AccountId: 011433970860
ContactId: 35845c03-318c-46f8-b740-14b06cce5778
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 827140 ms
Total Talk Time (AGENT): 349567 ms
Total Talk Time (CUSTOMER): 226593 ms
Interruptions: 4
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/35845c03-318c-46f8-b740-14b06cce5778_20250428T19:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], how are you? This is all.
[AGENT][POSITIVE] Oh, I'm good. How are you?
[CUSTOMER][POSITIVE] I'm waiting for 6, but I'm good.
[CUSTOMER][NEUTRAL] Um, I have, uh, a member on the line that, um, she is, well, she's not a member, uh, OK, come on, so, OK, this is a broker. I got the broker on the line. She's calling about a disability claim, but it looks like we sent a form that the member said he never received and she needs a copy to be sent out to her email, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I don't know if I can get that copy. I, I pulled the documents to see if it was image, but I, I didn't see an image. So, um, I don't know if you can send it to me so I can email it to her so I don't have to transfer her again because she was transferred for broker resources.
[AGENT][NEUTRAL] Yeah just um shoot me a message or an email on what form it is that you need and I'll get it to you.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um, OK. Um, it's gonna be the, let me do it right now because I, I wanna send that before I let her go. Um, let's see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] [PII], you're [PII].
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, sure I wanna send it to somebody else.
[AGENT][NEUTRAL] Yeah, [PII]
[CUSTOMER][NEUTRAL] Um, but it's, yeah.
[CUSTOMER][NEUTRAL] OK. Yeah, it's the the medical record request one. let me see.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the, uh, policy, and I'll go ahead and make sure that like I'm giving you the, the correct thing too.
[CUSTOMER][NEGATIVE] I hope this is not.
[CUSTOMER][NEUTRAL] Oh, Sure, yes, yes, I'm sorry. It is uh 258-2977.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] Mhm. Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] OK, it looks like we're missing the employees portion of the claim form.
[AGENT][NEUTRAL] And the employer's portion.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then we, we were also missing the physician's form, but that may have been what we received.
[CUSTOMER][NEGATIVE] Yeah, it looks like we received the um the physician and the employers. It looks like we're missing the employees. Oh yeah, I already asked her for that.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, and then.
[AGENT][NEUTRAL] Let's see, we obtain your past medical history if your claim is due to a preexisting condition, please complete the enclosed form and return to our office if you have questions.
[CUSTOMER][NEUTRAL] Mm mhm.
[AGENT][NEUTRAL] OK, so it's for preexisting, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I should have said that on my records.
[AGENT][NEUTRAL] It's OK. It, it can just be so many different things when it's cancer or whatever. So I was like, uh, let me check.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Let me just double check.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEGATIVE] Yeah, I just don't want to transfer her. I mean, yeah, she was only like, if she called me and I needed to transfer, I'll go ahead and transfer, but whenever she's transferred from another department, I'm like, oh, let me try to get this resolved. Especially if it's a broker. I don't want to be transferring her so many times.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, right. OK. So let's see which one is that.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] That's not it.
[CUSTOMER][NEUTRAL] If you don't mind, I might put you on a brief hold so I can let her know and maybe I can get that email at the same time. OK. Thank you.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Hey, hello, it's [PII].
[AGENT][NEUTRAL] Hey.
[AGENT][NEUTRAL] I'm trying to make sure. I think so. I think it's the list of attending physicians um form.
[CUSTOMER][NEUTRAL] Did you find it?
[CUSTOMER][NEUTRAL] Yeah, I believe so too. Mhm.
[AGENT][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] So I'm going to download this.
[CUSTOMER][NEUTRAL] Yeah, I wish we had a copy of that. I don't remember having a copy, and I checked Guru and I don't see it unless I look in the wrong place.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] It is on SharePoint so.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, so it's the HIPAA form and yeah I'm gonna send you a link um.
[CUSTOMER][NEUTRAL] It is.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Uh,
[AGENT][NEGATIVE] Let's see, so here's, that is not what I wanted.
[AGENT][POSITIVE] Wow, wow.
[CUSTOMER][NEUTRAL] Oh, you know what, yeah, I think it's see. Let me see.
[AGENT][NEUTRAL] OK, so there's the list of attending physicians for preexisting investigation.
[AGENT][NEUTRAL] And then, um, and then we'll just need the hip release.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] So I don't know if we've gotten that already. If we've gotten that one, then we shouldn't need that one, but if we.
[AGENT][NEUTRAL] Don't, then I'm assuming we need to get that as well.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And what I see here, and I'm just going by the notes, I see that we got the doctor claim form and the authorization claim. Those are the last two things that was received.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Doctor claims and authorization claims.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Let me pull this up.
[CUSTOMER][NEUTRAL] And for this one.
[AGENT][NEUTRAL] Because I don't want to, I don't want you to send over a HIPAA release if we already have it because then they're gonna be like why are we having to fill this out again?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we have on file.
[AGENT][NEUTRAL] OK, so this is statement of the insured.
[AGENT][NEUTRAL] And then,
[AGENT][NEUTRAL] The employer statement which I think they said wasn't like completed in full last time.
[AGENT][NEUTRAL] I think that's what we previously, I'm gonna double check that then now we'll see.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] DL 39 incomplete um in order for additional consideration be given. I please have your physician just kidding, OK, so that we have the insured and then we have the employer previously and then this one was.
[AGENT][NEUTRAL] That was most recently submitted.
[AGENT][NEUTRAL] Which I don't know why.
[AGENT][NEUTRAL] Maybe because we didn't have the physicians form we didn't request information maybe I don't know I feel like we should have requested that already, but that's just me.
[CUSTOMER][NEUTRAL] Mm not sure.
[AGENT][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] OK, so do we need something else so I can add it here to the email?
[AGENT][NEUTRAL] I am double checking now. Let's see, policyholder statement.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] HIPA authorization.
[AGENT][NEUTRAL] OK, so we have.
[AGENT][NEUTRAL] AIPA authorization on file it looks like.
[AGENT][NEUTRAL] And then we got direct deposit.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So it looks like we are needing the doctor's claim form which I sent you.
[AGENT][NEUTRAL] It looks like we need the physician's statement.
[CUSTOMER][NEUTRAL] OK. The decision's statement.
[AGENT][NEUTRAL] Yeah, because like.
[AGENT][NEUTRAL] What we have on file is the insured's portion which is basically just, you know.
[AGENT][NEUTRAL] Their information.
[AGENT][NEUTRAL] What their sources of income are and stuff like that.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] After that, we have.
[AGENT][NEUTRAL] The HIPAA authorization.
[AGENT][NEUTRAL] And their direct deposit.
[AGENT][NEUTRAL] And then we have a.
[AGENT][NEUTRAL] Please upload the supporting documents for your client physicians form detailed billing, other uh tests that the documents uploaded are true to the best of my knowledge. I don't know what that is.
[AGENT][NEUTRAL] Maybe that's from the broker to them.
[CUSTOMER][NEUTRAL] OK. So it's gonna be the yeah, probably the physician's statement and the employer's statement. Those are the ones that are missing.
[AGENT][NEUTRAL] Mm it looks like we have that um because I resubmitted it.
[CUSTOMER][NEUTRAL] But what about the employee?
[AGENT][NEUTRAL] Yeah, it looks like we have all of that we just need the physician statement and then um.
[AGENT][NEUTRAL] And then that other denial is stating that we need to check for preexisting so it's gonna be that list of physicians, which is that link that I sent you.
[CUSTOMER][NEUTRAL] OK, I'm, I'm just going by the last claim that says, uh, that, uh, OK, it says in order to consider your claim, we need the employers to complete the employer's portion.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Entirely.
[AGENT][NEUTRAL] Yeah, I don't know why that remark code was used because we have that we got that back in March.
[CUSTOMER][NEUTRAL] OK, so we do not, OK, we don't need that. OK, make sure.
[AGENT][NEUTRAL] We don't need the employer or the employee. We just need the physicians. I think they accidentally did 6 instead of 9. I'm pretty sure it should have been DL 39, which states that we are missing the physician's form. So I think that was a keystroke error, um, because it looks like we have the third party release, we have a direct deposit, we have the um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I'm gonna like that.
[CUSTOMER][NEUTRAL] Oh, got you, OK.
[AGENT][NEUTRAL] The policyholder or the employer's statement saying.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] You know, all of that information and then we have the insured statement. So it looks like we have all of that, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We just don't have the physician's portion of the disability claim form and then that.
[AGENT][NEUTRAL] Preexisting list of physicians that I sent you the link for as well, so those are the two ones that we would need.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, all right, here we go.
[CUSTOMER][POSITIVE] Um, OK, it's fine. Alright, so I sent it right. OK, thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] OK. Have a good day.
[AGENT][NEUTRAL] You too.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Huh, mhm, bye.