AccountId: 011433970860
ContactId: 09228208-a6b5-4ab3-9da7-319145c07e12
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 671940 ms
Total Talk Time (AGENT): 423914 ms
Total Talk Time (CUSTOMER): 207859 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/09228208-a6b5-4ab3-9da7-319145c07e12_20250331T18:08_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], it's [PII]. I've got um Miss [PII] on the phone and her policy number is let me get back over there.
[CUSTOMER][NEUTRAL] It's 257-563-9.
[CUSTOMER][NEUTRAL] And I have verified her and the number she's calling from is a good call back number on her claim number is the only one in there um 358-1275.
[CUSTOMER][NEUTRAL] She received a letter stating that she needed to sign the release of medical records, but the release of medical records was not sent to her, so she needs a release of medical records form sent to her.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] She said that the first page had the letter but on page two it was just blank.
[AGENT][NEUTRAL] And it's let me.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] And she's she says she received a blank form.
[AGENT][NEUTRAL] I'm gonna look at the what was sent to her.
[AGENT][NEUTRAL] So she just received the EOB basically and then another blank form.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes. Yup. That's what she got.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] It's not just the release of information, it looks like.
[AGENT][NEUTRAL] She's needing to provide?
[AGENT][NEUTRAL] It's the preexisting medical history. So that's a separate form, and she didn't get that form, right?
[CUSTOMER][NEUTRAL] That's what I could read by.
[CUSTOMER][NEUTRAL] Yes, because she has.
[CUSTOMER][NEGATIVE] She didn't get any forms to complete.
[AGENT][NEUTRAL] OK, and everything's been verified?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, and let's see.
[AGENT][NEUTRAL] I'm just looking to see if she signed our HIPAA form and it doesn't look like that one with the claim form. I was looking for that as well. I don't see that here.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so I'm not sure if they need that form as well, but I'll go ahead and send that to her and uh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] And it's [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] And she's really sweet. She's she's a nice one.
[AGENT][NEUTRAL] Oh good that's good. OK, I think I should be able to, yeah I think I may be able to go ahead and send those blank forms to her via email. That's what I've been doing um as long as they're blank, but it's just a little bit more convenient for them, especially if they're not using the OSC and it looks like she's not, is she not using the OSC or you didn't get that far?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] I didn't get that far with her when she explained to me she only got the EOB and everything else was blank pages. I was like, oh, I don't even know what all needs to be sent to her so I transferred her for help.
[AGENT][NEUTRAL] Yeah, I'm just gonna just check to make sure that we don't have an active OSC on her.
[AGENT][POSITIVE] But you can go ahead and transfer over and I'll help her as best I can.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you so much. Uh-huh.
[CUSTOMER][POSITIVE] All right, thank you, [PII].
[CUSTOMER][NEUTRAL] Mm bye bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello. Hi, good afternoon.
[CUSTOMER][NEUTRAL] Hello? Yes.
[AGENT][NEUTRAL] Can you hear me OK?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hi, good afternoon. This is, uh, [PII] is it [PII]?
[CUSTOMER][POSITIVE] Yes, I can.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] Did I say that correctly? OK, alright, um, [PII] transferred you over to me. I'm on the claim support team and I understand that we, uh, had sent some, uh, sent you an explanation of benefits to you, and we are requesting some additional information for your claim and [PII] advised me that you didn't receive the forms attached you just had the um the explanation of benefits is that right for the claim?
[CUSTOMER][NEUTRAL] Yes, I said.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] That's, that's correct.
[AGENT][NEUTRAL] OK, alright, so it looks like what we're needing, we're needing a couple different um items here so we didn't receive um along with the claim form there's a 2nd or 3rd I think it's the 3rd page of the claim form packet there's a um what we call that release of information form.
[AGENT][NEUTRAL] Um, and what that just entails is having you, uh, sign a form that lets us know that we can reach out if need be and request information on your behalf so we don't have that form and there's also a form that looks like we're needing that, um.
[AGENT][NEUTRAL] Would be the attending physicians that have treated you in the past year, um, because your policy just um became effective on [PII], they're asking for some additional information regarding the doctors that treated you in the past year. Now, um, can.
[CUSTOMER][NEUTRAL] Yeah, yes, I, I get that. Uh-huh, I just don't have the forms.
[AGENT][NEUTRAL] Right, OK, and that's what I was gonna ask you now I have an email address. Can you confirm your email address for me?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I have my work email. It's [PII]
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, would it be OK if I go ahead and email those forms to you um at that email address?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, that's fine. Uh-huh.
[AGENT][NEUTRAL] Now, um, we use the email um only limited and the reason why is because it's not secure, but I can send you the documents because they are gonna be blank and you'll just go ahead and and complete those documents now do you um have access to our um online um service portal or did you just fax your documents to us?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you know how you submitted them?
[CUSTOMER][NEUTRAL] I can go ahead. I, I can go ahead and fax them or I do have access to the portal. I can, I can do either or.
[AGENT][NEUTRAL] You do.
[AGENT][NEUTRAL] OK, well, and that's what I was just gonna say I can send those forms to you go ahead and complete them and you can either upload them or fax them back to us, um, but I can go ahead and send them to you at that email address that you verified for me and um you'll receive those forms and like I said you'll just complete them and they either, um, like I said you can either fax or upload through the portal once they're completed um and I'll send those to you momentarily. Did you have any other questions I could answer for you at this time?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, no, at this time, that's, uh, that's basically, so what, so maybe you can answer. The, the first form where it says page one explanation of benefits, that's just indicating that you all did not pay for the surgery benefits or I, I, I don't not sure I understand how to read this correctly.
[AGENT][NEUTRAL] Sure. Let me go over that with you. Absolutely. OK, so it looks like, let me just double check. So it looks like um there was some surgery and anesthesia and then um we were looking for that um.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh, the cancer benefit as well, and which is why we're asking for that additional information. Now, as far as the surgery,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it looks like we want that, uh, pre-existing. Now, do you have a surgery bill from the surgeon where, uh, the surgeon that did the, um,
[AGENT][NEUTRAL] Uh, the, the surgery itself, do you have a surgery bill or can you obtain one? Cause it looks like we're needing those surgery charges as well.
[CUSTOMER][POSITIVE] Yeah, I can obtain those. I can.
[AGENT][NEUTRAL] OK, OK, because, so they're needing a surgery bill for that, uh, [PII] date, um, and I think you submitted the information submitted was, looks like it was the um the actual uh path was it pathology report?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That you submitted? Yeah. And it gives us kind of like the description of what was done, but what we're needing is that bill as well. So if you wanna go ahead and obtain that surgery bill, usually you can just obtain if you call the surgeon's office and you let them know that you're filing a claim with your um supplemental coverage and we're asking for a surgical bill, they should be able to provide that for you.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so the surgery bill and what else? And this is for [PII].
[AGENT][NEUTRAL] And then you're gonna
[AGENT][NEUTRAL] Yes, and it's gonna be the attending physician form and then also that uh that release of information I'll send that both of those forms to you, the release of information and attending physician form. I'm gonna send those blank forms to you uh through the email.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so you said it was the attending physician form and which other one I'm sorry?
[AGENT][NEUTRAL] It's just the uh release of uh information yeah it's called our HIPAA form our release of information like I said basically that is the um that gives us authorization and to reach out on your behalf um to get information if if they're needing to obtain that information.
[CUSTOMER][NEUTRAL] I got the
[CUSTOMER][NEUTRAL] Oh, really? OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and I'm gonna send those forms to you momentarily, um, so if you just give me a few minutes to prepare that and I'll send that to you in in the email um to the email address you verified for me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so now let me ask you the bill uh for the surgery, uh, from [PII]. Once I receive that, do I upload it uh or fax it to you all?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] You could do either one however you'd like if you'd like to upload it or you'd like to um fax it to us either one would be fine um and it's this you can reference this claim number if you'd like on those pages, the claim number just make sure your policy number's included and you have your policy number?
[CUSTOMER][NEUTRAL] Yes, OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, is this the one I gave you, the one, hold on, uh, let me look at the paper again, the policy number 02575639.
[AGENT][NEUTRAL] Yes ma'am, that's your policy number and then the claim number is the 3581275 where we requested that information yes ma'am, OK?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I referenced, I referenced both of those, uh, on those forms.
[AGENT][NEUTRAL] Yes, it, yes, and like I said, most important that policy number just so that we can um trace it back to your information for sure.
[CUSTOMER][NEUTRAL] Right, I, I, uh.
[AGENT][NEUTRAL] So what happens usually is what what's happened is we received your claim we've acknowledged it but now we're needing additional information so that's why we're requesting that so it's kind of like in a pending status waiting for that additional information that we requested.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Got it. Thank you. Yes, got it. Thank you so much.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You're welcome. If you have any other questions?
[CUSTOMER][NEUTRAL] Uh-huh. No, that's it for now. Yes.
[AGENT][POSITIVE] OK, well, thank you so much for your patience, Ms. [PII], and thank you for uh calling APL and I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you. Likewise. Bye-bye.
[AGENT][NEUTRAL] Bye bye.