AccountId: 011433970860
ContactId: 0c3c0812-e096-44ba-937c-a1a5cbd4b73e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 766809 ms
Total Talk Time (AGENT): 219632 ms
Total Talk Time (CUSTOMER): 281880 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/0c3c0812-e096-44ba-937c-a1a5cbd4b73e_20250407T17:14_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII], and I filed a claim, um, over a week ago because y'all said y'all needed additional documentation to prove that one of my appointments was a follow up to receive the correct amount. And today when I looked in the system, um, y'all deleted all the documents I've sent and deleted out the um claims forms that I, I submitted. I'm just trying to figure out what's going on.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. [PII], do you have your policy number?
[CUSTOMER][NEUTRAL] No, but I can give you my social security.
[AGENT][NEUTRAL] OK, what's that?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, just need to verify a few pieces of information. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And your birth date?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And last thing would be your email address.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let's see here
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] What was the date of service for that claim?
[CUSTOMER][NEGATIVE] I don't know. I submitted it the week before last and they deleted them all out so I can't see my service dates anymore.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But they sent me a letter in the mail. I got it this weekend, so I know they started it.
[CUSTOMER][NEGATIVE] And it's been in the computer and now it's all gone.
[AGENT][NEUTRAL] Like.
[AGENT][NEUTRAL] OK, let me see. It looks like there's a different policy number. Is it from some services from [PII]?
[CUSTOMER][NEUTRAL] I submitted from another deal from [PII] and a recent one from [PII] showing documents that both of those were follow up necessary appointments.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, give me just a moment. It looks like there is a different policy that was filed under, and so I'm looking at that.
[CUSTOMER][NEGATIVE] I just think it's weird that, you know, when they deny place they used to just put a 0 and do the deal, but this time they've deleted everything out and it's all gone so I can't even give you the dates or anything.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] OK. Um.
[AGENT][NEUTRAL] So did you submit those through the portal or was that by fax or?
[CUSTOMER][NEUTRAL] By the portal.
[AGENT][NEUTRAL] Portal, OK.
[CUSTOMER][NEGATIVE] Yeah, and that was received in the portal because it, you know, I double checked it and made sure they made it in and then y'all mailed me a letter saying that you're reviewing my claims and it was there this morning because I checked on it to see if y'all made any progress because it's been over a week and they were still all there and then I only checked it at lunch, um, they're all gone.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well let me um do you mind if I transfer you to our claims department? They have access to different things that I don't, um, and they should be able to look into the system further to see what is going on.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][NEUTRAL] OK, I'll let them know that I've verified all your information and give them the information that we've discussed, so if you can hold one moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Afternoon, thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, [PII], this is [PII] on the care team. Um, I'm wondering if you could assist this member with her claims. Um, she's got two different policy numbers, but I'm having a hard time following what's transpired, so.
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] OK, what was the policy number? What was she calling in regards to just on the claim question or?
[AGENT][NEUTRAL] Yeah, she, she said she submitted the claims over a week ago and she got a letter confirming that we received them, and then she said they were there this morning and now they've all disappeared when she looks at the portal. So I'm not sure what's, I don't, I can't tell what's going on, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can you give me one of the policy numbers?
[AGENT][NEUTRAL] Yeah, uh, the old one is 2384924.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And she said she had.
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] Yeah, and I verified her information. Um, she said she submitted some dates from [PII] that were for follow-ups, and she said she submitted, this is what the additional information she submitted a week ago stating they were for follow-ups, and then she also had some dates from [PII].
[AGENT][NEUTRAL] But I can't follow what's um going on on the claims.
[CUSTOMER][NEUTRAL] So did she say they were follow up? OK, let's see what else here because I do see that.
[CUSTOMER][NEUTRAL] Mail was moved. Let me look under this other policy.
[AGENT][NEUTRAL] Yeah, one references the other policy number and then when I pull it up on the other one, it references the other policy number, so I'm not sure what. I can't decipher what happened.
[CUSTOMER][NEUTRAL] Yeah, I
[CUSTOMER][NEUTRAL] Let me see if I can see what's going on. Let's see, give me a moment, let me take a look here.
[CUSTOMER][NEUTRAL] Oh my. I see what you're talking about.
[AGENT][NEUTRAL] Yeah, I know
[CUSTOMER][NEUTRAL] That's, they, that's done on under all the policies.
[CUSTOMER][NEUTRAL] Yeah, let me see.
[CUSTOMER][NEUTRAL] If I can find the mail itself and see if they maybe put a note on the mail.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Wonder who
[CUSTOMER][NEGATIVE] I can't even find the mail. Let's see here.
[CUSTOMER][NEUTRAL] Oh wait, OK, it looks like it's been sent back to indexing. OK, let's see here, see if they put a note on here to see what is going on.
[CUSTOMER][NEUTRAL] Hm, and you said she's sent in for several different dates of service for [PII]?
[AGENT][NEGATIVE] Yeah, she said she had some for [PII] um she I, she didn't specify how many and then some for [PII] she's just concerned because she said she saw it on the portal and now it's disappeared.
[CUSTOMER][NEUTRAL] Mm, cause this piece of mail here that I see that it was put under the policy 2384924, it's only one page. It looks like it's only just a referral for, it looks like a date of.
[CUSTOMER][NEUTRAL] [PII] and that's it, that's the only page. Let me look at something else. Let me see.
[CUSTOMER][NEUTRAL] Yeah, that's the only thing that I see that was sent under that policy, the 2384924 on that document.
[AGENT][NEUTRAL] Oh it looks like we had uh 1114 23 on the 2528619, but then it says see policy 2384924.
[CUSTOMER][NEUTRAL] Let me
[AGENT][NEUTRAL] So I don't know what's happened.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, I'll have to look further on this one. I'll have to get with the examiner that DM this mail to see exactly what's going on.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Because I'm not able to determine why come this mall is being DM2 under both of these policies and it isn't noted on the noted anywhere as to what's going on with this. I will have to reach out to the examiner to check on this.
[AGENT][NEUTRAL] OK, do you wanna talk to the member? Do you want me to just tell her somebody will research and call her back or?
[CUSTOMER][POSITIVE] Yes, yes, you can get, get her um information and we can give her a call back.
[AGENT][NEUTRAL] OK. Do you need anything else from me?
[CUSTOMER][NEUTRAL] No, I don't.
[AGENT][NEUTRAL] You'll look, OK, OK. Do you want me to like, um, send a chat?
[CUSTOMER][NEUTRAL] And what is her callback number?
[AGENT][NEUTRAL] Uh, call back is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Yeah, I'll take, I'll um I'll have, I took her number [PII] and I'll have the examiner reach back out to her cause I'm, I have to check with her to see what's going on with these documents because I'm not able to see what's going on while they're getting DM2d.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right. I'll let her know somebody will be reaching back out.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Oh thank you, bye.
[CUSTOMER][NEUTRAL] Mm bye.
[AGENT][NEUTRAL] OK, I am so sorry about that, [PII]. Um, the claims department has to do some research on this because they can't figure out what's transpired either, so they're gonna research that, um, and give you a call back. I've got the [PII], is that right?
[CUSTOMER][NEUTRAL] Right, and my email should be on file and if I don't answer if they could send me an email, that would be great just because I'm in the classroom all day and I can't answer my cell phone, but I think it's really weird. I mean, I, I submitted all that. I talked to a representative on the phone, she double checked, make sure the documents were there. They were literally there this morning because I was double checking because usually it takes you 3 to 5 days. It's been over that and when I went in the system to look at the documents, they've all disappeared.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. All right. I'll.
[CUSTOMER][NEUTRAL] So, and then, and he also sent me a letter last week and then it got to me on Saturday saying that y'all are starting to review the claim. So 100% sure that y'all started it because I've got a letter.
[AGENT][NEUTRAL] Right, yeah, and they were having trouble determining what's transpired, so they're gonna do some research on that we'll we'll figure out what's going on and then they'll reach out to you when they um have a resolution.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][POSITIVE] OK, thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] OK bye bye.