AccountId: 011433970860
ContactId: 26745dbc-9037-4d8d-9dc0-95b4f4d9045b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 712950 ms
Total Talk Time (AGENT): 266851 ms
Total Talk Time (CUSTOMER): 196439 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/26745dbc-9037-4d8d-9dc0-95b4f4d9045b_20250516T15:00_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, I need to check on my, I filed a claim and I need to figure out what I need to send in, what I need to do to finish it.
[AGENT][POSITIVE] OK, um, I can definitely let you know what's needed.
[CUSTOMER][POSITIVE] OK, that would be good.
[AGENT][NEUTRAL] And may I have your
[AGENT][NEUTRAL] All right. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] And my number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] Um, I don't have my policy. My claim number is 2361481.
[AGENT][NEUTRAL] You said that's the claim number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, and so you said [PII], what's your first and last name?
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] Is my last name?
[AGENT][NEUTRAL] Are you calling on behalf of the member?
[CUSTOMER][NEUTRAL] I, I, I am, I.
[CUSTOMER][NEGATIVE] OK, well, I don't understand what you're asking me.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Let me, um,
[CUSTOMER][NEUTRAL] The claim, the claim that the claim that I have open is under [PII].
[AGENT][NEUTRAL] OK, so maybe you gave me the policy number for the claim number. Hold on one second.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, here we go. Yeah, the, the 2361481 was your policy number. So when I was putting it in as a claim number, it pulled up a different patient.
[CUSTOMER][NEUTRAL] 00, sorry, sorry, I read that wrong, but.
[AGENT][NEUTRAL] It's OK. No, you're fine. Hold on one moment, let me just get to you.
[AGENT][NEUTRAL] Alright, and I have you here, Ms. [PII]. I just need you to verify your date of birth and the mailing address on file.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And um I think you have [PII].
[AGENT][NEUTRAL] Thank you and all the information provided is a verification of benefits, not a guarantee of payment, and hold on one moment, let me go to your claims.
[AGENT][NEUTRAL] OK, so it's this one here.
[AGENT][NEUTRAL] Alright, so we only have the one claim here for you. Let me take a look and see what's being asked. Hold on one moment, I'm still here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we received the claim, it just wasn't received with the claim form. Um, do you have a copy of the accident claim form?
[CUSTOMER][NEUTRAL] So, hold on, I'm walking back in here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, the claim form.
[CUSTOMER][NEUTRAL] I had filled the claim form out and had faxed it to y'all way back in the very beginning.
[AGENT][NEUTRAL] When you say beginning, what do you mean because we only have one claim here for you.
[CUSTOMER][NEUTRAL] Yeah, I mean, what was like, well, when the the beginning of the plane?
[AGENT][NEUTRAL] So you're saying that you sent it in with this claim?
[CUSTOMER][POSITIVE] Yes ma'am I did yes ma'am I did.
[AGENT][NEUTRAL] OK, so let me look at your documents so I can let them know. Hold on one moment.
[AGENT][NEUTRAL] OK, I'm just waiting for the documents to populate that were received.
[CUSTOMER][NEUTRAL] This is [PII] is when I faxed it.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold while I go through the documents?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Alright, thank you. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes I am.
[AGENT][NEUTRAL] All right, thank you so much for holding. So, we haven't received it um after [PII], we haven't received anything until an email April of this year, but there's no timely filing. So if you still have the um claim form where I can send, well, I can send you a copy, whichever you prefer, you can send that in and we can continue processing.
[CUSTOMER][NEUTRAL] OK, so you just wanna send me a new one. So, so what do I need to do to do this, just fill out that form?
[AGENT][NEUTRAL] Right, um, just fill out the claim form and then you can um save it and upload it to the online service center or how do you send the claims?
[CUSTOMER][NEUTRAL] I faxed it last time.
[AGENT][NEUTRAL] OK, you can fax it this time too.
[CUSTOMER][NEUTRAL] OK, um, hold on just a second. I'm putting on my shoes. Let me go back in here because I have written down a fax number. Let me see if this fax number is the number I needed to send it to.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, that is our fax number, um, but yeah, we have not received it, but that is the correct fax. Did you put attention APL claims department?
[CUSTOMER][NEUTRAL] Um, APO claims.
[CUSTOMER][NEUTRAL] Department, heck, I don't know it was so long ago.
[CUSTOMER][NEUTRAL] Um, and I've got, so I also have like my breakdown of my physical therapy. They just emailed me that. Do I need to send that to?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, let me see if this policy has coverage for physical therapy. But yes, um, and anytime you send the claim in, just make sure you have the claim form filled out, signed and dated, um, cause it'll, I don't want you to have to get denied. Um, let me see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I'll fill that out. I'll send the physical therapy.
[CUSTOMER][NEUTRAL] Um, I'm fixing to pick up one from my doctor today and then.
[CUSTOMER][NEUTRAL] I will, um.
[CUSTOMER][NEUTRAL] Get the other doctor and I'll send it in.
[AGENT][NEUTRAL] And physical therapy.
[AGENT][NEUTRAL] Let me see if there's a.
[CUSTOMER][NEUTRAL] I thought they said there was.
[AGENT][NEUTRAL] I'm not showing like a, uh, no, there is, it's $50. I'm looking to see like is it a max of visits or?
[AGENT][NEUTRAL] Or it's just $50 per visit. Um, let me see.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, um, so the policy will pay um the $50 each day or each visit, um, that a person, the covered person receives physical therapy from a physical therapy, um, or physical therapist, um, in an office or clinic is the result of a covered accident, which is why they're asking for the claim form so they can see the details.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So, yes, um, you can go ahead and send those in as well. I'll, um, did you want me to email you a copy?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do I
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, and then what were you asking?
[CUSTOMER][NEUTRAL] Do I need to have doctors, anything else from the doctor too, or?
[AGENT][NEUTRAL] I believe on the, let me pull up the form. Hold on one moment.
[AGENT][NEUTRAL] Because I believe on the form, there may be a doctor's section, but let me just double check for you.
[AGENT][NEUTRAL] So, the first page of the claim form is a list of instructions. So depending on what happened if it was an accident or a sickness, um, it'll tell you what's what documents are needed. Um, so you'll have to do a portion and then, yes, your doctor does have to fill out the last page.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEGATIVE] All right, well, I have her do that again because we had this filled out way back when and I sent it and shame on me. I don't, I didn't, I don't, when I faxed it, I don't know what I did with it, so I don't even have the one she gave me. I called her and they don't even have it on file.
[CUSTOMER][NEUTRAL] Well, this is just my look. so is my luck, OK.
[AGENT][NEUTRAL] Well
[AGENT][NEUTRAL] We'll save the, um, I'm gonna send it to you and then it's the same form also on our website, there's a list of claims and forms. If, if just in case if you ever need them, you can access it there as well.
[CUSTOMER][NEUTRAL] OK, so you're gonna email it to me?
[AGENT][NEUTRAL] Yes, um, I email.
[CUSTOMER][NEUTRAL] And you got, you have what email do you have on there?
[AGENT][NEUTRAL] Um [PII].
[CUSTOMER][NEUTRAL] Can you, can you send, can you send them to me? That's my husband.
[AGENT][NEUTRAL] Um, I can only send it to the email on file. Is he available to
[CUSTOMER][NEUTRAL] OK, that's fine.
[AGENT][NEUTRAL] You sure?
[CUSTOMER][NEUTRAL] I'll just have to, yeah, he can just forward them to me. He's just not here, so I'm trying to get it done so I can get it in there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, that's fine.
[AGENT][NEUTRAL] All right. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, ma'am. That's it. Thank you.
[AGENT][POSITIVE] You're welcome. Well, thanks for calling APL. I hope you have a great weekend.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye-bye.