AccountId: 011433970860
ContactId: 4e98e721-3839-4766-8b19-fca0cde7efb2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 475700 ms
Total Talk Time (AGENT): 215621 ms
Total Talk Time (CUSTOMER): 203973 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/4e98e721-3839-4766-8b19-fca0cde7efb2_20250612T17:49_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] How may I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], this is [PII] in [PII]. How are you doing?
[AGENT][POSITIVE] I'm doing good. How are you doing?
[CUSTOMER][POSITIVE] Doing great, doing great. I'm a broker just calling to check uh I wanted to touch base with you on a claim for one of our customers.
[AGENT][POSITIVE] Oh, sure. I'll be happy to help you with the claim status. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, it's, it's 504.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Your policy number is 2252931.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you're welcome. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII], and date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Um, I don't have that. Let me see. It, it, it's, he has a, a critical illness claim. It's a, he had a heart attack.
[AGENT][NEUTRAL] Oh, it's OK.
[AGENT][NEUTRAL] OK, so it'll be the most recent claim that came in?
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes, ma'am.
[AGENT][NEUTRAL] OK, hold on one second.
[CUSTOMER][NEUTRAL] So basically what we did initially was we did a direct deposit and we sent in the claim form from the doctor signing off saying he had a heart attack. And then the Home Office said they wanted the itemized bills and some medical records showing he had a heart attack as well. So we uploaded the bill and we uploaded some records showing that he had a heart attack, and when we reached out over email to the Home Office, they said they were waiting on the itemized bill and medical records, but we had already sent that in.
[AGENT][NEUTRAL] OK. So I do see um document.
[CUSTOMER][NEUTRAL] So, so I'm trying to make sure you show it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry, I do see that documents came in on [PII]. Um, I'm just waiting for them to populate so I can see the images and see what it is. Um, hold on one second. You're welcome.
[CUSTOMER][POSITIVE] Sure, thank you.
[CUSTOMER][NEUTRAL] I used to be able to see on my side.
[CUSTOMER][NEUTRAL] The, the things I uploaded as well, but for some reason I'm having fits with the new system lately. I'm trying to, and I'm pretty tech savvy. I think it's just probably growing pains a little bit, you know.
[AGENT][NEUTRAL] OK, so here's the thing.
[CUSTOMER][NEUTRAL] With the new system
[AGENT][NEUTRAL] So I'm looking at the documents. So these are itemized bills, right? But this is the patient's copy. You see how the coding is just, these codes here are just procedure codes. So basically this tells us the treatment they received and what they paid for, but we need to know why.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] To determine the medical, to be able to prove the necessity.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And we
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Correct. So basically, he had a heart attack. That's the itemized bill from him being in the hospital. And we also sent a separate attachment that shows the medical records while he, you know, why he was in there.
[AGENT][NEUTRAL] I can um reach out the claims and see if this can be used. What I'm saying is this is the patient, there's a patient bill and a hospital bill. The itemized bill that they're asking for is from the hospital. It shows the diagnosis codes, procedure codes, all the charges, um, uh.
[AGENT][NEUTRAL] But I can definitely reach out to claims and see if this will.
[CUSTOMER][NEUTRAL] Let me go look at what you're looking at. Let me go see.
[AGENT][NEUTRAL] OK, cause
[CUSTOMER][NEGATIVE] I've never had the, I've never had the bill be a problem on a critical illness claim. It's always the medical records and the diagnosis that they really fight for, um, just cause it's not a, it's not like he's not getting it. Go ahead.
[AGENT][NEUTRAL] Well, that's the, that's
[AGENT][NEUTRAL] That's what I'm saying. So what you're saying is correct, that usually if it has a diagnosis and things like that on it, the itemized bill that we're asking has the diagnosis and things on here. This does not, it just shows what he got and what he paid for, but why?
[CUSTOMER][POSITIVE] Correct, correct, and I, oh, what I was saying was only we attach this in the medical records and they, with those two together that normally gives them everything they need.
[CUSTOMER][NEUTRAL] If certain if certain companies don't have um diagnosis codes on their bills, we send medical records with the itemized bills so they can coincide and look at them together, you know what I mean?
[AGENT][NEUTRAL] Yes, sir. Mhm. Was the medical records sent separately because this year is 13 pages, but I went through all of them, but they're just the, the patient's bills.
[CUSTOMER][NEUTRAL] That makes sense?
[CUSTOMER][NEUTRAL] Yes, it was sent separately. It was uploaded.
[AGENT][NEUTRAL] Before or after the, before or after the um
[CUSTOMER][NEUTRAL] After the bill.
[AGENT][NEUTRAL] OK, so it might still be coming in because we haven't received it yet.
[AGENT][NEUTRAL] I just want to make sure.
[CUSTOMER][NEGATIVE] That makes me nervous because it was sent um.
[CUSTOMER][NEUTRAL] Probably either Friday or Monday so it would have showed up by now for sure.
[AGENT][NEUTRAL] Yes, it would have. Um, OK, let me see, let me just make sure, let me double check.
[CUSTOMER][NEUTRAL] One
[AGENT][NEUTRAL] Mm, did anything else come in on the [PII]? I just wanna make sure. Hold on one moment.
[AGENT][NEUTRAL] OK, now that's the email.
[AGENT][NEUTRAL] OK, so so far that's the only thing that came in. It is 13 pages, but it's all billing, all the patient's bill.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm gonna get my office manager to resend in what she sent in because she sent some medical records.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Do you want me to check with claims just to make sure um that when the medical records come in, we'll be able to go ahead and process everything or if they do really need the universal bill from the hospital or where he went?
[CUSTOMER][POSITIVE] Um, that's OK. I appreciate it and, uh, I'll, I'll, I'll fight that fight, um, because, um, the doctor's already signed off on it on the claim form and the medical records will back it up. So, um, but I appreciate you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] You're very welcome. Well.
[CUSTOMER][NEUTRAL] So they, it's
[CUSTOMER][NEUTRAL] Uh, I'm gonna go get them to reupload it. We, we have some medical records. We have some records that are like 12 pages, and we also have a file that's like 2500 pages, which I feel like if I give that to the examiner, they're gonna stretch it out and, you know, make it last a long time because they're gonna say the file so big. Um, do you recommend me sending the shorter version first?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] I would.
[CUSTOMER][NEGATIVE] Because I feel like when I give them too much to look at, they take forever, you know.
[AGENT][NEUTRAL] I was in the shorter version.
[AGENT][NEUTRAL] Yeah, cause we got, uh, yeah, cause we'll have they'll have to go through each page, yeah, I would send the.
[AGENT][NEUTRAL] I was in the shorter one, really is.
[AGENT][NEUTRAL] I was in the shorter one. I was just thinking while I was speaking, but yes, I was in the shorter one, and then
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because I don't want to delay it anymore. So hopefully that's everything that's in there and it if it has a diagnosis.
[CUSTOMER][NEUTRAL] I mean that's what I'm thinking as well.
[AGENT][NEUTRAL] That should be, that should be sufficient. Of course, I'm not an examiner, but to me that makes sense.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] Exactly. And I feel like I do so many claims like I've been doing this 24 years, but every now and then something gets past me, but most of the time I can look at something and say, this is gonna get paid, it's clean, you know, um, but you never know, you never know, you know.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But I will, um,
[AGENT][NEUTRAL] And everything is changing so quickly, so, yeah, I will send it.
[CUSTOMER][POSITIVE] OK, that'll work I appreciate your time.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][POSITIVE] That's it. Have a great day.
[AGENT][POSITIVE] All right, [PII], you also, and thanks for calling APR. Have a good weekend.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][POSITIVE] Thank you. You're welcome. Bye-bye.
[CUSTOMER][POSITIVE] Thanks bye bye.