AccountId: 011433970860
ContactId: f2ae6d07-d4f0-4841-a56f-647a208428ad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 771669 ms
Total Talk Time (AGENT): 198886 ms
Total Talk Time (CUSTOMER): 299429 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/f2ae6d07-d4f0-4841-a56f-647a208428ad_20250423T13:42_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Sorry, hold on a second. You're on my car. What did you say your name was?
[AGENT][NEUTRAL] This is [PII].
[CUSTOMER][NEUTRAL] OK, um, I'm calling about a claim that I filed. I was looking at the EOB. I need to talk to somebody about the information that you need.
[AGENT][NEUTRAL] OK. Um, may I have um your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And my number is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, and do you have the policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Oh, I'm driving. I mean, I don't know. Can you look it up with my social?
[AGENT][NEUTRAL] OK, bear with me just a second, let me.
[AGENT][NEUTRAL] For another system. OK, go ahead.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] For security, may I have your date of birth, mailing address and email address on file?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] And let me pull the most recent claim one and that claim was under yourself for one of your dependents.
[CUSTOMER][NEUTRAL] For my husband.
[CUSTOMER][NEUTRAL] For my husband.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And um what is your question exactly to see if I need to get the examiner?
[CUSTOMER][NEUTRAL] OK, OK, on the one where it says you need the admit and discharge for [PII], so he was in the hospital for like a week and you have all that information in a previous claim. This is just, that was what we didn't get with the rest of the information. You had me go get some more information.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, you say you send that prior to this one?
[CUSTOMER][POSITIVE] Yes, it should, you should have all of that. It was like a whole week of stuff.
[AGENT][NEUTRAL] And you said the date of service for that was.
[CUSTOMER][NEUTRAL] [PII] is when he was in the hospital.
[AGENT][NEUTRAL] You can.
[AGENT][NEUTRAL] Bear with me.
[CUSTOMER][NEUTRAL] And when you say admit and discharge, that the medical records or the actual bills?
[AGENT][NEUTRAL] No, that is the document. It's a discharge summary. That's the name of the document.
[AGENT][NEUTRAL] The discharge summary will show exactly the time. So let's say that he was there um till like he got in on [PII] and he got out at [PII] then we know that's a whole day, like, basically it's gonna be 24 hours. So that's how we determine how many days to pay, if we need to pay 6 or 7 days. Um, but that's the name of it. Yeah, it's a discharge summary. Yeah. Mhm. Um.
[CUSTOMER][NEUTRAL] Oh, I see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Oh, that, that doesn't make any sense because, so you asked for this information when I filed the, the last time he asked for additional information. I finally got it for the surgery, but it was while he was in the hospital. So the discharge would be the same as the hospital discharge which was days later.
[CUSTOMER][NEUTRAL] So I don't know.
[CUSTOMER][NEUTRAL] How that, why that we needed that then.
[AGENT][NEUTRAL] Mm OK. Let me get a examiner on the line and see if she has that paper or if she's really missing that paper because yeah, that will determine how many days is pay. OK, one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], how are you? This is [PII].
[CUSTOMER][NEUTRAL] Oh hi there. Oh, I'm sorry, you're breaking out a little bit. Can you hear me?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can hear you. Can you hear me?
[CUSTOMER][NEUTRAL] OK. You're breaking up just a little bit.
[AGENT][NEGATIVE] Oh, I'm sorry. Uh, and then I'm a little bit sick too, so yeah, that's not a good combination. Um, can you hear me better now?
[CUSTOMER][NEUTRAL] Um, I guess it's kind of still cutting out just a little bit. I'm, I'm trying hope maybe maybe when you transfer the call over, hopefully it won't be choppy.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah, yeah, um, but I have a member, um, that she's trying to check on a claim, and she said that she did send a discharge summary and that we're asking for it. It's on the husband. She is the main holder um policy 256-919-9.
[CUSTOMER][NEUTRAL] OK, so she's just asking for claim status?
[AGENT][NEUTRAL] Um, yeah, it's a little bit more than just a claim status. She, she said we're asking for the discharge summary.
[AGENT][NEUTRAL] And she said she already sent that information for the date of service of [PII].
[CUSTOMER][NEUTRAL] OK, let me, sorry, you said [PII]?
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, uh, give me just a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Did she say when she sent the admin discharge summary?
[AGENT][NEUTRAL] She said it was on the, like the first um documents that she sent in.
[CUSTOMER][NEUTRAL] OK, on her initial claim she sent the admin discharge summary?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] She said under the under the first one. So I guess probably the second batch, not really the first one because she said we asked for it one time already.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so she's saying that she sent it back in April that.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I see that there were 2 submissions, one in January and one in April.
[AGENT][NEUTRAL] Yes, it's gonna be the one in April.
[CUSTOMER][NEUTRAL] OK, let me give me just a second.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and do you have the callback number?
[AGENT][NEUTRAL] I do, yeah, the callback number is [PII].
[AGENT][NEUTRAL] You need me to repeat it. I'm sorry.
[CUSTOMER][NEUTRAL] OK, no, I got it. And you said it's Ms. [PII] on the other line?
[AGENT][NEUTRAL] Yes, Miss [PII]. Yes.
[CUSTOMER][POSITIVE] OK, thank you. I can go ahead and uh help her.
[AGENT][POSITIVE] OK, thank you, here she comes.
[AGENT][POSITIVE] Thank you for holding and being patient for Ms. [PII]. I got Miss uh [PII] on the line. She's gonna assist you from here.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Thank you for holding. How can I help you today?
[CUSTOMER][NEUTRAL] OK, so I had some questions. Um, I sent in what I could get on that surgery he had while he was in the hospital. You paid a previous claim for um that [PII] or [PII] hospital visit, but it said on there you wanted him for uh the stuff for the surgery when he had uh his side drained.
[CUSTOMER][NEUTRAL] And then he had a plural window done, uh, I'm not a plural window, a pericardial window done. And so I got what I could and I sent that in, but I don't know why now you're wanting to admit discharge. There wasn't one for that. It was with the surgery thing previously.
[CUSTOMER][NEUTRAL] OK. So you say you're asking what else is needed for the surgery procedure from [PII]? Yes.
[CUSTOMER][NEGATIVE] Because I got and it was not easy to try to get all that junk cause like this person changed and this person and this person doesn't do it and and it's ridiculous trying to get the information.
[CUSTOMER][NEUTRAL] I wanted a separate search.
[CUSTOMER][NEUTRAL] Yeah, I wanted a separate surgeon's bill, and they were, they all act like, what are you talking about? I don't know what, and I'm like, OK.
[CUSTOMER][NEUTRAL] I don't know. I'm just telling you what they needed.
[CUSTOMER][NEUTRAL] Sure. So yeah, for, for, well, for the surgeon bills, um, the reason why we do request those is because it will have the actual procedure codes um for the, the surgery that he, that was performed and so that's how we're able to pay you each of the benefits for the surgery and anesthesia is by having the actual surgeon bills that, you know, provide information that was performed. Um, so that's the reason for that.
[CUSTOMER][NEUTRAL] Um, but let me just take a look here and see what else we were needing for, and you said it was the surgery on [PII] [PII]?
[CUSTOMER][NEUTRAL] Well, and it was during that time, so the [PII] is when he went me and he had a drain and then like two days later is when they did the surgery for the pericardial window [PII], I guess the [PII].
[CUSTOMER][NEUTRAL] OK, so I just wanna make sure I understand exactly um.