AccountId: 011433970860
ContactId: e99d5be0-04f4-4c1f-8c64-5a01839b8aeb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1233260 ms
Total Talk Time (AGENT): 550534 ms
Total Talk Time (CUSTOMER): 514495 ms
Interruptions: 6
Overall Sentiment: AGENT=0.7, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/e99d5be0-04f4-4c1f-8c64-5a01839b8aeb_20250507T20:55_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], this is [PII] on the care team. How are you doing?
[AGENT][POSITIVE] Doing great [PII] thank you how are you?
[CUSTOMER][NEUTRAL] I'm doing good. Um, I have an insured on the other line. She, she's really trying to get to [PII], but [PII]'s not here. We sent the email earlier today. Now she's calling back. Um, is policy number 2091331. She's not upset or anything. She just, [PII]'s helping her with her claim and um she just wants to talk to someone in claims.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] From the notes, it looks like some.
[CUSTOMER][NEUTRAL] Like the surgeon's bill is needed, so it might be something in reference to that.
[AGENT][NEUTRAL] And this is for [PII].
[CUSTOMER][NEUTRAL] Mhm. [PII].
[AGENT][NEUTRAL] And we're trying to get information.
[CUSTOMER][NEUTRAL] Just from what I picked up from the notes, cause she's, she's not giving me much information. She just wants to speak to somebody in claims, but from what I saw in the notes, we, at one point, we were asking for the surgery bill.
[CUSTOMER][NEUTRAL] And then she called in today.
[CUSTOMER][NEUTRAL] About medical, it just says medical information. So it sounds like she's trying to get some documents to us, maybe.
[AGENT][NEUTRAL] Yeah, I'm trying to read the notes here. Sorry, advise me to itemize surgeon bill.
[CUSTOMER][NEUTRAL] Oh yeah, you're fine.
[AGENT][NEUTRAL] You wanna know if we can contact the provider and see if they can send us advise we'll check to see if that's something we can do and call her back.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] And this is for
[AGENT][NEUTRAL] [PII] is the claim for [PII], yeah, part 4. OK, got it.
[CUSTOMER][NEUTRAL] Part 4.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Just wanted to make sure I was on the same page.
[CUSTOMER][NEUTRAL] No, I had to think about what you were saying. I, I, it didn't register at first.
[CUSTOMER][NEGATIVE] I got like 30, 30 more minutes and my head is pounding.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Well.
[AGENT][NEUTRAL] I hear that 30 minutes. OK, um, not really sure if I can help or any, um.
[AGENT][NEUTRAL] She said [PII] talked to her earlier and said she was gonna send an email to [PII] and you're saying [PII]'s not available. Let me see if I can.
[AGENT][NEUTRAL] Because I'm not really sure what to tell her.
[CUSTOMER][NEUTRAL] I looked in teams.
[AGENT][NEUTRAL] Yeah, I don't see [PII] here at all, so.
[AGENT][NEUTRAL] Possible she.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I guess transfer her to me and that's her callback number the [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] All right, um let me see if I can.
[AGENT][NEUTRAL] Make some headway with her and everything's been verified correct [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, you can send her over to me and I'll see if I can assist her.
[CUSTOMER][NEUTRAL] Alright thank you [PII] hold on one moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Hello Ms. [PII].
[CUSTOMER][POSITIVE] Yes ma'am, thank you so much for holding. I have [PII] on the line and she'll be assisting you further, OK?
[CUSTOMER][POSITIVE] OK, thank you. You're welcome.
[AGENT][NEUTRAL] Hi, Ms. [PII], my name is [PII]. I'm on the claim support team and I understand uh we were um we had spoke with you earlier regarding a claim for uh [PII] and we were needing some additional information.
[CUSTOMER][POSITIVE] That's correct. Mhm.
[AGENT][NEUTRAL] OK, now um the last update I see here is that um.
[AGENT][NEUTRAL] I believe that you were speaking with [PII] earlier and she was going to see if she could reach out for that information.
[AGENT][NEUTRAL] Um, and then I'll, yeah, um, now I don't see an update from her and unfortunately it doesn't look like she is, like, she may have left for the day. Let me just check something here real quick.
[CUSTOMER][POSITIVE] That's correct, uh-huh.
[CUSTOMER][NEUTRAL] Mhm. Now, the last time I spoke with her, uh, the, the, she asked me, she said that she could um
[CUSTOMER][NEUTRAL] Uh, request that information directly to the, to the hospital, uh, because every time I request it, I send what they send me.
[CUSTOMER][NEUTRAL] What the hospital send me, that's what I sent, and then I still, you know, have received the same letter saying the same information that y'all need to continue process the so my thinking is that probably what the hospital is doing is sending the whole, uh, I mean a lot of uh some other information.
[CUSTOMER][NEUTRAL] And he was in the hospital for almost 2 years, so that's a lot. So I don't know specifically what you got on file, but um Ms. [PII] told me that uh what we need to, the claim that is still pending is for his surgeries. Uh, I believe you'll need the, the itemized bills with the, with the uh codes.
[CUSTOMER][NEUTRAL] And uh also the uh pathology reports from the surgeries and then the anesthesia for those uh surgeries as well. So she asked me, she said that the, the way that she could help me, uh, you know, sending the request to Texas Children's Hospital is if I have the dates and the name of the, the doctors.
[CUSTOMER][NEUTRAL] The procedures surgeries and I do have all those dates and the name of the doctors.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, let's see.
[AGENT][NEUTRAL] So it looks like you said we're needing the surgery, uh, the surgery bill, the um pathology report, and then the anesthesia, correct?
[CUSTOMER][NEUTRAL] Correct, uh huh, you'll need, it says here on my letter that I got from you, it says um that um.
[CUSTOMER][NEUTRAL] In order to continue to process your claim, please provide us with the following information. The itemized billing for surgery performed listing the change, the charge and procedure codes for the surgery. Number 2, the pathology report for the sur the surgical procedure, and then the anesthesia, uh, for the surgery as well.
[AGENT][NEUTRAL] Yeah, and it looks like we've got quite a few dates listed here from [PII], is that right?
[AGENT][NEUTRAL] Does that sound right?
[CUSTOMER][NEUTRAL] Uh, I have, uh, yes, it's, it's, I have, but I'm missing two more, after day [PII], I'm missing two more.
[CUSTOMER][NEGATIVE] You're missing 2 more.
[CUSTOMER][NEUTRAL] I have [PII] [PII].
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] [PII], [PII] and [PII], [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So [PII] [PII] [PII] [PII] [PII] [PII] [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] [PII] [PII], [PII] and then [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, um, now.
[AGENT][NEUTRAL] Now she told you to call us back with those dates and the doctor information or if you requested this information from?
[CUSTOMER][NEUTRAL] The names of the
[CUSTOMER][NEUTRAL] Like Ms [PII] told she uh she asked me if I knew the names of the surgeons and I didn't have them that at the moment, but I do now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I would think some of them.
[CUSTOMER][NEUTRAL] And I can tell you
[AGENT][NEUTRAL] Would be on here like I see.
[AGENT][NEUTRAL] So they're not the doctor, the doctor's office isn't providing you this information?
[AGENT][NEUTRAL] Or they just keep sending you the same, they keep sending you the same information, is that what you said?
[CUSTOMER][NEUTRAL] Well, the thing is that.
[CUSTOMER][NEUTRAL] Exactly, yes, ma'am, and I think because it, it was, everything was done at Texas Children's Hospital and I requested it just the private surgeon's office, but they told me that there's no way that I can get that because their work at the hospital and the procedures were done at the hospital.
[CUSTOMER][NEUTRAL] And everything was uh billed through Texas Children's Hospital, even though uh the the physicians, they told me that uh there is not a number that I could get to request it directly from the doctor's office. It has to be through the hospital.
[CUSTOMER][NEUTRAL] And so that's what I've been doing requesting those uh uh documents that what y'all have on hand is what they've been sending me.
[CUSTOMER][NEUTRAL] Even though we went through with Texas Children's Hospital, uh, billing and um medical records, uh, we went through the dates and the names um of the surgeons, the doctors, that they still, the last thing that y'all got, uh, that's what they send me and you, and you'll still send me this letter that they need those particular documents.
[AGENT][NEUTRAL] Right. But um I think, I think what's happening too is that, so even though the surgeons that perform these procedures work for the hospital, the hospital still would have that information because there's gonna be two sets. Now, you have um um
[AGENT][NEUTRAL] You have a major medical insurance in place as well as this policy, correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, so they still have to build those services to your major medical insurance and so what happens is you should have two actually you would have a separate charge from the hospital charges they're called professional charges, and those professional fees would be those physicians that either did surgery or did sometimes they might just do a consultation.
[AGENT][NEUTRAL] Um, you know, where they come in and see the patient while they're in, in, uh, in the hospital. So they still would have that billing as separate for those professional fees. So that's what we're needing is the, the professional we call.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Professional component or that professional fee for that surgeon because that surgeon knows what type of procedure was done. They're the ones that did the surgery and there's a CPT code that they use for that particular procedure. And even though um the hospital charges would still be on that bill that you're that they send to you, there would be a separate charge for that physician or that surgeon that's doing that surgery.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So they're not able to provide you that information, is that what you're telling me?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, are they all different physicians that uh performed these surgeries, or were they the same doctor?
[CUSTOMER][NEUTRAL] No, it's, it, there's different ones. I can, I can, I can tell you the uh on the you date what doctor was it?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And so um I, I think you said Miss [PII] was gonna try to help you reach out to get this information, is that right?
[CUSTOMER][NEGATIVE] Yes, ma'am. She said she was gonna call me, but I haven't heard from her and it's been as much. And honestly, I have, I, I haven't been able to um get back before because now my daughter's daughter uh got, got diagnosed with cancer as well, and now we're going through chemo and all that, so I've been super busy.
[AGENT][POSITIVE] Oh, I'm so sorry to hear that.
[AGENT][POSITIVE] Yeah, I can imagine. I'm so sorry. OK, so.
[CUSTOMER][POSITIVE] Thank you. Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, first it was my, first it was my son and now her.
[AGENT][NEUTRAL] Oh my.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Oh, I'm so sorry to hear that.
[AGENT][NEUTRAL] Um, that's a lot to deal with, so, um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It it is, honey, it is.
[AGENT][NEUTRAL] So, um, I guess at this point, Ms. [PII], what I can do is take the information. I did write the dates down and um I'll put them in the notes and like I said, um, it, it does look like um Ms. [PII]'s out of the office at this time. I'm not sure if she'll be returning.
[AGENT][NEUTRAL] I'll be here for a little bit longer and then what I can do is try to uh reach out to her and let her know that you did call us back and you were able to provide us at least the doctor's information for each day of service. So I guess um what we'll do is we can start there. So you want to start with that first date of [PII]?
[CUSTOMER][POSITIVE] Perfect. Mhm.
[CUSTOMER][NEUTRAL] Yes, ma'am. It was um.
[CUSTOMER][NEUTRAL] Uh, Doctor, uh, [PII]. I'm gonna spell it for you.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And then uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And that was for 9722.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Then, um,
[CUSTOMER][NEUTRAL] The, OK, and then the next one was um.
[CUSTOMER][NEUTRAL] OK, I don't know you have the.
[CUSTOMER][NEUTRAL] [PII], OK. I also have another one, another day, but um I'll go get that in a minute. [PII].
[CUSTOMER][NEUTRAL] Oh, I thought I had him in order, in order.
[AGENT][NEUTRAL] It might be easier um you do have access, you, you do have access to the portal, Ms. [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It might be easier as a if you could um document this information and go ahead and upload it through the portal or do you have a fax machine?
[CUSTOMER][NEUTRAL] I sure don't.
[AGENT][NEUTRAL] You don't, OK, so what it might be a little bit easier and that way we can um keep track of it a little better is maybe um write this information on a piece of paper for each day with the doctor's information and then um maybe submit it through the portal for us just like you do the claim you won't have to uh file a claim for you just go ahead and upload that document like you're doing a new claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then that way we'll have it on on paper because it might be a little bit easier rather than you going through each state and trying to figure out so I would um kinda document just like the way you told me the date and then put the doctor's name there.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the next day, put, you know, put those, put that information for that surgery and then the doctor's name there. Like I said, it might be a little bit easier for um because I'm not sure if Ms [PII]'s gonna reach out or, or how she's going to handle this particular uh order of.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You know how we're gonna try to request this information because I'm not sure if we can do it in one request or if it's gonna have to be multiple so like I said if we have that information on a piece of paper at least or you know documented somehow then then we could kind of sort it through that way.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Does that sound, does that sound like something you'll be able to do?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes ma'am, yes ma'am.
[AGENT][NEUTRAL] And then like I said that way we have it all um in one place and rather than trying to list it out in in the notes we can have it in the file and then that way we can kind of uh tackle it that way it's like I said if we have each date with each doctor and then maybe it might be a little bit easier to uh keep track of each date since we have multiple dates like we do.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, OK, sounds good. Mhm.
[AGENT][NEUTRAL] Does that, does that sound like I said I know it's a little bit more of a work for you, but if like I said, at least we'll have it in the file and then we can go ahead and reference each day for each doctor depending on how we're gonna go ahead and approach, you know, trying to obtain this information.
[CUSTOMER][POSITIVE] Right, right. Yes, I understand. Yes, I, oh, and honey, trust me, I have been trying several times in different ways and reach out to the hospital, but I will definitely do that. Yes, ma'am. And I will hopefully Ms [PII] calls me and I will see what else it can be done. Mhm.
[AGENT][NEUTRAL] Yeah and like I said, in the meantime I, I know that there is a note in here that someone did send from your earlier call somebody did send her a message and let her know to contact you and then what I'll do is go ahead and update the notes and and and I'll uh you know reference that we spoke and that you gave me the dates and that I asked you to go ahead and document them and put them on paper so that we can put them in the file.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Yes ma'am, sounds good.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, did you have any other questions at this time, Ms. [PII]?
[CUSTOMER][NEUTRAL] All right. OK.
[CUSTOMER][POSITIVE] That, that'll be it, honey. Thank you so much, appreciate it.
[AGENT][POSITIVE] You're so welcome and, and uh I just wanna say uh good luck to you. I hope everything goes well and like I said, hopefully we can get this sorted out for you.
[CUSTOMER][POSITIVE] Thank you so much. I appreciate it, honey.
[AGENT][POSITIVE] You you're welcome, Ms. [PII]. You have a great day and thank you so much for being a valued customer.
[CUSTOMER][NEUTRAL] Mm. You too. Bye-bye.
[AGENT][POSITIVE] Take care, take care, bye bye.