any additional information.
[AGENT][NEUTRAL] Oh this, have you sent us anything since December?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] every time I've been sent, no, I don't, I don't remember if I have sent anything since December, but every time I have sent something, uh, the, the last, the letters that I received, it keeps telling me that in order to process your claim, please provide us with the following information, and it is asking me for the itemized bill for each surgery.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And, uh, the, with the procedure code and then the pathology report for the surgeries and uh, and also the anesthesia benefits are based on the benefits available under the surgery benefits and then it can me send uh the surgery charges for the day of that uh surgery.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am. I do see that that is what we are in need of. And you've spoken to the hospital, to the billing department, or to medical records explaining what you need?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because
[CUSTOMER][POSITIVE] I sure did. I sure did, and as a matter of fact.
[AGENT][NEUTRAL] OK, and they
[AGENT][NEUTRAL] And they're not sending you that information?
[CUSTOMER][NEUTRAL] Yes, every time they
[CUSTOMER][NEUTRAL] Well, what they sent me is what I have sent y'all, but the last time that I spoke with uh somebody, as a matter of fact, was on uh [PII], I, I spoke with Ms [PII] and um
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And uh that's when I was explaining that uh they were she was gonna call me back to get those dates to uh to see if y'all can request it uh directly from the uh surgeons.
[CUSTOMER][NEUTRAL] The physician's office, because
[AGENT][POSITIVE] OK, so give me just, oh, I'm so sorry. Go ahead. I'm so sorry. I didn't mean to interrupt you.
[CUSTOMER][POSITIVE] No, no, no. No, no, you're good, honey. No, you're good.
[CUSTOMER][NEGATIVE] But um, anyway, she never called me back and I, I'm just now going through all my paperwork trying to catch up with everything that I've been, you know, um.
[CUSTOMER][NEGATIVE] Because I'm also now my, my other daughter, daughter got diagnosed with cancer, so.
[AGENT][NEUTRAL] Oh, I'm sorry. I'm sorry to hear that. Yes, ma'am. OK, so let me see, if you don't mind, give me just a couple of moments. Let me see if [PII] may be available since she was who you last spoke to, um, so give me just a moment.
[CUSTOMER][POSITIVE] So I've been a little busy. Yes, ma'am. Thank you so much. Thank you so much.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, ma'am. Thank you so much.
[AGENT][POSITIVE] You're welcome, absolutely.
[CUSTOMER][NEUTRAL] And I do, I do have.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The, the, um, just to let you know, I do have the dates of the surgery and the names, the names of the doctors.
[AGENT][NEUTRAL] OK, so I'm going because I can only tell you that we would need the itemized bill, you know, I mean, basically, what I can help you with, um, Ms. [PII] is what is stated on this explanation of benefits.
[AGENT][NEUTRAL] As far as you contacting, you know, the facility and requesting itemized bills, I mean reading that verbiage to them that's on the document.
[AGENT][NEUTRAL] There is a specific claim form called a UBO4.
[AGENT][NEUTRAL] That if the facility files claims that's typically the claim form that they filed that would have that information on it um but again because you last spoke with [PII] and she was according to her notes she was going to be looking into some information with you now it's possible it appears she's available but she's not responded to my um.
[AGENT][NEUTRAL] My little message to her Miss [PII]. She could possibly be at lunch since it's [PII]. Our time, um.
[AGENT][POSITIVE] Now I'll be happy to send her an email and asking her to give you a call if you would like.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so give me just one second to do that for you.
[CUSTOMER][NEUTRAL] And does uh she have by any chance a direct uh extension number or?
[AGENT][NEUTRAL] No, ma'am. She doesn't. But um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, and I don't know when she does call you how, because we have a lot of different phone numbers, you know, that go out, so I don't know how it's going to show up on your phone. I can tell you that that it would not be the [PII] that you called in on today.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And the best phone number again to call you on would be the [PII]. Is that correct?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, Ms. [PII]. So I had just sent this [PII], um this. I have just sent this email to [PII] asking her to give you a call again. She's still not responded to my little message I sent her, so it's very possible that she's at lunch at the moment.
[CUSTOMER][NEUTRAL] All right. OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So is there anything else that I could help you with today, Mr. [PII]?
[CUSTOMER][NEUTRAL] No, honey, what was your name again, please?
[AGENT][NEUTRAL] My, yes, ma'am. My name is [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right, Ms. [PII]. Well, thank you so much. I appreciate your help.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] Oh, absolutely. You're very welcome and it was my pleasure in speaking to you today, Ms. [PII]. So if there is nothing else that I can help you with, thank you so much for calling APL and I do hope you have a nice afternoon.
[CUSTOMER][NEUTRAL] Mm, you too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.