AccountId: 011433970860
ContactId: 4b80b7fe-453b-45df-badf-044a405eda6c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 967719 ms
Total Talk Time (AGENT): 232759 ms
Total Talk Time (CUSTOMER): 401058 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/4b80b7fe-453b-45df-badf-044a405eda6c_20250212T21:45_UTC.wav
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[AGENT][NEUTRAL] This is [PII] with American Public Lives.
[CUSTOMER][POSITIVE] Hi [PII], I'm so sorry. Somebody called and I switched over and I thought I hung up with you, but apparently it didn't hung up. So I'm terribly sorry if you've been waiting for me for like 5 minutes.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Oh, no, I haven't been Way long.
[CUSTOMER][NEUTRAL] I'm so sorry I'm so sorry, yes, I do need help. I am, my name is [PII] and I work with Southeast Insurance Group.
[AGENT][NEUTRAL] Did you need help or?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I am trying to help a client with a claim from last year and so I've been communicating with uh uh [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Do you know if she's in the office this afternoon?
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] And if she's not available I probably could ask you this question and you would know the answer but I figured since [PII]'s been helping me um she, you know, might be a little bit more and uh up to date on the details.
[AGENT][NEUTRAL] Right, got it.
[AGENT][NEUTRAL] Right, um, give me one moment.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] Do you have the policy number?
[CUSTOMER][NEUTRAL] Mhm yeah.
[AGENT][NEUTRAL] Let me have that.
[CUSTOMER][NEUTRAL] Let me find it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Actually I'm just gonna go to, I could find it somewhere, but I think I'm just gonna go to the APL portal.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I'm getting another call. I don't know about you, but I'm like, does anybody else have anything else to do today except call the insurance people.
[AGENT][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Says the person who's calling an insurance person, so sorry about that.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] On the pot calling the kettle black here.
[CUSTOMER][NEUTRAL] OK, let's see. She's pulling up ever so slowly.
[CUSTOMER][NEUTRAL] OK, policy number, it's an accident policy. 234.
[CUSTOMER][NEUTRAL] 3037
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I messaged [PII]. I think she's on a call we'll see and then I'll go ahead and pull up the claim policy.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And who is it?
[CUSTOMER][NEUTRAL] Well, basically, what my question is, um,
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] This member received a PHI form.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And so she had filled it out but I think she put her husband's information in there instead of hers so um the claim was for uh um this woman's daughter so [PII] is the lady's name, the employee's name, and she's a policy holder so should [PII] be filling out the paperwork and signing the paperwork instead of the child's father? I think it's a blended family situation and.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Should the policyholder, whoever is filling out, whoever holds the policy that has the dependent coverage, should they be the one signing the paperwork?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. That's what I kind of thought.
[AGENT][NEUTRAL] Yes. Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright well then I will get her to refill that out and her sign it now in the paperwork it also asks for I guess kind of like reasons or like releasing authorization for certain entities to.
[CUSTOMER][NEUTRAL] You know, inquire about this person, you know, anybody over the age of [PII], so do we need to put details in those blanks or not necessarily?
[AGENT][NEUTRAL] What's the name of the form that you have?
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] It is author authorization to disclose protected health information.
[AGENT][NEUTRAL] OK, let me see give me one moment.
[AGENT][NEUTRAL] Right, so definitely [PII] needs to complete this form.
[AGENT][NEUTRAL] And which section are you? Are you in section B?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am, or all of them, yes, but section B, section C, and from what I could tell, so.
[CUSTOMER][NEUTRAL] This poor woman has been trying to get this claim paid for a year and so [PII] said she it led me to believe that she was gonna reach out to the hospital on [PII]'s behalf to see if she could acquire the lab results from her daughter's emergency room visit. So is that what this form is for? We're releasing or that's not what this form is for.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah, I think the form that we use to if we need to request records from a facility is a part of the the claim form that was completed.
[AGENT][NEUTRAL] The AP APL claim form and this is an accident policy. Let me go there.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] And I'm gonna tell you what page that's on.
[AGENT][NEUTRAL] The one that you have is giving let's say for instance um husband calls um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And he's wanting us to disclose certain types of information on the dependent children, the one that you have, [PII] has to give us permission to speak with whomever she would state his name, his relationship, and then also there's a box for her to tell us what information can we disclose, claim status, benefits, you know, she'll have to be specific there.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that's the form that you currently have.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Under the accident claim form there's an authorization to request information including protected health information. This is if we were if we needed to call up a provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Request information.
[CUSTOMER][NEUTRAL] Do you know what page that's on? I wanna make sure that that's filled out in the claim on the claim form.
[AGENT][NEUTRAL] It's, it's 45 and it does require her signature and date. It's page 4 or 5.
[CUSTOMER][NEUTRAL] OK. I wonder if she signed that.
[AGENT][NEUTRAL] On what she sent, let's see.
[AGENT][NEUTRAL] It's supposed to be submitted with each claim.
[AGENT][NEUTRAL] Gonna pull up one of our claims.
[AGENT][NEUTRAL] What was what's the data service for the lab?
[CUSTOMER][NEUTRAL] 13124.
[AGENT][NEUTRAL] Yeah, so for some of the previous claims that have been submitted, I do see the authorization form, but I believe it would need to be current. You said 13124?
[CUSTOMER][NEUTRAL] That's the date of the accident.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Uh-huh, OK, so let's look at that claims around that date and see. I'm sure the claim form was completed for this.
[CUSTOMER][POSITIVE] Yes, bless her heart, she's done it like 6 times. I say 6. She's done it multiple times. We submitted all this stuff and so the hang up is the lab from the emergency room.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I won't get all the details, but I think she sent in the claim for claim forms and everything that's been required and so she's just becoming increasingly frustrated and I'm just trying to help, you know, push this along and get it, get it in the right hands.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, let's see.
[AGENT][NEUTRAL] [PII] is on a call. She said that she can call you back if need be.
[AGENT][NEUTRAL] I'm looking for a claim form.
[AGENT][NEUTRAL] It would need to be current, um, [PII].
[CUSTOMER][NEUTRAL] Can you or [PII]?
[CUSTOMER][NEGATIVE] Email me what form needs to be signed and and current because this this lady is like she said I am not calling the hospital and getting it she said either they'll pay it or they won't pay it and I'm dropping this and so I'm trying to get her not to call so if y'all can if we can give y'all the authorization to call the hospital, get the lab results.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] That would be great because she said I she said I ain't doing it. I already gave them everything they need so but I'm trying, she's had this policy for like 2 years and I'm trying to get her her money out of it but we just keep getting we just keep hitting these obstacles. So can you or [PII] send me the claim form we will fill it out, give APL authorization to, you know, inquire with the hospital on her behalf to get what y'all need.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then I will have her also sign this PHI form. I think she was confused because it's a blended family, but I think [PII]'s her daughter like um her blood daughter. I don't know. I'll get her to fill that out if one of y'all can send me the claim form for us to fill out, but I think y'all have everything else we're just, you know.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Uh, what email, what email address do we need to send this to?
[CUSTOMER][NEUTRAL] Waiting on those few things.
[CUSTOMER][NEUTRAL] If you can send it to me, my first name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, what's a good phone number for you, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, give me 1 2nd.
[AGENT][NEUTRAL] [PII], what's the name of the insurance agency?
[AGENT][NEUTRAL] Southeast Insurance Group.
[CUSTOMER][NEUTRAL] Yes, Southeast Insurance Group, yes ma'am.
[AGENT][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] All right, I just sent that to you.
[AGENT][NEUTRAL] And it is page 4 of 5.
[CUSTOMER][NEUTRAL] page 4.
[CUSTOMER][NEUTRAL] Is she going we'll need to just fill out the whole thing just fill out the whole thing all over again.
[AGENT][NEUTRAL] No, no, no, no, just page 4, page 4 is basically something to read, it's a legality, some some information in there telling who has the authorization. It requires her policy number, her to print her name, her date of birth, and then her signature and then sign it at the bottom and so that's what we need.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Very good.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Policy number, date of birth. I'll see it on the form, no doubt, um.
[AGENT][NEUTRAL] You will, you will.
[AGENT][NEUTRAL] So just page 4 of 5.
[CUSTOMER][POSITIVE] [PII], got it. Very good. That'll be, that'll be good.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I'm, I'm gonna call [PII] and say, OK, look, here's what we need to do. And then hopefully, y'all won't have to fool with us anymore.
[AGENT][NEUTRAL] Right, and so you can read paragraph 1 and 2, and it'll specifically state that, you know, this gives us um or the hospital permission to um disclose releasing information to APL.
[CUSTOMER][NEUTRAL] We'll all be done.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, very good.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Excellent. OK. Well, [PII], I'm so sorry that our phone call started out with you being on hold. How embarrassing. But um, I appreciate all the information. I'm I can't believe that happened I'm so blushing. I'm so embarrassed.
[AGENT][POSITIVE] No worries.
[AGENT][NEUTRAL] It wasn't long.
[AGENT][NEUTRAL] You're welcome. The email is coming from [PII] instead of um, yeah, so.
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][POSITIVE] Perfect well I appreciate your help and tell [PII] I appreciate her help and as soon as I get this information back I will probably just respond to her and that way we can keep our email thread going.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] I agree with that. Thank you so much.
[CUSTOMER][POSITIVE] Very good. Thank you. You have a good evening.
[AGENT][NEUTRAL] You too, [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.