AccountId: 011433970860
ContactId: 0548dc83-176c-4428-9512-f0d32d964c1c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 384970 ms
Total Talk Time (AGENT): 211238 ms
Total Talk Time (CUSTOMER): 132563 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/0548dc83-176c-4428-9512-f0d32d964c1c_20250107T20:41_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] [PII], this is [PII]. I spoke to someone this morning and um she said I couldn't um upload my medical records, but I wanna speak to the supervisor because my claim has been pending since November. They've been waiting for medical records.
[AGENT][POSITIVE] OK, um, well, I can definitely assist you with that. [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right, and may I have your policy number?
[CUSTOMER][NEUTRAL] Mhm. 740.
[CUSTOMER][NEUTRAL] 240.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and I do see the notes from today. OK, so, um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're wanting to speak to a supervisor because we haven't received the medical records and you sent them yourself.
[CUSTOMER][NEUTRAL] Uh, well I sent them in, yeah, she said the lady, whoever I spoke with said I'm going to send them in, but I don't know if I needed to see if someone Mac, sugar, if someone could um go ahead and look at those records and process it. Sugar.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so you're wanting to speak to a supervisor or you're wanting to speak to someone to someone in claims to process the payment. I mean, I just want to make sure I understand.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I don't know who do I have to speak with to let them know I submitted my records if they can go ahead and process it.
[AGENT][NEUTRAL] Oh, it's already in processing. The, the record, we, so we received the records, it's about 9 pages. Um, the only reason it was on hold was because we hadn't received the records from the doctor, but I see yours here, so it's already in processing.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] She told me it was pending.
[AGENT][NEUTRAL] I mean, it's
[CUSTOMER][NEUTRAL] That they were pinning 4 records.
[AGENT][NEUTRAL] It was, but you sent them in.
[CUSTOMER][NEUTRAL] So now, cause on my portal, it's
[AGENT][NEUTRAL] So when we have a
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So when we have a claim, if medical records are requested, we have to send the letter out to your doctor and then we just have to wait until they send it to us. Um, it's nothing that we do on.
[CUSTOMER][NEUTRAL] No, no, right, I understand.
[AGENT][NEUTRAL] So now that you've sent these records in, it's now pending and I mean, you know, the examiner is gonna go through them if something is missing or, you know, you'll be notified, but
[AGENT][NEUTRAL] I can let claims know that you that you've submitted it, submitted it and um but I mean it's in processing, like that's how I was able to pull it up. If it wasn't or if it was pending, I would just see zeros here or um like I wouldn't be able to access it because it's, it's pending.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Because when I log in to my portal,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's still, it doesn't say in process. Mine shows pending.
[AGENT][NEUTRAL] OK, well, I would say, I mean, the only thing that, so at this point, the only thing that you can do, since you just submitted it today, there's nothing gonna be updated online until tonight because we don't do any changes during the day. Everything, payments made to the bank, updates to policies, all of that is done at midnight every night.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, if you do see pending still, I, I can understand that, but your records are here and as soon as we receive it, we could we continue processing, so.
[AGENT][NEUTRAL] I mean, do you want to talk to someone and
[CUSTOMER][NEUTRAL] But do I have to wait the whole like 7 days for it to be showing like an update or that's what I'm trying to ask if someone from the claims department can go ahead and see, oh, she sent the record, we can go ahead and start working on the processing part, you know, portion.
[AGENT][NEUTRAL] Right, but that's what I'm saying. It's already continued processing because that's what we were waiting for the whole time your doctor to send the records, but you did.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] So now it's processed.
[CUSTOMER][NEUTRAL] OK, well, when I uploaded them, I didn't even write like what date of service. I don't, do I need to do that?
[AGENT][NEUTRAL] No, um, the exam, so what's gonna happen now is the examiner is gonna go through the documents that you sent over, let you know if something is missing or if they need additional information, but they have to examine the documents first. So, you will be notified like if something is needed or some, you know, it's not going to just go silent. It was just that pause in there because we were waiting for the records from the doctor.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] But are they gonna accept mine or do they want them from the facility because they didn't they just, I mean they came from the facility but not from them, they came from, from me. I sent them.
[AGENT][NEUTRAL] Um, it depends. Sometimes we are able to use the, the, well, yours has the diagnosis codes and procedure codes on there. I mean,
[CUSTOMER][NEUTRAL] That's why I want to check with somebody that's over like the claims department and they can tell me if that is sufficient.
[AGENT][NEUTRAL] But no one would be able to do that until they actually examine the claim. We all would be just guessing because we're not in there physically doing the work. So, the only thing that you can do at this point would be, because they're gonna contact you. So if something's needed or if these documents aren't feasible, but just to, I was just trying to answer, you know, your original question, let you know, yes, these records have been received and are in processing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK. Well, thank you so much.
[AGENT][NEUTRAL] You're welcome, Ms. [PII]. Well, you can call us at any time you have any questions, let us know. Um, was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] No, ma'am. That's it.
[AGENT][POSITIVE] All right. Well, thank you so much for calling APL. Happy [PII] and I hope you have a great evening.
[CUSTOMER][POSITIVE] You too. Thank you. Mm mm bye-bye. Bye-bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.