AccountId: 011433970860
ContactId: 17bf883a-dbe6-4155-9805-b8556b416e44
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2250860 ms
Total Talk Time (AGENT): 637345 ms
Total Talk Time (CUSTOMER): 831125 ms
Interruptions: 7
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/17bf883a-dbe6-4155-9805-b8556b416e44_20250430T17:44_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] Hi [PII], this is [PII]. I was calling to see if uh a fax if you guys received a fax from me today.
[AGENT][NEUTRAL] Hi.
[AGENT][NEUTRAL] OK, well, I can definitely check the faxes for you. How long ago was it sent? Well?
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] It was sent today?
[CUSTOMER][NEUTRAL] Well, it was sent on the [PII]. I talked to someone on Monday and she told me she didn't get it, but I mean the the thing said it went through just fine and my husband just sent me a uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] An email of both of them.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know, saying that it was received on the [PII] and on today, so let's see, he sent it at, uh, that's the [PII]. Let me look at the [PII].
[CUSTOMER][NEUTRAL] And I think I talked to you a time before.
[CUSTOMER][NEUTRAL] I think.
[AGENT][NEUTRAL] You may have
[CUSTOMER][NEUTRAL] Uh-huh. Let's see, he sent it this mm, I can't tell the time, but anyway, it said that it
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] The result was OK on the [PII] and uh I, I needed to send in a police report of my accident on the [PII], which led to me having to have all this, my blood pressure elevated after the accident and I had a bunch of cardiologists, cardiology tests.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Uh-huh, and I sent the police report and the emergency room, uh, thing, so I don't know if that's helpful or not, but anyway, I talked to a young lady on Monday, she said they didn't even get it on the [PII] and he just sent.
[CUSTOMER][NEGATIVE] A copy. Well, he showed me the one from the [PII] yesterday, and he did the one today, the same report. So I was just checking on my claim to see how it was going, cause after I talked to them too, he was like, well, it, it should pay 70%, he should have paid 70%. I said, well, the claim was denied, so yeah, me and that insurance can't, we can't do business anymore.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Well, I can definitely um look up the policy and see if we've received it or let you know what I see. Um, Ms. [PII], may I have a good contact number in case we're disconnected and then your policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am, [PII] and then my policy number is 0259.
[CUSTOMER][NEUTRAL] 1638
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] All right, and I have you here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] OK, date of birth is [PII].
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Address is [PII].
[CUSTOMER][NEUTRAL] Email address is [PII], so it's [PII], and it's not case sensitive.
[AGENT][NEUTRAL] OK. And thank you so much for verifying your information. All your information provided is the um a verification of benefits, not a guarantee of payment. And Ms. Will, do you mind if I place you on just a brief hold so I can go through the faxes because I don't see anything posted on your policy as coming in yet.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, yes ma'am, that's fine I can hold.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] This will probably be one.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello Ms. [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. Um, I was just going through all the faxes. What fax number are y'all faxing it to?
[CUSTOMER][NEUTRAL] OK, let me, um.
[CUSTOMER][NEUTRAL] It is coming to.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] OK, let me go back to
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] See if I can see it.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, let me put some glasses on. I think they got the other numbers here.
[AGENT][POSITIVE] OK, take your time.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] It's the same number I've been using, you know, all the time, so I don't know, maybe, maybe he could be putting in something wrong. I don't know let's see.
[CUSTOMER][NEUTRAL] But I think it's the same one. Alright, it is [PII].
[AGENT][NEUTRAL] Yeah, OK, so that's the problem. I'm not sure what fax number that is.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me see if maybe that's for, oh, let me, hold on one second now, that just put, so I still don't know what fax number that is, but I do see that you all are with Business Workers of America too, and if, and you can send the claim to them and they will process the claim. So let me pull up their um information and see if that's their fax number that we have in our system. Now, if that's the case, then, then that solves everything because we can't see anything on their side and they can't see anything on ours.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, got you. So that could be what the problem is, huh? OK.
[AGENT][NEUTRAL] So I'm just gonna pull up their little contact here and see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because like you can even email the claims into them and but we don't, we can't accept claims through email, but you have the option if you send it to them, they'll go ahead and process it and handle it. If you send it to us, we will, so.
[AGENT][NEUTRAL] It's OK, we just need to see who it really went to so we know what to do.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let me see. I'm, I'm looking on the back of like their ID card to see if I can.
[AGENT][NEUTRAL] See facts.
[AGENT][NEGATIVE] No, that number isn't even on their card, ma'am, I don't know what that number is.
[AGENT][NEUTRAL] Cause like on the back.
[CUSTOMER][NEUTRAL] I think it's from now I think.
[CUSTOMER][NEUTRAL] I didn't bring any of the let me see.
[CUSTOMER][NEUTRAL] I didn't bring, I'm out of town, so I didn't bring like the original.
[CUSTOMER][NEUTRAL] The form that that's the number from the form, the original thing that I sent in. Let me see if I can find it in my text messages right quick.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I'll have to be right quick. Let me see.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I gotta go way back. Let's see.
[CUSTOMER][NEUTRAL] Cause I solicited them when I was trying to figure out the, you know, to get the test done or whatever.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I called about the claim.
[CUSTOMER][NEUTRAL] So maybe this could just all be a misunderstanding and I really hope that it is.
[CUSTOMER][NEUTRAL] Let me see 3 when I had that test.
[CUSTOMER][NEUTRAL] 3.
[CUSTOMER][NEUTRAL] 7 I think.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'm just looking now because the form has uh.
[AGENT][NEUTRAL] Oh, take your time. I'm just looking at this card.
[AGENT][NEUTRAL] 2
[AGENT][NEUTRAL] To see if I can find something that matches.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But [PII] is who sent me the.
[CUSTOMER][NEUTRAL] This form about
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] You know that everything was turned down.
[AGENT][NEUTRAL] Like the denial?
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Uh-huh, explanation of benefits and then it did say visit the website, but.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Where I first originally sent it to, that's the same number that he is.
[CUSTOMER][NEUTRAL] Uh, faxing for me. Let's see if I can find it.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Gosh it
[CUSTOMER][NEUTRAL] Sent me all the way back, oh man.
[CUSTOMER][NEUTRAL] OK, 49.
[CUSTOMER][NEGATIVE] I probably should have brought my folder with me.
[CUSTOMER][NEUTRAL] And are you still there? OK.
[AGENT][NEUTRAL] Oh, yes, I'm here.
[AGENT][NEUTRAL] I'm just looking on my side trying to.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, look on the claim, look on the um.
[AGENT][NEUTRAL] I'm trying to see where.
[AGENT][NEUTRAL] I wonder if they have their own claim forms and that number was, that's not, I mean, that phone number is nothing APL. I, I have no idea what that because we only have one claims fax number, no matter what the product is, you know, it all goes to the claims department. I, I mean, I can definitely give you the the correct fax number, but I, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If you like, or were you just trying to.
[CUSTOMER][NEUTRAL] Well that's what I'm saying. That's the same. I'm gonna get, I'll get that one too, but that's the, the first, that's why I sent the original claim forms in.
[CUSTOMER][NEUTRAL] I'm just trying to find, I had a couple of phone calls to come in and of course it took me all the way back to the beginning of my text messages so I was trying to find.
[CUSTOMER][NEUTRAL] Where I sent the message about the claims after, you know, the doctor's office was telling me, you know, they couldn't do it. I was like, OK.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Yeah, I think it has something to do with Business Workers of America. The reason I say that is because I just pulled up the um just the documents that were received from the claim you sent in.
[AGENT][NEUTRAL] And like the group ID number, that member number, all of that is is Business Workers of America. We don't.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Like you have a group number with us.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] But like that 68.
[CUSTOMER][NEUTRAL] So who, well then, do you know?
[CUSTOMER][NEUTRAL] Do you know who would actually, who's gonna make the decision on if I get any of my money back or not? Do you know?
[AGENT][NEUTRAL] Well, that's what I'm saying. You, you have two options. If you send your documents to Business Workers of America, they will process. If you send them to us, we will process. So either way, it's going to be processed. It's just if you send it to Business Workers of America and you call APL, we're not gonna have any record of it.
[CUSTOMER][POSITIVE] Right, so see, APL sent me this, uh, the original, it's funny. I'm looking for some more email and phone calls. Keep them normally nobody ever calls me, but I've had 4 calls already and it keeps taking me all right when I get to where I think I wanna be, it takes me right back to the beginning of my email. Gosh, yes, it's, it's flipping his phone.
[AGENT][NEUTRAL] To the beginning.
[CUSTOMER][NEUTRAL] Let me see, uh.
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's north side.
[CUSTOMER][NEUTRAL] Cause I guess I, I guess what I'm thinking is, you know, I originally sent the the email to.
[CUSTOMER][NEUTRAL] Guess it was, is it business workers of, I don't know. Oh, here it is, claims.
[CUSTOMER][NEUTRAL] OK, so she said I attached a claim form for you to fill out. This is [PII]. She's the claims supervisor.
[AGENT][NEUTRAL] Yeah, that's Business Workers of America.
[CUSTOMER][NEUTRAL] So, let me see that.
[CUSTOMER][NEUTRAL] Uh-huh and so it says BWA slash APL claim form and then the fax number is [PII], so your member ID number is required on the claim form, so that's why I have sent everything to is that particular fax number. So are you saying your fax number is [PII]?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am, that's the only fax number we have. So you sent your documents to Business Workers of America. So I can give you their phone number. I can give you the phone number and get a representative on the line so that we can try to get you a claim status. Sure.
[CUSTOMER][POSITIVE] I, I'd appreciate it.
[CUSTOMER][POSITIVE] OK, I would appreciate it thank you so much.
[AGENT][NEUTRAL] But yeah, that's what's happening. So if, if you just moving forward, if you choose to send it to that [PII] fax number, then you're gonna have to go to Business Workers of America to get your claim statuses, but if you send it to the [PII], that's us, that's APL and we'll be able to help you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so I'm just gonna write down APL is 8 and I know my husband, he's, that's where he's been sending it to the other one. So I guess, I guess [PII] what I'm confused about is.
[CUSTOMER][NEUTRAL] OK, so I guess originally maybe we sent it to the 9423. I, I don't know cause I don't know how I got the explanation of benefits from you and then when I talked to BWA they're like, well it's supposed to pay 70%, so it's kind of like.
[CUSTOMER][NEUTRAL] I'm going in between two people, right?
[AGENT][NEUTRAL] Yeah, so basically, so APL, all of our policies are through like jobs, like the employer. Business workers of America is kind of like a
[CUSTOMER][NEUTRAL] That's what it is. OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] They're kind of like a third party that allows people who might be like self-employed or retired. They'll allow like they, they would act as the group and get the policies and all of that. So, Business Workers of America is kind of like the middle man that allows individuals to get policies with APL because usually we could only go through the job.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you did this first claim that was sent in on [PII], you did send that to us, but after that, that's the last thing that was sent to us.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEGATIVE] So it looks like this was denied and then all the additional information instead of sending, sending it to us, it was sent to Business Workers of America.
[CUSTOMER][NEUTRAL] Oh, got you, so.
[AGENT][NEUTRAL] Who's probably confused because
[CUSTOMER][NEUTRAL] OK, and that is OK, right?
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] I mean, I, to be honest with you.
[CUSTOMER][NEGATIVE] I guess we messed up.
[AGENT][NEUTRAL] And well, it's OK because it's, it's, it's confusing. Um, I, I would.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I will pick one or the other. If you want to send your claims to us, go ahead and send them to us and just have everything in one place so you don't have to worry about all around the world. But if you want to send it to Business Workers of America, you do have that option as well, but um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now, see, now I'm wondering if Business Workers of America is like, what's this information from because they didn't deny the claim we did. So they, so to them it might just look like you're sending in these documents, but for what? Because they never they didn't receive the original claim, you see what I'm saying?
[CUSTOMER][NEUTRAL] I'm trying to figure out how in the world did we switch fax numbers.
[CUSTOMER][NEUTRAL] Uh, I don't know, it had to be from some piece of information I received. It had to be.
[AGENT][NEUTRAL] And if they, if, if she emailed, if she emailed you the claim form, their number is probably on it because that's that's BWA. So that's that might have been where you got it from.
[CUSTOMER][NEUTRAL] I don't know. I'm, I'm confused now.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That um form she emailed you to emailed to you.
[CUSTOMER][NEUTRAL] I guess because the uh-huh the fax is what [PII] that's you all though, right? That's APL?
[AGENT][NEUTRAL] Um, we're [PII].
[AGENT][NEUTRAL] That's our claims facts.
[CUSTOMER][NEUTRAL] OK, you know what? I, I think we have just gotten turned around because there's another one on here too it's [PII]. I think that's the one.
[AGENT][NEUTRAL] Now that's Business Workers of America.
[CUSTOMER][NEUTRAL] Yeah, that's for member services, uh-huh, yeah, OK, so what number do you have for them and then if you'll connect me and maybe we can, is it possible to get all these documents to one spot? I mean because I don't know, I didn't even realize we were going in between two places, so that probably would explain a lot of why don't know anything.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, to be honest, I don't know, but I can ask them when I get them on the phone. I don't know if it's just a matter of them just sending us I've never seen this before, so I don't know.
[CUSTOMER][NEUTRAL] Mm, OK, OK.
[AGENT][NEUTRAL] Um, but I can definitely ask and see what the options are or if they
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] They may just be able to process the claim on the, I don't know, but I'll ask them for you.
[CUSTOMER][NEUTRAL] OK, and then you have a number for them that I could.
[CUSTOMER][NEUTRAL] That I could call
[AGENT][NEUTRAL] Yes, ma'am. So they have 2 customer service numbers.
[CUSTOMER][NEUTRAL] In case we get some.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, so the first one is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the other number is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, and before I get a representative.
[CUSTOMER][NEUTRAL] Alright, so maybe if you could connect with them.
[CUSTOMER][NEUTRAL] OK, I'm sorry, go ahead.
[AGENT][NEUTRAL] I'm sorry. No, I was just gonna ask um if you, I think I just
[AGENT][NEUTRAL] I think I was just asking if there was anything else I could assist you with before I transfer you.
[CUSTOMER][NEUTRAL] No, cause now I think the, the, the issue has been cleared up. Now I know that.
[CUSTOMER][NEUTRAL] The original form that I filled out was sent to APL and then everything that my husband has been faxing for me here lately has been going to BWA. So that's, that's the problem, that's the mystery solved now. I don't, I don't know how we jumped fax numbers. It had to be on.
[AGENT][NEUTRAL] That claim form.
[CUSTOMER][NEUTRAL] Something that I received I don't know, I don't know.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Alright, well I have you all's fax number [PII] correct?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, alright then well let me try to talk to them and see what what can be done.
[AGENT][NEUTRAL] Alright, so I'll go ahead and give them a call on the other line. And was there anything else I can help you with today, Miss uh Ms. [PII]?
[CUSTOMER][POSITIVE] No, ma'am. No, ma'am. Thank you so much, [PII]. I really appreciate you. Thank you so much.
[AGENT][NEUTRAL] You're welcome. Well, thanks for calling APL and hold on one moment while I get a representative for you, OK?
[CUSTOMER][POSITIVE] OK alright thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Thank you for calling member services. All calls are recorded for quality assurance. Our hours of operation are Monday through Friday [PII] Central Standard Time. If you know your party's extension, please dial it now.
[CUSTOMER][NEUTRAL] For customer support, press 2. For agent support, press 3. For claim support, press 4. For provider support, press 5. You are currently caller number 18 waiting to speak with a representative. The estimated hold time is currently 6 minutes. Thank you for your patience.
[AGENT][NEUTRAL] Oh my God.
[AGENT][NEUTRAL] Oh my God
[CUSTOMER][NEUTRAL] You are currently caller number 16, waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] You are currently caller number 15, waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] You are currently caller number 14, waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] You are currently caller number 13, waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] You are currently caller number 12, waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] You are currently caller number 11, waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] You are currently caller number 10 waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] You are currently caller number 8 waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Thank you so much for holding. I'm just checking on you. I'm on hold on the other line. I'm number 11. I, I was [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, I didn't want you to think I forgot about you or anything. You're welcome.
[CUSTOMER][POSITIVE] Alright thank you I appreciate it.
[CUSTOMER][POSITIVE] OK, it's OK. It's OK. All right, thank you.
[AGENT][NEUTRAL] Alright, you're welcome hold on.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] You are currently caller number 8, waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] You are currently caller number 5, waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] This is [PII]. Can I help you?
[AGENT][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from APL. How are you?
[CUSTOMER][POSITIVE] I'm doing good how are you?
[AGENT][NEUTRAL] I'm doing well. I have, uh, we have a mutual patient that I'm trying to assist. Um, her name is M [PII]. Um, I have any information you need, but basically, it sounds like um she faxed the original claim to us and we denied it asking for additional information and it the fax number looks like it the additional information was sent to y'all. So I'm trying to see if you have anything on your side so we can
[CUSTOMER][NEUTRAL] We have, uh, we have, uh, let's talk.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, try to help her, and then I've never seen this before to where it's like split, so what would happen if y'all
[AGENT][NEUTRAL] Do you have it like, do you finish processing or can you send it to us or how how would that work? I've never
[AGENT][NEUTRAL] I've never dealt with that before.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, what's the member ID number?
[AGENT][NEUTRAL] So, let me see if I can find you. Hold on one second. Um, 683.
[CUSTOMER][NEUTRAL] That's.
[AGENT][NEUTRAL] 484.
[AGENT][NEUTRAL] 362.
[CUSTOMER][NEUTRAL] Alright, let me get her pulled up here.
[CUSTOMER][NEUTRAL] Alright, let me see about those forms.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hey this is [PII] who am I speaking to?
[AGENT][NEUTRAL] Hey [PII], this is [PII]. I'm from, I was gonna say from BWA. I'm sorry from APL. How are you doing?
[CUSTOMER][NEUTRAL] That that's OK. I'm doing alright. How are you?
[AGENT][POSITIVE] I'm doing good. Um,
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] I don't know. Did you hear what was happening?
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] I did a little bit, uh, is it like something from a wreck?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] That she that you're getting OK uh that's not from us she's sending it to our fax and y'all's fax and I don't know what it is. I've tried to get a hold of her um she sent it to us at this 0.5 times, but I can't get her on the phone to find out what's going on. I don't know if she's trying to file, um.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] So basically, um, she filed the original claim with us back in [PII] and the claim was denied asking for additional information to prove that it was an accident, but she faxed it to y'all, the additional information to y'all instead of us. So, can you fax that to us or how can we get that so we can continue processing?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, I can fax it over to y'all. Do you have a claim number assigned to it?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let me give you that claim number. You said do I, do you?
[AGENT][NEUTRAL] You said do I, do you need the claim number?
[CUSTOMER][NEUTRAL] Yeah, can I get the claim number so that I can put it on my fax?
[AGENT][NEUTRAL] Mhm. Alright, so it's, let me know when you're ready.
[CUSTOMER][POSITIVE] Yes ma'am, I'm ready thank you.
[AGENT][NEUTRAL] Alright, it's 358.
[AGENT][NEUTRAL] 1133.
[CUSTOMER][POSITIVE] Awesome all right yeah I'll go back over and I'll shoot it over to y'all right now.
[AGENT][POSITIVE] All right, thank you, [PII].
[CUSTOMER][POSITIVE] You're welcome have a good one, [PII].
[AGENT][NEUTRAL] You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] So what does this mean?
[AGENT][NEUTRAL] Alright, so basically, yes, you all were, she said they got it about 5 times, so you were sending it to BWA but they didn't know what to do with it because they never had the original claim. So she's getting ready to send us what you sent to them so we can go ahead and continue processing this claim. And I just gave her the claim number, so she's gonna put it on there, so we'll know it's for this.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, cause
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so if, if I get anything else from APL, I have the correct I'm, I'm honest, I don't know how we crossed over fax numbers. I, I don't, it had to be from a piece of mail that I received it had to be. I mean other than that I don't know.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yeah, it was on that claim form. It was on the claim form that said BWA slash APL.
[CUSTOMER][NEUTRAL] Mhm, OK.
[AGENT][NEUTRAL] That's probably what happened, but, um, moving forward, I would just
[CUSTOMER][NEUTRAL] Well, I'm just um.
[AGENT][NEUTRAL] I would just, uh, if you want to send it to us, go ahead and keep everything with us, you know, so we can process it, but they do have the option to process too, so it, it is up to you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] OK, cause I did talk to a young man. His name was [PII], and I, I have not talked to [PII], so I mean if she's been trying to get me, my number is the same, but I mean and that's no here here nor there. But uh he was just telling me that it should be paid up to at least 70%. So and he was looking at everything on his end so I I mean I don't know, but I'm glad we found out today that yeah we've been sending it to the wrong thing.
[AGENT][NEUTRAL] Yes, ma'am. So just keep that 877 number. You know if it's an 8 anything, not 877.
[CUSTOMER][POSITIVE] OK, that's good.
[CUSTOMER][NEUTRAL] OK. I wrote it down, uh, APL. I wrote it down. [PII]. So I hope to hear from you all, you know, within the, what, 7 to 10 business days maybe, I don't know.
[AGENT][NEUTRAL] Yes, ma'am. So once she faxes it over to us, we're just going to continue processing and then you'll get the new explanation of benefits either giving you the decision or, you know, letting you know if something else is missing, you know, whatever the outcome is.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, OK, alright thank you I appreciate it so much.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] No, ma'am, no ma'am. This mystery has been cleared up.
[AGENT][POSITIVE] It has been solved. All right. Well, thanks for calling APL. You're welcome. Have a great day.
[CUSTOMER][POSITIVE] Yeah, thank you so much. OK. You have a great rest of the day. Thank you.
[AGENT][POSITIVE] You're welcome. Bye bye.