AccountId: 011433970860
ContactId: 1589b7e4-d623-4a8b-b296-b9198096f677
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1000640 ms
Total Talk Time (AGENT): 237013 ms
Total Talk Time (CUSTOMER): 678744 ms
Interruptions: 13
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/1589b7e4-d623-4a8b-b296-b9198096f677_20250623T12:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Good morning [PII], how's your day going?
[AGENT][POSITIVE] Good. How are you?
[CUSTOMER][POSITIVE] Well, so far good. Hopefully when I get done talking to you I'll be better.
[CUSTOMER][NEUTRAL] I have a ques question on my uh husband's claims.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you need the policy number?
[AGENT][NEUTRAL] Yeah, let's start with that. Go ahead.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, 2452637.
[AGENT][NEUTRAL] All right, let's pull this up here.
[AGENT][NEUTRAL] And if I could get name on the policy and date of birth, please, for verification.
[CUSTOMER][NEUTRAL] Yes, [PII] date of birth [PII].
[AGENT][NEUTRAL] Thank you. And then what would be the address that we should have on file?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Let me pull up this most recent claim.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So it looks like requesting the claim form when it was submitted, did you guys do a claim form?
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] I believe it wasn't.
[CUSTOMER][NEUTRAL] A signed and dated.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Page 2 and page 4.
[CUSTOMER][NEUTRAL] And I have that
[CUSTOMER][NEUTRAL] I did send it but like I said, we forgot those two things.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And also the attending physician statement.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I sent that also.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] Page 5 of 5, that whole packet.
[CUSTOMER][NEUTRAL] Went through except that.
[CUSTOMER][NEUTRAL] 2 and 4 without the signature and date.
[CUSTOMER][NEUTRAL] On [PII], so I'm resending that out today.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Those page 2 and page 4.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the next one.
[CUSTOMER][NEUTRAL] It's confusing. We see the your claim is acknowledged blah blah blah blah blah blah blah blah blah.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, uh, supporting documentation may include but not limited to office notes.
[CUSTOMER][NEUTRAL] Hospital admission and discharge summaries and or diagnostic testing results. I filled out those forms let me get another pile here.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It's like
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEGATIVE] I got too many bundles. I'm sorry. No, I'm not.
[AGENT][NEUTRAL] That's OK. No, it's totally fine, yeah.
[CUSTOMER][NEUTRAL] Uh, on [PII] I.
[CUSTOMER][NEUTRAL] Uh, had filled out the authorization to release patient information from Promedica medical records. Did you get that? I sent a copy.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Of all that signed.
[AGENT][NEUTRAL] Let me see here.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes,
[AGENT][NEUTRAL] I see that. OK.
[CUSTOMER][NEUTRAL] And did you get it on the [PII]? I'm putting dates down so I know.
[AGENT][NEUTRAL] Well I just see the request um.
[CUSTOMER][NEUTRAL] This is.
[CUSTOMER][NEUTRAL] That you received that paper yeah when.
[AGENT][NEUTRAL] Yeah, I just see it signed by, you know, um, just a request to like release the information. I see that, yeah.
[CUSTOMER][NEUTRAL] I can get it
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Do you have a date that you received it?
[AGENT][NEUTRAL] Well, the document date shows [PII], but you're saying it was sent on the [PII]?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, there, there may be another one in there this one in particular.
[CUSTOMER][NEUTRAL] Uh, you sent, I got a, a paper because
[CUSTOMER][NEUTRAL] The last person I talked to was, I might say this wrong, [PII].
[AGENT][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] And she said sign page 2 and 4, which I did.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then ER she kept saying the office and he went to the emergency room, then he went home, then went back via EMS and was admitted and so she said I need the ER discharge summary, the admitting.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Physician notes and the discharge summary so from that I went to the hospital and requested authorization to release patient information.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And filled all that out for Promedica to send.
[CUSTOMER][NEUTRAL] ER visit discharge summary. ER return via EMS admit through.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] ER discharge blah blah hospital blah blah blah blah blah that's the page that I faxed on [PII] did two pages did you receive that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, OK. I don't see.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Anything received on [PII] on our side now. Mm mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I'll resend that also.
[CUSTOMER][NEUTRAL] Let me put a note on here.
[AGENT][NEUTRAL] So I think that, yeah, and I think that that's what they're talking about the, you know, the when you were saying the receipt of your claim is acknowledged, um, so I think it's just asking for that, um, admin discharge summary as far as proof of the accident, so that's, that's what that is.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, now the accident itself is a slip and fall, not a vehicle accident, didn't fall off a ladder, but I, I just wanted to send that copy to prove that we sent it to the medical records department at Promedica on that date, so I will resend that also.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, yeah, sounds good.
[CUSTOMER][NEUTRAL] And then, and then I've also sent on [PII] the UBO4 forms, is that what it's called and you received those.
[AGENT][NEUTRAL] Mhm, mhm, mhm.
[AGENT][NEUTRAL] Mhm, I see that in the, yeah, let me see, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then also there were some follow up.
[CUSTOMER][NEUTRAL] With ortho and family doctor.
[CUSTOMER][NEUTRAL] And she said [PII] said.
[CUSTOMER][NEUTRAL] It doesn't have the.
[CUSTOMER][NEUTRAL] Uh huh, codes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That makes sense so I have, OK, um.
[AGENT][NEUTRAL] The CPT code, yeah.
[CUSTOMER][NEUTRAL] I have my.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] EOB thank you too many letters for a clumsy old woman that doesn't understand this business anyhow for the total.
[AGENT][NEUTRAL] EOB mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] ER
[CUSTOMER][NEUTRAL] Everything that happened in the hospital. Now, on this.
[CUSTOMER][NEUTRAL] E
[CUSTOMER][NEUTRAL] EOB.
[AGENT][NEUTRAL] On the EAOB, uh-huh.
[CUSTOMER][NEUTRAL] OK, I'm gonna just give you an example.
[CUSTOMER][NEUTRAL] And you tell me I have um the doctor or facility um.
[CUSTOMER][NEUTRAL] And the doctor's name, date of service, services, and then the amounts under services it has emergency department visit problem of high severity and then it has 99284. Would that be the code number?
[AGENT][POSITIVE] That's right. That's a procedure code, correct. That's what.
[CUSTOMER][POSITIVE] OK, good.
[AGENT][NEUTRAL] Yeah, that's what they, the procedure they did, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I have.
[CUSTOMER][NEUTRAL] Uh, 16 pages.
[CUSTOMER][NEUTRAL] Um, both sides, so I guess you'd call that 32 pages.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I'm gonna send that out today.
[CUSTOMER][NEUTRAL] So you have the
[CUSTOMER][NEUTRAL] Office visits, the follow up office visits with ortho family doctor are on there also.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so my final question.
[CUSTOMER][NEUTRAL] Is is there anything else because I keep filling out.
[CUSTOMER][NEUTRAL] And paying for all these papers.
[CUSTOMER][NEGATIVE] And then I get another note and I need something different and like nobody ever told me about.
[CUSTOMER][NEUTRAL] The physician's notes from the ER and I'm like how the heck do I get those, you know I, I didn't know so that's that's why I filled out that release of information with APL's fax number and all that and the policy number on it. I sent that to medical records like I said whatever date I said I sent that on.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Ah.
[CUSTOMER][NEUTRAL] But I'll send a copy of that.
[AGENT][NEUTRAL] Yeah I mean I don't see.
[CUSTOMER][NEUTRAL] What I had for breakfast.
[AGENT][NEUTRAL] I don't see anything else. Even the note from [PII], you know, reading, it looks like you um have everything that she was speaking of. So, yeah, I mean, I don't see that it's asking for anything else additional.
[CUSTOMER][NEUTRAL] I don't see anything else even.
[CUSTOMER][NEUTRAL] And then you know
[CUSTOMER][NEUTRAL] Yeah I mean.
[CUSTOMER][NEGATIVE] Can you put that on, write that down? Because I'm getting a little um frustrated.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, I know.
[CUSTOMER][NEUTRAL] This happened on [PII]. It's like
[CUSTOMER][NEUTRAL] If you just give me a complete list of what I need on in March.
[CUSTOMER][NEGATIVE] I would have had all this done.
[AGENT][NEUTRAL] Um, are you gonna send it to us via fax? Are you gonna fax all that stuff to us?
[CUSTOMER][NEUTRAL] Excuse me.
[CUSTOMER][POSITIVE] Yes, I'm gonna go to the library, yes, everything I told you.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] And some of them I'm gonna resend because.
[CUSTOMER][NEUTRAL] You said you didn't get it and I did fax it, but I'm gonna send that like the.
[AGENT][NEUTRAL] Right. OK.
[CUSTOMER][NEUTRAL] The physicians, uh, what, let me get back there.
[CUSTOMER][NEUTRAL] I don't wanna misquote myself.
[CUSTOMER][NEGATIVE] I think that's the wrong packet.
[AGENT][NEUTRAL] Oh, it's the physician's statement, I believe that would, that would needed to be signed.
[CUSTOMER][NEUTRAL] Uh let me see here.
[CUSTOMER][NEUTRAL] Yes, the page 5 of that accident claim for, yeah, because I had sent that like I said, and it's signed, but I'm gonna resend it just because, um, like I said when I was.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Yeah, and then
[AGENT][NEUTRAL] Maybe then after you get it sent, if you wanna just give us a call and we'll just make sure that um give it like 24 hours and then we can just take a look at everything and make sure we've received it all and um.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Maybe just double check on it, make sure we got it all after you send it, OK?
[CUSTOMER][NEUTRAL] Yeah, OK, so what I'm gonna send to you today is.
[CUSTOMER][NEUTRAL] The 16 double sided pages so I'm assuming that would be called 32 pages, right? I don't know if, OK, so there's 32 pages there and then the 2 pages from the release the consent to release information to you from um um Promedica so that's and then 3 and a face sheet so what do we have here 521, 22.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] And that's not right. 32, 34, 3738 or so pages is what I'm gonna be faxing.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so once those get sent then I would just give us 24 hours and then just give us a call, make sure that we show it uploaded on our side, OK?
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK, yeah, that's why I said, you know, it's like I'm trying to do my best and I come from a generation of insurance companies used to talk to hospitals or whatever. I'm sure they didn't fax back then. I don't even remember that word.
[CUSTOMER][NEGATIVE] Email and fax that didn't exist. It's like now all of a sudden the patient or family has to do all that work and I'm like, why am I doing all this? I think I could get a job. It's like.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] OK, so I have the code numbers if I send my EOB from [PII], which is what we filed because.
[CUSTOMER][NEGATIVE] It's just a confused mess we were told at first he had.
[CUSTOMER][NEUTRAL] Disability and after I went and paid for papers.
[CUSTOMER][NEGATIVE] A whole pack of papers to be sent for disability. They received it. She even told him how much he was gonna be making.
[CUSTOMER][NEUTRAL] Then they said, oh he doesn't have disability, he has.
[CUSTOMER][NEUTRAL] Group accident, is that what it's called where you're at?
[AGENT][NEUTRAL] Mhm, mhm, mhm.
[CUSTOMER][POSITIVE] OK, well then I get another pack of papers and I'm like you're driving me crazy here so anyhow, I appreciate you being patient with me so I'll go ahead and send that to ton of papers today and tomorrow or Wednesday I'll call back and be put on hold for another half hour.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Wait for someone to make sure.
[CUSTOMER][POSITIVE] That you got everything this time.
[AGENT][POSITIVE] All right. Well, I apologize for any frustration and yeah.
[CUSTOMER][NEUTRAL] That's no it's OK. I know it's not your fault and, and like, like I said I just want to let you know I'm getting a little frustrated not at you, not at you, but just with you know all the paperwork, so but anyhow uh that's why I keep calling and checking is there anything else before I fax all this again.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] I get it, for sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, right.
[CUSTOMER][NEGATIVE] And you know, and like I said, it's, it's hard enough because I don't understand what.
[CUSTOMER][NEUTRAL] What it is they're asking for and then I go and get that. I say OK this is the wording they give me here look at it that's what I need and the people tell me to do this and then I have to pay for having processed papers and blah blah blah blah blah blah and pay the fax and it's like.
[CUSTOMER][NEGATIVE] Getting a little frustrating, so.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] [PII], it's been wonderful talking to you. I'm apologize if I sounded snippy. I'm not blaming you at all.
[AGENT][POSITIVE] No, that's totally fine. I get it. I get it. So I will definitely document our conversation uh today, so we appreciate you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, well, [PII], thank you very much and you have a wonderful day.
[AGENT][POSITIVE] You as well. Take care.
[CUSTOMER][NEUTRAL] Uh huh bye bye.
[AGENT][NEUTRAL] Bye bye.