AccountId: 011433970860
ContactId: f1e290e4-3415-4903-a9f1-87e03f2a38ed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 820239 ms
Total Talk Time (AGENT): 148366 ms
Total Talk Time (CUSTOMER): 136408 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/f1e290e4-3415-4903-a9f1-87e03f2a38ed_20250224T18:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, good afternoon, [PII]. My name is [PII], and I'm calling in regards to a claim that I had submitted.
[CUSTOMER][NEUTRAL] For a
[AGENT][NEUTRAL] OK, we just need to check on that claim.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, it is 02110350.
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][NEUTRAL] I got an explanation of benefits where it was denied because I, it was.
[CUSTOMER][NEUTRAL] It's showing up as a out of patient, outpatient surgery, but
[CUSTOMER][NEUTRAL] That I did not stay in the hospital for more than 18 hours and I was in there.
[CUSTOMER][NEUTRAL] Almost 32 hours.
[AGENT][NEUTRAL] OK, we will definitely take a look at that. Um, can I get, I'm just gonna verify some information really quick though. Can I get your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Perfect. Um, last thing I need is the email address we've got on file. Um, it might be, uh, [PII] is through an employer.
[CUSTOMER][NEUTRAL] Uh, let me see, [PII].
[AGENT][NEUTRAL] I think it's through his employer um that's OK it's [PII].
[CUSTOMER][NEUTRAL] Yeah, I think
[CUSTOMER][NEUTRAL] Yeah, [PII], I think it's just.
[AGENT][NEUTRAL] Yes, no, that, that's perfect that's fine, thank you for verifying that. OK, bear with me just a moment. This claim was for you, you said?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Bear with me just a moment, let me take a look.
[AGENT][NEUTRAL] Not paying for outpatient, OK.
[AGENT][NEUTRAL] And you did say that this, uh, you were there at around [PII].
[CUSTOMER][NEUTRAL] Yeah, I went in on uh [PII] on the [PII] at [PII] and I did not leave until the [PII] after [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so from the [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, um, let's see.
[AGENT][NEUTRAL] Alrighty, if you don't mind I'm going to put you on a brief hold and I'm going to reach out to our claim specialist just so they could take a look, make sure that the information we have is accurate, um, if most of the time of course how they determine that is going to be the um.
[AGENT][NEUTRAL] Oh my goodness, the admission date and time and then the discharge date and time. So we'll take a look at that and make sure that we have sufficient information. um, I'm just gonna put you on a brief hold I'll get right back with you, OK?
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Ferring
[AGENT][POSITIVE] All [PII]. I'm so sorry about that. Wait, are you still with me?
[CUSTOMER][NEUTRAL] Yes, I'm still here.
[AGENT][NEUTRAL] OK, I appreciate your patience. So from what we have, um, from [PII], that'd be at the most 24 hours. So if you said it's 32 hours, we definitely need some uh uh correct information um because what we have is showing that it's less. So what I would do is if you were there for much longer than that, um, is to contact the.
[CUSTOMER][NEUTRAL] No,
[AGENT][NEUTRAL] With Artesia General Hospital and get that correct information to us.
[CUSTOMER][NEUTRAL] Well, let me, let me, hey, there's a document that I have submitted that.
[CUSTOMER][NEUTRAL] The, and it's a.
[CUSTOMER][NEUTRAL] The very first documents that I submitted show the admission date on [PII] at [PII] discharged on [PII] at [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And that has already been uploaded into the system, so you should have that documentation that was denied that deny my claim.
[CUSTOMER][NEUTRAL] The first time.
[AGENT][NEUTRAL] OK, is that with that's that information that you submitted, um, this was that [PII], does that sound right to you?
[CUSTOMER][NEUTRAL] But you
[CUSTOMER][NEUTRAL] No, this one was submitted, let me see.
[CUSTOMER][NEGATIVE] It's just been denied so many times. It's
[AGENT][NEUTRAL] Oh, I see you've had to resubmit it.
[AGENT][NEUTRAL] Um, let's see if I can't find that original.
[CUSTOMER][NEUTRAL] So then this that information was submitted with the actual claim form.
[AGENT][NEUTRAL] OK, OK. I think that's where that.
[CUSTOMER][NEUTRAL] It was all uploaded at the same time.
[AGENT][POSITIVE] I got you. OK, sorry about that confusion. I think that's where that.
[AGENT][NEUTRAL] was, so let me continue taking a look at that. Give me just a moment to see if that is any more accurate.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Can you go ahead?
[CUSTOMER][NEUTRAL] No, I went to the doctor. No, I went. I went to the clinic. It was packed. I called Doctor [PII]'s office and she was able to squeeze me in.
[CUSTOMER][NEUTRAL] She said I probably had the flu, but because it's already the 5th day.
[CUSTOMER][NEUTRAL] There's nothing she could give me for the flu, so she treated me for a sinus infection.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] No, I'm good. I'll leave me, I'll warm up some chicken soup Polita.
[CUSTOMER][NEUTRAL] No