AccountId: 011433970860
ContactId: 333a266b-5817-4a7f-93e9-d30fd33b79a7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 922609 ms
Total Talk Time (AGENT): 221644 ms
Total Talk Time (CUSTOMER): 461421 ms
Interruptions: 5
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/333a266b-5817-4a7f-93e9-d30fd33b79a7_20250326T15:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEGATIVE] Hey there, um, let's see, on I believe it was the [PII] I emailed a new authorization to disclose to you guys and I haven't heard anything back, and it's been over a week. I sent a follow up email and I didn't get a response and.
[AGENT][NEUTRAL] Mhm, are you the policy holder?
[CUSTOMER][NEUTRAL] No, I am the one that's going to be submitting his claims.
[AGENT][NEUTRAL] OK, and who was the authorization completed by?
[CUSTOMER][NEUTRAL] Well, I filled it out and the owner of the policy signed it.
[AGENT][NEUTRAL] OK, do you have the policy number?
[CUSTOMER][NEUTRAL] Let's see, you know what, let me log in and get it.
[AGENT][NEUTRAL] And if I can get your your full name.
[CUSTOMER][NEUTRAL] Yes, my name is [PII].
[AGENT][NEUTRAL] [PII], OK, and what relationship are you to the policy holder?
[CUSTOMER][NEUTRAL] I am his administrator.
[AGENT][NEUTRAL] And what's a good phone number for you, [PII]?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII] no.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][POSITIVE] Yeah and I can give you that number when you're ready.
[AGENT][POSITIVE] I'm ready. Mhm.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said that you faxed the authorization on did you say the [PII]? And then a follow up on what date?
[CUSTOMER][NEUTRAL] The [PII]. Hold on, let me, let me go back.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I followed up on Monday and I sent it over it looks like on the [PII]. Let me, let me get in here just.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, OK, let's see.
[CUSTOMER][NEUTRAL] I emailed it. I emailed it to [PII] on the [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] And then they followed up with an email saying they got it.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] On the [PII], yeah.
[AGENT][NEUTRAL] I'm checking for you one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And what is the policy holder's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And do you have a date of birth for him?
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] Hold on one second, I just took over this role, so I've got papers I have to look at.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and was he present when you completed the form?
[CUSTOMER][NEUTRAL] Oh, he signed the form, yes.
[AGENT][NEUTRAL] I mean, but when you filled it out, was he present?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And on the document I could see that you can call regarding claims and I can't I we did receive it and what other information?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry, say that again.
[AGENT][NEUTRAL] On the authorization that that was completed, it, it, you know, it tells us what information we can disclose. The only thing I can understand is uh claims and can you read what the other information is?
[CUSTOMER][NEUTRAL] It says filing claims.
[AGENT][NEUTRAL] In reviewing the uh-huh.
[CUSTOMER][NEUTRAL] Calls to check status questions concerning policy coverage, and then all.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The print it was real small, but we did receive it on the on the on the [PII].
[CUSTOMER][NEUTRAL] I want
[AGENT][POSITIVE] And how can I help you today?
[CUSTOMER][NEUTRAL] Has it been approved? Well, he, he wants me to there were some claims that were rejected and I've got to go back and and figure out the reasons why and actually I had gone online to see, you know.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The claims and become familiar with them, but there were 22 claim numbers that the files were not uploaded so I can't dispute or or do anything with it unless I know what was uploaded and I wanted to know like what I need to do to get that information so I can.
[CUSTOMER][NEGATIVE] Dispute what was um not paid.
[AGENT][NEUTRAL] So any information submitted to us we can't send it back.
[CUSTOMER][NEUTRAL] I can give you
[AGENT][NEGATIVE] We can't send it back.
[CUSTOMER][NEUTRAL] Um, well, I don't need it. I don't need it sent back. I just need to be able to see what was sent in. I've got the claim number, so there's, there's 3 different claims out, 2 don't have files connected to it online where I can go back and.
[CUSTOMER][NEUTRAL] Say well you know it's correct the claim if it was filed incorrectly or whatever for the reasons of why y'all disputed it.
[AGENT][NEUTRAL] OK, so, so, OK, so you're wanting to dispute claims, but you don't know which ones? Do you have a data service or anything? OK, what's the data service?
[CUSTOMER][NEUTRAL] Or deny the claim.
[CUSTOMER][NEUTRAL] I do know which one.
[CUSTOMER][POSITIVE] Yes I do.
[CUSTOMER][NEUTRAL] Um, let me, let me pull a file real quick, but I'll give you the two dates of service, and if you need the claim numbers I can give you those as well.
[AGENT][NEUTRAL] Yeah, if you have the claim numbers that would be great.
[CUSTOMER][NEUTRAL] Um, the fir
[CUSTOMER][NEUTRAL] OK, the first one is 355-044-1.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And do you want me to give you the second one or do you want to wait?
[AGENT][NEUTRAL] Mhm, go ahead and give me the 2nd 1.
[CUSTOMER][NEUTRAL] OK, it's 355-737-3 and while you're pulling those up I'm gonna pull my file. Can you hold on one second? OK, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, whenever you're ready I've got my files.
[AGENT][NEUTRAL] I'm ready, [PII]. Um, before we get started, what can you verify Mr. uh [PII]'s mailing address for me?
[CUSTOMER][NEUTRAL] Yes, it should be the [PII].
[AGENT][NEUTRAL] I'm showing a physical.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And so we're looking at claim number 355-0441. What was your concerns regarding this one?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Um, well, let's see, so.
[CUSTOMER][NEUTRAL] There were services that it's it well there's claim it it wasn't paid in in full and for me to go back and fix that I don't know I mean I'm picking this up from someone else that's no longer here and there's no paperwork attached to it, nor is there any online files connected to this claim so I can filter through it and fix it.
[CUSTOMER][NEUTRAL] So I was wanting to know what.
[CUSTOMER][NEUTRAL] Documentation you have for this claim.
[CUSTOMER][NEGATIVE] But because there's no files attached to it online.
[AGENT][NEUTRAL] There is, there was an explanation of benefits mailed and on the second page, OK.
[CUSTOMER][NEUTRAL] I've got that I've I've got that but I'm saying I don't have our receipts, so.
[CUSTOMER][NEUTRAL] were mailed cause
[AGENT][NEUTRAL] We do not process from receipts. We need the itemized bills from each um medical provider.
[CUSTOMER][NEUTRAL] Well those would be receipts maybe using the wrong, the right lingo but the paperwork.
[AGENT][NEUTRAL] OK, you mean itemized bills? Mhm.
[CUSTOMER][NEUTRAL] Yes, so, but what I'm saying is there is one there's 3 claims on here and one has the files connected so I can, I can, I can handle that one. This one and the other one I'm asking about I don't see any files uploaded on the site for these two claims, so how can I access those so I can dispute what was denied.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so when you say files, what do you mean?
[CUSTOMER][NEUTRAL] Um, are you familiar with the website that we see, the part that we see the customer?
[AGENT][NEUTRAL] I am on the portal. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, yes, on the portal, so there's 3 claims to this cancer policy that I'm looking at, um, one of them on [PII], which I'm not asking about, has files that were uploaded that go with that claim and so the other two that I'm asking you about were had no files that were uploaded I guess to the portal I'm not sure how it was done originally.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] But I'm not able to.
[CUSTOMER][NEUTRAL] Argue this um.
[CUSTOMER][NEUTRAL] This, uh, explanation of benefits because I don't have any paperwork associated with it when I took over.
[CUSTOMER][NEUTRAL] Um, and I don't see it on the portal where I can, I can look, but they had to be turned in because y'all had this EOB with remarks of why it wasn't paid. So how can I access what you were given.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] To when this claim was filed.
[AGENT][NEUTRAL] So when you go to the portal once it's uploaded it of course it comes to us you're not gonna have access to the original documents all you can see is the.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] The explanation of benefits. Now, did I understand you to say that?
[CUSTOMER][NEUTRAL] There there is one I I there is one claim that can I give you the claim number because there are files that are attached to it on your portal that I can.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm, what claim number is it?
[CUSTOMER][NEUTRAL] It is 356-922-8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so if the claims were uploaded via the online service center.
[AGENT][NEUTRAL] Um, then you, you'll have access as that one was, but the other claims must have been mailed.
[CUSTOMER][NEUTRAL] OK, so that's what happened.
[CUSTOMER][NEUTRAL] OK, OK all right OK well that makes more sense to me now um it's just you know I've come in, uh, kind of not being trained and having to dig and and and scratch to get all the information I can so these were mailed and the other one was uploaded and that's why I can see it so I just need to dig around here more I guess to find where those.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah. Mhm.
[CUSTOMER][POSITIVE] OK, OK then, well thank you.
[AGENT][NEUTRAL] But but I mean
[AGENT][NEUTRAL] So you technically can use the explanation of benefits because it's specifically or it should tell you why the claim wasn't payable or it could be that we're requesting additional information.
[CUSTOMER][NEUTRAL] But, but.
[CUSTOMER][NEUTRAL] It does and it just it gives the dates of service and then it will say non covered service but I don't know what was given to y'all so I can go back and figure out if indeed we have a right for this because there's no it's not very um descriptive on the EOB so anyway but I'll I'll.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so, so on.
[CUSTOMER][POSITIVE] I'll dig around here some more and then if I still have questions I will I will call back and I appreciate your patience with me and your time and and guiding me through this process.
[AGENT][NEUTRAL] Well, I mean I think I can, I mean like the 355-041-1.
[AGENT][NEUTRAL] Um, I'm showing two codes on the claim.
[AGENT][NEUTRAL] That we're requesting additional information.
[CUSTOMER][NEUTRAL] Which ones is that? Is it the, OK, I'm looking at the EOB is it the um it's not in the remarks is it at the.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Let's see, let me look at number 4.
[AGENT][NEUTRAL] So on the ELD you should see a remark code. Uh, one of them is DE133.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And then on the next page it should give you the description of that letting you know what it is that we need.
[AGENT][NEUTRAL] So on this one, we need the other insurance explanation of benefits.
[CUSTOMER][NEUTRAL] Yeah, I'm seeing, I'm seeing that.
[CUSTOMER][NEUTRAL] OK, I've just gotta find where all this.
[CUSTOMER][POSITIVE] This paperwork paperwork is so OK well I've got it and thank you I appreciate your help so very much and I hope you have a lovely day.
[AGENT][POSITIVE] Oh, you're welcome. Anything.
[AGENT][NEUTRAL] You too, [PII]. Anything else?
[CUSTOMER][POSITIVE] No nothing else, not yet, but I'm sure I'll call back. Thank you all right bye bye.
[AGENT][POSITIVE] Oh, all right. OK. You're welcome. Thanks for calling APL. Have a good day.