AccountId: 011433970860
ContactId: f1effd59-3fe6-49d3-a95c-04f1a6dd4a96
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 648340 ms
Total Talk Time (AGENT): 150035 ms
Total Talk Time (CUSTOMER): 344948 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/f1effd59-3fe6-49d3-a95c-04f1a6dd4a96_20250331T19:52_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi Ms. [PII], it's [PII] in the care team. I've got um Ms. [PII] on the phone. Her policy number is 2091331.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, she is calling about claim number 3526086.
[AGENT][NEUTRAL] It's Part 1, part 2, part 3.
[CUSTOMER][NEUTRAL] Uh, part, uh, I just, I know it's [PII], whoever, [PII] is part 4.
[AGENT][NEUTRAL] OK, and the claim number again? I'm sorry?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes ma'am, it's 352-608-6.
[CUSTOMER][NEUTRAL] She keeps going back and forth with us on her claim, uh, she says that.
[CUSTOMER][NEUTRAL] She keeps getting all the information that we need from the, you know, from the doctors from the providers, the EOB and the itemized statement and then she sends it in and it tells us tells her that she needs the same thing over again but the provider keeps sending the same documentation so she is wondering if there's a way that we can request the information from the provider for her for the claim, and she's on the other line.
[CUSTOMER][NEUTRAL] Wanting to talk to somebody about that.
[AGENT][NEUTRAL] Give me 1 2nd to look at this one.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] 348
[CUSTOMER][NEUTRAL] And apparently her son passed away.
[CUSTOMER][NEUTRAL] And this is bills that he had when he was in the hospital before he passed away.
[AGENT][NEUTRAL] Oh, that chemotherapy
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, so basically all we need is surgeons.
[AGENT][NEUTRAL] OK, you can send her on over.
[CUSTOMER][POSITIVE] Thank you, Ms. [PII]. You have a blessed day.
[AGENT][POSITIVE] You as well thank you.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hello Ms [PII]. Um, I hope you're doing good. My name is Mr. [PII]. I'm just calling because, um, for my claim, you've been requesting some documents and every time I requested them to Texas Children's Hospital, I send them to.
[CUSTOMER][NEUTRAL] You, but I keep, I keep receiving um the same letter uh asking for those documents. So uh I would like to see if there is any way that you can request those uh documents to the, to the hospital.
[CUSTOMER][NEUTRAL] But they're asking me for the surgery, the uh the um itemized billing for the surgeries that he had, the pathology reports for the surgeries, and also the anesthesia.
[CUSTOMER][NEUTRAL] For the surgery mhm.
[AGENT][NEUTRAL] Give me 1 2nd to see what was sent in to us.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so, uh, the claim that she gave me is for the services that he had on [PII].
[AGENT][NEUTRAL] And so I'm looking at that information and so those are the itemized charges for the hospital.
[AGENT][NEUTRAL] And so the information that we're needing is the uh itemized billing for the surgeon that performed the surgeon. So the doctor's charges, not the um not the hospital charges.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, see, and I, I even send them like a copy of what y'all request them to show what they're asking for, but that's, that's what they send me, so that's what I say. Um, so that's why I would like to see if there is any way that y'all can request those um documents directly to the hospital.
[CUSTOMER][NEUTRAL] And there's, uh, I have, there was not just one surgery, it was 123456789 surgeries that he had.
[AGENT][NEUTRAL] OK, so we don't need the information, we don't need the information from the hospital. We need the information from the surgeon who was the doctor that performed his sur surgery?
[CUSTOMER][NEUTRAL] Through his journey, yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Well, that's the thing, it was several of them. And they, they, that's what they, it's been so hard because I keep asking them, uh, I keep asking them, uh, if there is any way that I can directly ask the doctor's office, and they said it has to be through Texas Children's Hospital.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's why, and that the only thing that they keep telling me is that is the two different offers that I have to request those documents, which is, uh, the, the, when I need the, the pathology report and all that is one office or another department if it is an itemized bill.
[CUSTOMER][NEGATIVE] But um I even try with each, uh different uh doctors and um they keep telling me that he has to be through the hospital because he is when all the surgeries he had and well, he was sick and um in the hospital.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And they, and he was uh treated in Texas Children's Hospital.
[AGENT][NEUTRAL] OK, so, um, after he had the surgery, did the, the surgeon and the anesthesiologist, they usually bills separately. So do you remember receiving any bills from the surgeon or the anesthesiologist?
[CUSTOMER][NEGATIVE] They, they, no, ma'am, they never emailed me separate. They, it was all together with Texas Children's Hospital. All the bills that I really received was through uh Texas Children's Hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Is there any way I can get a callback number and let me see if they can request the billing for you, um, but if not.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Uh, we'll see what we can try to help you with. Uh, what's a good call back number for you?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, ma'am. Uh, it is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm gonna read that back to make sure I have it correct.
[AGENT][NEUTRAL] I have [PII].
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][POSITIVE] That's, that's correct.
[AGENT][NEUTRAL] OK, and can I get your name?
[CUSTOMER][NEUTRAL] And, and the and the
[CUSTOMER][NEUTRAL] Yes, ma'am. Uh my name is [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm [PII]'s mom. Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And what were you gonna say?
[CUSTOMER][NEUTRAL] Now, I don't know if um.
[CUSTOMER][POSITIVE] Yes, ma'am, that I do have all the dates for those surgeries, that will be something that it will be easy, instead of y'all trying to find those dates, I already have the dates of those surgeries. And what I can also do is, in the meantime while you call me back, trying to find all
[CUSTOMER][NEUTRAL] All the, the uh surgeon's names.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I know, for instance, one was Doctor [PII].
[CUSTOMER][POSITIVE] But uh yes, ma'am. I can definitely do that.
[CUSTOMER][NEUTRAL] As well.
[AGENT][NEUTRAL] OK. All right. Uh, give me a second. Well, and I'll try to get with some of the examiners, uh, to see if that's something that they can do, and then I'll give you a call back to let you know.
[CUSTOMER][POSITIVE] Yeah, OK, honey, and the reason that I thought about asking you is because I have different, other different insurance companies, and I've, they've been doing that as well. So, uh, you know, since this one is the only one that I have left to finish, uh, I thought that, you know, I should call back and try to see if there was a possibility that y'all can do that for me as well.
[AGENT][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] I will
[CUSTOMER][NEUTRAL] Yes, ma'am. And what was your name again, please?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, Ms [PII]. Mhm.
[AGENT][NEUTRAL] All right, Ms. [PII]. I'll check on that for you and get back with you. Was there anything else that you uh had any questions on today?
[CUSTOMER][NEUTRAL] Yes, do you, do you have your uh number or an extension where I can contact you in case of anything?
[AGENT][NEUTRAL] Yes ma'am, it's [PII].
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And my extension is [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] [PII]. OK, perfect.
[AGENT][NEUTRAL] Yes, ma'am. OK.
[CUSTOMER][POSITIVE] All right. Oh, OK, ma'am. Well, thank you so much. I appreciate it.
[AGENT][POSITIVE] You're welcome and you have a great rest of your day.
[CUSTOMER][POSITIVE] You too honey bye bye.
[AGENT][NEUTRAL] OK. Bye-bye.