AccountId: 011433970860
ContactId: 1b2ec093-5fda-4045-952e-1ec15953c871
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 736130 ms
Total Talk Time (AGENT): 309139 ms
Total Talk Time (CUSTOMER): 348699 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/1b2ec093-5fda-4045-952e-1ec15953c871_20250620T12:42_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, [PII]. My name is [PII], and I used to have a policy with y'all. I work for a school district.
[CUSTOMER][NEGATIVE] And unfortunately they changed the company that we do business with um the thing is is I had a claim.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] That um I never filed for and I thought about it actually when I was doing um one for my husband. And so I went ahead and I contacted y'all um last week or maybe it was even earlier this week, um, and they said to go ahead and submit the information. So I submitted all the information that I possibly could, um, because of my, I had, um.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I fell down some stairs and I tore my knee and so they reconstructed it, and with that being said, that was in [PII].
[CUSTOMER][NEUTRAL] A couple of things have happened since then. My doctor's office said that they've basically destructed those records last year.
[CUSTOMER][POSITIVE] And so I was able to go into my Blue Cross Blue Shield portal and you know, pull up all the things that were done to me.
[CUSTOMER][NEUTRAL] Um, but I don't have like any kind of itemized bills, obviously, um, nor do I have hospital bills because the hospital changed, um, and is no longer the hospital that it is anymore.
[CUSTOMER][NEUTRAL] And so they don't have any records from the old hospital about, you know, the procedures and, and so forth that was done there. All I have is the name of the hospital and stuff, again, on the Blue Cross Blue Shield information.
[CUSTOMER][NEUTRAL] So is that something that can still be worked with or not?
[AGENT][NEUTRAL] OK, Ms. [PII], so you've, you've come across something that you needed that you never filed with us, but now you're unable to get all of the required documentation. Is that correct? It's necessary?
[CUSTOMER][NEUTRAL] Yes, I was, I, I was able to get, of course, like the doctor, um, his location, his name, his office phone number. Um, but when I contacted them in regards to being specific with my records, um, from [PII], they don't have those of the surgery and stuff.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, because, of course, in a sense, I was kind of discharged from him after, you know, you know, reconstruction and, um, you know, my visits to him to make sure everything was good and then physical therapy and, you know, since [PII], it's been done and good. So I haven't had to go back to him. So literally, last year, [PII], she said that was when they destructed those records because something with HIPAA.
[CUSTOMER][NEGATIVE] You're only supposed to have them or or something like that for like 7 years. And so they had to destruct them is what she told me.
[CUSTOMER][NEUTRAL] And so, um.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Like I said, that's where I stand with the doctor.
[AGENT][NEUTRAL] OK, so let's first off, Miss. [PII], let me pull up your information, verify some things with you for security, and then I can, we can go from there. What's a good call back number for you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And do you still have your policy number?
[CUSTOMER][NEUTRAL] And what I did
[AGENT][NEUTRAL] Yeah, I need to pull up your information for a sec.
[CUSTOMER][NEUTRAL] Um, I thought when I called, when, yeah, when I called y'all earlier in the week they gave, um, anyway, I'm just gonna give you this because I did upload everything, um, the lady that I spoke to, um, I was able to make like a new portal because she said that, you know, since then y'all changed and I was actually able to generate a portal and she was surprised, but anyway, um, so I uploaded all the information and did the claim.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah. Mhm. I am too.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it says C0182896.
[AGENT][NEUTRAL] OK, so that's, OK, what is your full social if this policy was in your name so that I can look that up?
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, Miss [PII], I believe I've located your policy, and any information that I do provide today would be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and also your home mailing address.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] is the zip code.
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you, one of them is the same as the one that you gave me, and then we also have another phone number on file for you. I don't know what is another number we could have.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it's, it's my home.
[AGENT][NEUTRAL] OK, and what, uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and then your email.
[CUSTOMER][NEUTRAL] But the cell phone's usually easier.
[AGENT][NEUTRAL] OK, sure. And your
[CUSTOMER][NEUTRAL] Uh, a [PII].
[AGENT][POSITIVE] OK, thank you so much for verifying everything. So give me just a moment, Miss [PII] to look at a few things.
[AGENT][NEUTRAL] OK, so Ms. [PII], this policy with APL was, you know, active from [PII]. Now, on accident claims, there is specific documentation that is required. When you spoke to the representative last, did they
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, either email you or explain to you where to obtain that claim form because and the reason I'm asking is you have to submit the claim form but at page one of that claim form also has all of the instructions for the required documentation.
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEUTRAL] Now,
[CUSTOMER][NEUTRAL] She didn't say that but I mean I was able to find y'all's claim form online, you know.
[AGENT][NEUTRAL] Oh, the accident claim form? OK. OK, good.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] So yes ma'am, those documents.
[CUSTOMER][NEUTRAL] And I uploaded that information.
[AGENT][NEUTRAL] OK, you uploaded what you had.
[CUSTOMER][NEUTRAL] So I was just gonna see if you could look at that stuff.
[AGENT][NEUTRAL] Well, yeah, I can see that we received an upload, Ms. [PII], and it is in line for review. You uploaded that on the [PII], it looks like, um, so it is in line for review. It has not yet been reviewed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, but could you look at that do?
[AGENT][NEUTRAL] So they will
[CUSTOMER][NEUTRAL] And tell me what you think.
[AGENT][NEUTRAL] No, ma'am. I can't do that because that's, I'm in a different division than um who actually reviews that. So they, they can't look that up until
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Your claim is pulled for processing.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] But I will, you know, I can just let you know that what it states on that claim form is required. I will make a note regarding, you know, our conversation.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But again, there are certain things that are required for a review.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I mean, I was pretty much able to get what I could get um because like I said I've got two situations that are.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Unfortunate that the hospital closed, and then the doctor's office, like I said, um, I would figure maybe insurance companies might be able to, you know, tell me for sure because that's what the little girl said, is that, you know, because of HIPAA after 7 years or something like that, something about for our privacy of our information that it has to be destroyed.
[AGENT][NEUTRAL] Or
[CUSTOMER][NEUTRAL] So I was like, hmm.
[AGENT][NEUTRAL] Um,
[AGENT][NEGATIVE] Again, I, I don't know about completely destroying records where they're not online anymore as well as just paper copies.
[CUSTOMER][NEUTRAL] Mhm. Mm.
[AGENT][NEUTRAL] Uh, you're the first person who's, I have spoken to that has told me about this particular type of circumstance that you're in. And again, unfortunately, Ms. [PII], all I can explain to you is that for a review.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] That documentation and I mean it has this, you know, was, you said in [PII], correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] That your surgery that you had this incident. Um,
[AGENT][NEUTRAL] So we will be happy to review any documentation that you can support and then since you were able to set up a profile which I am surprised about as well, um, since the policy is no longer active, but uh you should, you will receive an explanation of benefits or you're, you know, you're welcome to call and follow up on the review. It typically on this type of review I could give us at least 10 business days.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Now the only thing.
[AGENT][NEUTRAL] To review the information that you submitted.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now the only thing that I could possibly generate that would be considered a bill is just contacting Blue Cross Blue Shield and telling them to.
[CUSTOMER][NEUTRAL] You know, they would find the bills that were submitted to them from the different locations.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] You know, and that's probably the only other kind of, I guess say back up that I would probably be able to.
[CUSTOMER][NEUTRAL] Generate
[AGENT][NEUTRAL] Yes, ma'am, and I don't know if they, I don't know, you know, obviously what Blue Cross's policies are about.
[AGENT][NEUTRAL] Releasing that type of information. I don't, I don't know. That would just be a question for them.
[CUSTOMER][NEUTRAL] Yeah, yeah, because I did try and pull it from the portal from my portal, but it only goes to [PII].
[CUSTOMER][NEGATIVE] No, [PII] and so I'm still lacking, you know, I can't even get it off their portal without, like I said, I would probably have to call and that's if they haven't destroyed that either.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am. So I, I'm sorry that I don't have better news for you on that, um, and I'm sorry that this is, you know, you're in this situation with this, you know, claim from a
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Prior data service like this, um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Again, all I can just reiterate is that we do have to have, there is certain documentation that is required for a review.
[AGENT][NEUTRAL] To process a claim, but we will review any information that you do submit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[AGENT][NEUTRAL] So is there anything else, Miss [PII] that I could help you with at the moment?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] Oh well, you're very welcome. So it was my pleasure in speaking to you today and thank you again for calling APL. I hope you have a very nice weekend.
[CUSTOMER][POSITIVE] Uh huh thank you bye bye.
[AGENT][NEUTRAL] Yes, ma'am. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah