AccountId: 011433970860
ContactId: 231f6e7f-242b-4ea5-9578-7ee31be5d148
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1225630 ms
Total Talk Time (AGENT): 406892 ms
Total Talk Time (CUSTOMER): 276220 ms
Interruptions: 7
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/231f6e7f-242b-4ea5-9578-7ee31be5d148_20250509T21:26_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, [PII], it's [PII] again. How are you?
[AGENT][POSITIVE] Hey, I'm good.
[AGENT][NEUTRAL] And how may I assist you? Did you find the policy?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah, I'm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, no, it's about, it's about the claims, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I think this is the right number. It's I I filed a BWA APL claims form. Is that you guys?
[AGENT][NEUTRAL] BWA. OK. So I can check and see if we received anything in our end, but yeah, the claims goes to BWA. OK. So let me have, um, since you don't have the policy number, let me have either your social or the spelling of your first and last name.
[CUSTOMER][POSITIVE] That would be great.
[CUSTOMER][NEUTRAL] So I do have the policy number. It's
[AGENT][NEUTRAL] Oh, you do? Oh yeah, OK, go ahead.
[CUSTOMER][NEUTRAL] Well, it's, it's the same number I gave you last time, but it says on the form that this is the policy number. It's 683113445.
[AGENT][NEUTRAL] Um, that's not our number.
[AGENT][NEUTRAL] That's not our policy numbers.
[CUSTOMER][NEUTRAL] That's not your number.
[AGENT][NEUTRAL] No, that's too many numbers. Uh-huh.
[CUSTOMER][NEUTRAL] Right, OK, well I can give you my social, although that's what I put on the form, so I wondered if that's what's holding up.
[AGENT][NEUTRAL] OK, give me just a second.
[AGENT][NEUTRAL] Hm. Probably, but if you send it to BWA they have ways of finding you with your personal information. So I don't think that will, you know, put a hold on the claim, um, because more than likely they will do like a name search or any other information that is on the claim they will use to find you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, so
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So what's the policy number then? Sorry, I don't, I don't know there's there's no other number.
[AGENT][NEUTRAL] OK. Let me have the spelling of your last name.
[CUSTOMER][NEUTRAL] You know what I mean?
[CUSTOMER][POSITIVE] Great, uh [PII]
[AGENT][NEUTRAL] That was [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, no, it's [PII]. So it's [PII].
[AGENT][NEUTRAL] And your first name was [PII] or [PII], just [PII]?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII], that's it.
[AGENT][NEUTRAL] OK. Mm.
[AGENT][NEUTRAL] What's your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What's your date of birth?
[CUSTOMER][NEUTRAL] The [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And one last thing, let me have the email address on file.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Let me look at it and see what um VWA send us. Let's see.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] This was sent on the [PII].
[AGENT][NEUTRAL] OK. Let me go ahead and pull all this information, OK? I'm gonna put you on a brief hold.
[CUSTOMER][POSITIVE] No worries.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[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][POSITIVE] Thank you for holding and being patient for me Mr. [PII].
[CUSTOMER][POSITIVE] No worries.
[AGENT][NEUTRAL] OK. So I pulled the information that we received um from BWA and it looks like the claims are being denied. Um, the reason for the denials is that um based on the rendering provider.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] He's not licensed, uh, he's not a doctor.
[AGENT][NEUTRAL] So, um, the, yeah, the claims are being denied. Let me go ahead and give you the correct definition.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, go on, sorry.
[AGENT][NEUTRAL] OK, so, OK, so in order for us to cover, it has to be a licensed doctor. Um, the person who's seen you, the rendering provider, is a doctor of psychology, but is not a licensed doctor.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] He's, he's a doctor, right?
[AGENT][NEUTRAL] He's a doctor, but he's not a licensed doctor like he's not an MD, like a medical doctor.
[AGENT][NEUTRAL] In order for the benefits to be paid, has to be a medical doctor.
[CUSTOMER][NEUTRAL] Sure. So,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK. Why is that, sorry? I mean, I'm receiving medical treatment, right?
[AGENT][NEUTRAL] OK. Um, yes, I know that. Yeah, it's OK. Let me go ahead and I'm gonna go ahead and try to get an examiner on the line. The examiner is the person who processed your claim, and she can give you a little bit more information on why she came to that determination and why we do not pay a doctor of psychology, why we only pay for a medical doctor, and she can give you like a better explanation because she's the one that processed the claim, OK?
[CUSTOMER][NEUTRAL] And there's, and there's
[CUSTOMER][POSITIVE] OK, sure, that'd be great.
[AGENT][NEUTRAL] OK. One moment.
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] no agent staff. Goodbye.
[AGENT][NEUTRAL] Thank you for holding, Mr. [PII]. OK, right now, she's in a call. Um, is it OK if she gives you a call back?
[CUSTOMER][NEUTRAL] Yeah, that's OK.
[AGENT][NEUTRAL] OK. It's probably not gonna be today. I'm not gonna lie to you. It's probably not gonna be today because um more than likely she's gonna be out in a couple of minutes and I'm not sure how long she's gonna be on this other call. She's in right now. Um, is it OK if she calls you on Monday?
[CUSTOMER][POSITIVE] Sure thing, yeah, yeah, no worries.
[CUSTOMER][NEUTRAL] She can, she can just call me back whenever I guess. I mean, it sounds like it's gonna be a denial nonetheless, but listen, I'm gonna actually, the reason I'm calling is because I have another claim that just came through, or sorry, another bill that came through that that should have been covered by insurance. Um, so, but and that is issued by a medical doctor. So, um, I'm gonna, I'm gonna email that one as well, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If you stay on the line ever so briefly, are you gonna be able to tell me that you've received it? Is that something?
[AGENT][NEUTRAL] No, we, we don't handle that part of it.
[CUSTOMER][NEUTRAL] You can do.
[AGENT][NEUTRAL] Now, whenever you email to that uh 4 members email that you gave me in the beginning, which is BWA, they're the ones that handles that claim and they send it to us. So it's like a chain, um, you send it to them, they check all the information and they send it to us. Then it comes to us and it goes to an examiner. The examiner will process the claim and then it will come to a determination of what's gonna happen with the claim, which that is the person who's gonna be calling you is the examiner.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Great.
[AGENT][NEUTRAL] So, um, I'm not gonna be able to see that email right away. It's gonna go to BWI so I don't know if they can see it right away or if it goes to a line. I'm not really sure how they handle that, um, but, um, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can you, can you confirm for me the email address that I'm supposed to send this to? Is it [PII]?
[AGENT][NEUTRAL] Um, let me pull BWA information.
[AGENT][NEUTRAL] OK, it's supposed to be customer support at 4 members, member, member without the uh let's see for member services uh-huh.com.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, member services. Yeah.
[CUSTOMER][POSITIVE] Cool. OK, great. That's fine. Um
[CUSTOMER][NEUTRAL] That's fine. I mean, what my concern is is that I emailed these things in February and then followed up in May, and they only received them in May and I'm like, well, that's
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I sent them in February, so am I gonna send this one and then they're not gonna get it for a while, you know what I mean?
[AGENT][POSITIVE] Oh wow.
[AGENT][NEUTRAL] Uh, the it is the BWI, but the best thing is once you send it in, I'm not sure if they work Saturdays because we don't have that information, but the best thing you can do is send it in, uh, on Monday, call BWA and see if they received that information if they have that email, OK? So they can at least verify that with you.
[CUSTOMER][NEUTRAL] But that's not your end, right? It's their end.
[CUSTOMER][NEGATIVE] No fine.
[CUSTOMER][NEUTRAL] OK, great. Can you
[CUSTOMER][NEUTRAL] Can you
[CUSTOMER][POSITIVE] Of course, no worries. Can you please give me BWA's number if you have it?
[AGENT][NEUTRAL] Yes, I do. Yes, I have 2 numbers. So let me go ahead and give you the 2 numbers and also I'm gonna go ahead and give you your policy number so when you call back to get the claim status, you have that number as well, OK?
[AGENT][NEUTRAL] Um, so let me give you the phone number first.
[CUSTOMER][POSITIVE] Great. Thank you.
[AGENT][NEUTRAL] The phone number to be WA is [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 247
[AGENT][NEUTRAL] 886 8.
[CUSTOMER][NEUTRAL] [PII] and that's for BWA.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's for BWA and then I got another number just in case they don't answer on that one. I got another one.
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][POSITIVE] Cool.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 697.
[AGENT][NEUTRAL] 70, I'm sorry, no, scratch is 70026. Let me repeat it again. It's
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] 00
[AGENT][NEUTRAL] 26.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so it's that one there was [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Perfect. OK, awesome. And then I would love my policy number as well please.
[AGENT][NEUTRAL] Yes, yes. Your policy number is 02.
[AGENT][NEUTRAL] 56
[CUSTOMER][NEUTRAL] 02.
[CUSTOMER][NEUTRAL] 56.
[AGENT][NEUTRAL] 21
[CUSTOMER][NEUTRAL] 21
[AGENT][NEUTRAL] 38.
[CUSTOMER][NEUTRAL] 38 and can I read that back to you and you can confirm it please?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So that's 02562136.
[AGENT][NEUTRAL] 38.
[CUSTOMER][NEUTRAL] 38, 0 sorry, 02562138.
[AGENT][NEUTRAL] It's, yeah, the last two digits is 38.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][POSITIVE] Yeah, OK, awesome. And BWA is the company that I'm insured with.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, you're with Business Workers of America. Yeah, that's why I wasn't able to find you in the beginning, and that's that's what I was asking to see if you had, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Amazing. OK. Awesome. OK, right, I'm gonna, I'm, no, that's OK. I just never really knew. I'm gonna use this as my policy number. Thank you, thank you, thank you so much. You've been great.
[AGENT][POSITIVE] I'm sorry for that.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank
[AGENT][NEUTRAL] And yes.
[AGENT][POSITIVE] Yeah, no problem. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] No, I'm all good, thank you. I hope you have a great weekend.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You as well, and I'll get that examiner to call you back and explain to you about that um denial and so she can give you a little bit more information about it, OK?
[CUSTOMER][POSITIVE] OK, sweet. Thanks again.
[AGENT][POSITIVE] Alright. You're welcome. Uh good afternoon. Happy weekend. Bye-bye. Thank you.
[CUSTOMER][NEUTRAL] You too. Bye bye.
[AGENT][NEUTRAL] OK