AccountId: 011433970860
ContactId: 585311db-b9b0-47ad-af00-f0e9aa4ad973
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1025739 ms
Total Talk Time (AGENT): 223772 ms
Total Talk Time (CUSTOMER): 462417 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/585311db-b9b0-47ad-af00-f0e9aa4ad973_20250318T14:20_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APO. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] fighting
[CUSTOMER][NEUTRAL] Good morning. So, my name is [PII]. I'm calling on behalf of my husband, [PII]. I'm gonna let you speak with him first so that he can give you permission to speak with me. He's right here, ma'am.
[AGENT][POSITIVE] OK, thank you, Miss [PII].
[AGENT][POSITIVE] Good morning.
[CUSTOMER][NEUTRAL] Hello, good morning, [PII]. This is [PII]. My age is [PII].
[CUSTOMER][NEUTRAL] And my address is [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Uh, can I get the policy number first, Mr. Ho?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh hold on let me get my glasses on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, it is 252.
[CUSTOMER][NEUTRAL] 1406.
[AGENT][NEUTRAL] OK, thank you. All right, so you said the date of birth. OK. And let me have that address one more time.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and the email address on file?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you. And you are giving me permission to release information to your wife, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Alright, I'm gonna pass the phone over to her.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Hi, so [PII] speaking.
[AGENT][NEUTRAL] Uh, it's fine. Mhm.
[CUSTOMER][NEUTRAL] So we've been kind of going back and forth on this uh claim trying to find out the appropriate status of what it is and um all I know is that in processing however when I spoke to.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I believe it was [PII] yesterday she said that they had mailed a form for further medical records to Texas Health, and I asked could they email it? They did email it. [PII], the lady at the claims location in Texas Health where [PII] had his appointment with Doctor [PII] in surgery.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That they're asking for medical records that go back from [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] we didn't see Doctor [PII] until [PII]. That was our first appointment, and they were asking, was [PII] referred by another doctor? And the answer to that information was no.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] [PII] was seeing Doctor [PII] here locally in [PII], but our neighbor had had surgery with Doctor [PII] in [PII]. He had hip done and knees, and he told us like, you know, she was such a great doctor, it was a great facility.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And he said, you know, [PII], before you make a decision who you want to have your surgery with, maybe you should go see Doctor [PII] in [PII]. So that's how we came to know Doctor [PII] in [PII], and we did go see him in [PII], made the decision to have the surgery in [PII].
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So he had one appointment with the doctor, one appointment for his surgery, and then a follow up virtual appointment and we have another one scheduled for April. But in the meantime, [PII] is gonna from [PII] Health is going to fill out the paperwork and send it back to APL, but it's only gonna have Doctor [PII]'s information for [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] This
[CUSTOMER][NEUTRAL] So I'm wondering what do we have to do next.
[AGENT][NEUTRAL] OK. Let me see if um they are also requesting the list of providers. Bear with me just a second, let me check and see exactly what they're needing, OK? Um, do you mind holding for me?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, that's fine thank you.
[AGENT][POSITIVE] Thank you. OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, [PII]. How are you? This is [PII].
[CUSTOMER][POSITIVE] Good morning [PII] how are you?
[AGENT][NEUTRAL] I'm good, thank you. Um, I have a member on the line that um there was a help request on and she received a call back yesterday, but now she's calling back because she has more questions about it, um, and the policy number is 2521406.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Do you happen to know what her specific questions are for today? Like what's going on? OK.
[AGENT][NEUTRAL] Mhm. Yes. OK, so the policy is for Mr. [PII], but he did authorize her, um, he was in the line earlier. Um, the, the question she has is because she said that she called the doctors um to see if they're gonna send in the medical records.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] They stated that they did, uh, they are gonna send the medical records through, I believe, fax or email or something like that. Um, and she said that they only have records from this year, [PII], that there's another doctor that we, um, we should have requested a medical records, the one prior to that one, but we did not. So she's wondering if we're gonna request the medical records from this other doctor.
[CUSTOMER][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Let me get over here.
[AGENT][NEUTRAL] Mhm. And I pulled them, yeah, I pulled the, the letters and everything, but I don't see another doctor that we have requested medical records for, so.
[CUSTOMER][NEUTRAL] To all of their
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][POSITIVE] Oh goodness, OK.
[CUSTOMER][NEUTRAL] Requested from [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Did she provide you with the name or any information for the other physician that she's saying we should request from?
[AGENT][NEUTRAL] Um, no, she kinda like mentioned it but I didn't really write it down. Um, but she said that there is, uh, she explained the whole thing, that there's this doctor, the first one that saw the, the, the member, and he's the one that said that he needed surgery, and then he had a conversation with.
[AGENT][NEUTRAL] The neighbor, the neighbor mentioned this other doctor, doctor, the one that we sent the request, and he went and saw that doctor in the beginning of this year. So that's how they, you know, they have this doctor listed, but the first doctor is, is the one that um said that he needed that surgery.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So on the letter it it asks for medical records for you know a specific date span and then it says you know if there aren't any records to for that particular date span to let us know and if they were referred to you to provide us with the referring physician's name and telephone number and or address so that we can request from them.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So you know if he didn't see this [PII] until early [PII] and we've requested records and they come back and say hey we didn't see him during this time they were referred to us.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Excuse me, ideally that he says, you know, or their nurse or whoever responds says they were referred to us, this is who they were referred by this is their phone number, their address, whatever information they can provide.
[CUSTOMER][NEUTRAL] And then we move forward with requesting from them, so.
[AGENT][NEUTRAL] Uh, mhm. Well, I think that's where she's trying to go because she said that they were not referred. They were, um, they just went on their own without having a referral.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Oh, they didn't go because of referral OK.
[AGENT][NEUTRAL] Mm mm. No. Mhm. Yeah.
[CUSTOMER][NEUTRAL] OK, OK, I mean I'll talk to her see if she has any information and I'll send it over to um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let's see, it looks like it was [PII] that did this one, so I'll send it. I can send it to [PII] and be like, hey, you know, I spoke with this insured's spouse. They weren't referred to this doctor, but apparently, you know, and just kind of give her the rundown and let her know that she might need a request from them for that particular date span.
[AGENT][NEUTRAL] No [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Then [PII].
[AGENT][NEUTRAL] Yeah, that's what I'm thinking. I'm thinking that usually, you know, we ask for that little list of all the doctors they have seen before, but this one doesn't have it. I went through the paperwork and see if we send it, but I don't see it anyway, so that's why I'm thinking that that's what the disconnection is, but it's OK. Uh let me go ahead and put her through and you can explain that to her and I'll go ahead and make my note. Her name is Miss [PII] with the same last name. Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What was her name?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you so.
[AGENT][POSITIVE] OK. You're welcome. Here she comes. Have a good day.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Ms. [PII]. I got Miss [PII] on the line. She's in the claims department and she's gonna assist you from here, OK?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Good morning Ms. [PII]. How are you?
[CUSTOMER][NEUTRAL] Fine thank you [PII] how are you? I'm doing well, um, OK, so [PII] was saying that the physician, the doctor [PII] that we requested from that um your husband did not see him during the time frame that we're requesting records for that you were actually seeing a a different position prior, is that correct?
[CUSTOMER][POSITIVE] That's right, we saw someone locally in Midland that made the decision and after speaking with a neighbor who had a hip replacement that we wanted to go see Doctor [PII] in [PII], and, uh, so we weren't referred. It was just a what great success that he had with Doctor [PII] and that that and that's how we found Doctor [PII] but locally.
[CUSTOMER][NEUTRAL] We had seen Doctor [PII]. I don't know if it went all the way back to [PII].
[CUSTOMER][NEUTRAL] It may have. I'm not positive, but I know we saw him quite a bit in [PII] in uh [PII] because he was getting some injections for his hip, which didn't help a lick. um and so it was just, he went to see him for we had uh an MRI done and an X-ray and all that information has been forwarded to Doctor [PII].
[CUSTOMER][NEUTRAL] Um, but Doctor [PII] really was just, yeah, you know, you got avascular narcosis, you're probably gonna have to have surgery. In the meantime, we can give you some injections and make a decision when you can't take the pain any longer. Oh my.
[CUSTOMER][POSITIVE] So he was more of a sit back and wait top physician it sounds like um well that's yeah you know you're gonna eventually have to have surgery but just make decision when you want to have it and uh we just found the neighbor saying that Doctor [PII] was fabulous so that's where we decided to go in the end. Hey, word of mouth, especially for something like that, that's that's your best, that's your best clue right there.