AccountId: 011433970860
ContactId: 13e36780-4b99-4c27-9b6f-131b8fb0cd20
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 819530 ms
Total Talk Time (AGENT): 312537 ms
Total Talk Time (CUSTOMER): 248498 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/13e36780-4b99-4c27-9b6f-131b8fb0cd20_20250305T19:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], it's [PII] with um Broker Resources. How are you?
[AGENT][POSITIVE] Hey, [PII], I'm good.
[CUSTOMER][NEUTRAL] Good, I have, hold on, I'm trying to verify that this is actually not Medlink, so bear with me. I'm sorry.
[AGENT][NEUTRAL] Sure, sure.
[CUSTOMER][NEUTRAL] Um, I don't know. What are you? Meli?
[CUSTOMER][NEUTRAL] Well, I have somebody, yeah, I have somebody on on I have [PII] on the phone. His policy number is 007.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 80942.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Why can't I see like what they have?
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEGATIVE] That's so bizarre.
[AGENT][NEUTRAL] Yeah, this is an accident policy.
[CUSTOMER][NEUTRAL] Oh perfect. So can he talk to you? He was just calling um to ask about his claims.
[AGENT][NEUTRAL] Sure, sure, send it through.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, did we get him verified or do I need to verify him?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Um, I looked up
[CUSTOMER][NEUTRAL] You, you can verify him. I believe that this is him. I didn't ask for a social or birthday though, but I did verify like [PII] that [PII], his last name is that policy number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. All righty. Thank you.
[CUSTOMER][POSITIVE] OK, of course, thank you.
[AGENT][NEUTRAL] Hi, [PII], this is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] How, how can I help you, [PII]?
[CUSTOMER][NEUTRAL] Yeah, I was calling about, um, I was sitting in a claim thing and the, uh, statement or the accident claim form a while back they were like we need more information like your, your itemized bill and I was like, yeah, I haven't got it yet. I'll send it in when I get it in. I sent it in and then they sent me another that thing already filled out in the mail, um, so I'm trying to figure out what's going on.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me, let me verify some information, [PII], and then we can proceed looking at that claim status, OK? Can you verify your date of birth and your complete mailing address for me?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, [PII] and then my address is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Perfect and what's your email address?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you. How did you come up with that email address? Catfish. You like catfish?
[CUSTOMER][NEUTRAL] I, I used to noodle a lot, so I was a big, big catfisher.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, pretty cool. All right, and so do you know the, thanks for verifying that, do you know the date of service of your claim?
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Was it an emergency room visit?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Was it [PII]?
[CUSTOMER][NEUTRAL] Uh, yeah, I believe so.
[AGENT][NEUTRAL] OK. Let me get a good phone number in case we're disconnected, [PII].
[CUSTOMER][NEUTRAL] Wait, it's, yeah, February, yeah, OK.
[CUSTOMER][NEUTRAL] Uh, my phone number is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I'm showing last activity was on [PII]. It's a claim that you submitted. It's from a Doctor [PII] looks like.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's for 25 of 25.
[AGENT][NEUTRAL] And let's see, we did send you correspondence which reads.
[AGENT][NEUTRAL] Says please provide a diagnosis code for this state of service. This information may be obtained.
[AGENT][NEUTRAL] From your uh provider of service.
[AGENT][NEUTRAL] And this was as of [PII]. Are you saying that you've submitted that requested information?
[CUSTOMER][NEUTRAL] What are they, what are they wanting?
[AGENT][NEUTRAL] It's a diagnosis code. The reason that you report it to the emergency room, so that would be your diagnosis.
[CUSTOMER][NEUTRAL] I that's what I sent him before that.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] I'm still looking, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] are you looking for like the thing where I it right on there what what happened to me why I went to the emergency room?
[AGENT][NEUTRAL] Mmm. This would be, and it, this, the diagnosis code is on the itemized bill that you received from your healthcare provider. In this instance, it'll be, it, it would be the hospital, but the claim has been received, however, the claim form is missing the signature.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Um, APL has mailed a new claim form, so the first time you sent it to us, OK, so it's saying that the APL claim form that you sent did not have a signature on it, so let me take a look at that. I have it here.
[CUSTOMER][NEUTRAL] Yeah, that the first one I sent, uh, my address card.
[AGENT][NEUTRAL] But the second one you sent does have your signature?
[CUSTOMER][NEGATIVE] I didn't send the 2nd 1 because I sent, uh, why would I send the 2nd 1 if I already sent one.
[AGENT][NEUTRAL] Yeah, you're you did you you didn't sign it. I'm looking at it.
[CUSTOMER][NEUTRAL] That's sounds.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] The first one sorry?
[AGENT][NEUTRAL] Yeah, you filled it out but you didn't sign it at the bottom where it says signature.
[AGENT][NEUTRAL] It's blank
[AGENT][NEUTRAL] You filled all of it out except the signature line.
[AGENT][NEUTRAL] Would you happen to have a copy of that one?
[CUSTOMER][NEUTRAL] Hold on, I'm trying to pull up a work computer.
[AGENT][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] And then you gave a description of the accident or the details it says on 25 that approximately 0800 hours I was doing yard work in the backyard of my property when I cut the palm of my hand, left hand while throwing branches into a brush brush pile. So now what we're asking for, um, after you've reported to the emergency room is for the diagnosis code that they would assign based on your injury.
[CUSTOMER][NEUTRAL] So where did it, where is it saying that it didn't sign at?
[AGENT][NEUTRAL] So on page.
[CUSTOMER][NEUTRAL] 205
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] This is on page.
[AGENT][NEUTRAL] Yep, 205 at the bottom where it says acknowledgement your signature is required for benefit consideration. It says signature of insured on what we received is blank and that the signature date is blank.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That's so weird, yeah, mine's signed, so uh.
[CUSTOMER][NEUTRAL] Let's see, is there any way I can email you this one?
[AGENT][NEUTRAL] Um, it's a claim form, so that's not, um, let me see.
[AGENT][NEUTRAL] Has your PHI on it. Can I give you the fax number to send that?
[AGENT][NEGATIVE] His email is not a secure way to send your claim documentation.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, let me um.
[CUSTOMER][NEUTRAL] Let me uh see if I can.
[CUSTOMER][NEUTRAL] Try to
[CUSTOMER][NEUTRAL] I, I don't, is there, let me, I guess I can try to um.
[CUSTOMER][NEUTRAL] Um, we like buys closing it out.
[AGENT][NEUTRAL] You may.
[CUSTOMER][NEUTRAL] Let's see desktop.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Are you doing an e-signature?
[CUSTOMER][NEUTRAL] No, I, I.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I printed this off and then signed it and then recopy scanned it and reem emailed it to myself.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then you can upload it like you did the other one and I would be able to see it if you're doing it now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so just upload documents, uh, little green.
[AGENT][NEUTRAL] Uh-huh. A all documents.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And um is this the emergency room physician's charge that you're claiming a benefit for?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. So, um, I can give you the form name to request from that doctor's office.
[AGENT][POSITIVE] That'll make it a little easier for you.
[CUSTOMER][NEUTRAL] But I need to get from them?
[AGENT][NEUTRAL] Yeah, we'll need the itemized bill which captures the diagnosis code which is what we're requesting.
[CUSTOMER][NEUTRAL] OK, let me um see if I have that.
[CUSTOMER][NEUTRAL] Well, last time I did something to claim this way was not that difficult. I didn't have to do any of this stuff.
[AGENT][NEUTRAL] Was it an accident claim that you sent in?
[CUSTOMER][NEUTRAL] But that
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I see it. Let's see.
[CUSTOMER][NEUTRAL] But this was, that was like a long time ago.
[AGENT][NEUTRAL] In [PII].
[AGENT][NEUTRAL] Something like that, that long ago?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] See.
[CUSTOMER][NEUTRAL] OK, I just, uh, submitted it to you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'll give it a minute and go in there and try to look at it.
[CUSTOMER][NEUTRAL] Alright Bill real quick see.
[CUSTOMER][NEUTRAL] They're not if it's itemized or whatever I think.
[CUSTOMER][NEUTRAL] I to copy it, um.
[AGENT][NEUTRAL] Oh, I see it. Let me pull it up.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you sign it initially on [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so I see that.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] I can give you the form name to request.
[AGENT][NEUTRAL] Uh, from your physician's office?
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] Um, let me see if they sent it to me.
[AGENT][NEUTRAL] Yeah this one is the one that you would usually have to request.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So they don't just automatically send you.
[AGENT][NEUTRAL] Not this particular form because it has PHI on it and they don't usually send it in the mail.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let me write it down.
[AGENT][NEUTRAL] OK, just let me know when you're ready.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Um, let me see, alright.
[CUSTOMER][POSITIVE] Alright, I'm ready.
[AGENT][NEUTRAL] OK, it's an acronym. It's C as in Charlie, M Mary, S Sam.
[AGENT][NEUTRAL] 1500, so that's CMS 1500 form that's the itemized bill for your physician.
[CUSTOMER][NEUTRAL] OK, are you a police officer?
[AGENT][NEUTRAL] Am I a police officer?
[CUSTOMER][NEUTRAL] Yeah, that's it.
[AGENT][NEUTRAL] Oh no, why did you have that?
[CUSTOMER][NEUTRAL] That's the, that's our um alphabet we use is the same one usually a lot of people don't use it so.
[AGENT][NEUTRAL] Oh, really? OK. No, I'm not.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, [PII], that's what that's our alphabet.
[AGENT][NEUTRAL] Right, 1500.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you can upload that as well.
[CUSTOMER][POSITIVE] OK, and then it should be good.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I will work on that and then I'll try to get it sent over.
[AGENT][NEUTRAL] OK. And did you have any other?
[CUSTOMER][NEUTRAL] And, and what's that, what is that, what is that called? the.
[AGENT][NEUTRAL] The form that the itemized bill.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's just called an itemized bill.
[AGENT][NEUTRAL] Yeah and that and that's the form name that's on it that's for the physician. The hospital's form name is different, but this is for the ER physician's office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right thank you very much.
[AGENT][POSITIVE] Oh, you're welcome, [PII]. Did you have any other questions I can help out with today?
[CUSTOMER][NEUTRAL] Uh, no, that's it.
[AGENT][POSITIVE] Alright well thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] Alright, you too.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye.