AccountId: 011433970860
ContactId: 592a23d6-1aa0-4ffb-b13f-72689222076c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1047790 ms
Total Talk Time (AGENT): 457105 ms
Total Talk Time (CUSTOMER): 549560 ms
Interruptions: 15
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/592a23d6-1aa0-4ffb-b13f-72689222076c_20250205T17:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh yes, my name is [PII] and I have a question about a claim.
[AGENT][NEUTRAL] OK, Miss [PII], I can help you with the claim. Can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Mhm [PII].
[AGENT][NEUTRAL] Thank you ma'am and then is the claim for yourself or is it are you a facility with a patient?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It is um a claim for my husband.
[AGENT][NEUTRAL] OK, Ms. [PII], can you please give me the policy number?
[CUSTOMER][NEUTRAL] Uh, yes, I walked away from that. Let me go back to that.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, it is.
[CUSTOMER][NEUTRAL] 252254-4
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, Ms. [PII], is your husband there so I can get the verbal consent to discuss the claim with you over the phone?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, but the but the policyholder is me, and I've always, I've never had to have his consent.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, so it's a HIPAA violation when it comes to claims if we discuss anything about services that an individual has done.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know, because that's private information if they go to the doctor, um, and it's a HIPAA violation if we give out information about claims without the member's personal consent to be able to do so.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me try to add him on to the call.
[AGENT][POSITIVE] Yes, ma'am. Certainly, yes ma'am.
[CUSTOMER][NEGATIVE] Because we're, we're not together during y'all's working hours.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So hold on just a second.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I'm gonna try to do this.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] October.
[CUSTOMER][NEUTRAL] OK, I think I have both of you on the phone now.
[AGENT][NEUTRAL] OK, great. um, Mr. [PII], this is [PII] with APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, can you just real quick verify your date of birth for me, sir?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Thank you sir and do I have your consent to be able to discuss your claim information with your wife Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes, that's fine.
[AGENT][POSITIVE] OK, thank, thank you, sir. I appreciate your consent. Thank you so much.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][POSITIVE] Thanks thanks [PII]. Uh huh, see y'all. OK bye bye.
[AGENT][NEUTRAL] All right bye bye, sir.
[AGENT][NEUTRAL] Hi Ms. [PII].
[CUSTOMER][NEUTRAL] OK, I've never done that before um I did it.
[AGENT][POSITIVE] Yes, and it worked.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, so do you have the claim number? Oh, well, first let me verify your, um, your address, phone number and email address on the policy, please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. All right. [PII].
[CUSTOMER][NEUTRAL] And my email is [PII].
[AGENT][NEUTRAL] Thank you. And then the phone number that you gave me to call you back on if we get disconnected, is that your cell phone number, please?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes ma'am. [PII], yeah.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you Ms. [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Alright, let me pull up Mr. [PII] real quick and what is the claim number you're questioning?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, when [PII] and I were
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] When we were uploading it, we didn't scroll all the way over to the side and we added it quite a few times. So, um, do you know what I mean? It was, we had 4 files and you could only see when it was uploading that it was doing 1, so we did it again and again but all separately and then I don't know, it's all convoluted now.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 00
[AGENT][NEUTRAL] OK, yes, I do see that.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So I'm not sure which one to to reference um but I have gone in and clicked on the claim numbers of those but um we could just do I guess the 1st 1 3559367.
[AGENT][NEUTRAL] OK, I've got it pulled up.
[CUSTOMER][NEUTRAL] They should all be about the same, OK? And it says that I need to include in there the initial diagnosis.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] So I can
[CUSTOMER][NEUTRAL] Um, I guess I can do that, but it was also a claim that we turned in in [PII].
[CUSTOMER][NEUTRAL] Um, to you guys, the initial was.
[CUSTOMER][NEUTRAL] Is there any way to grab that initial diagnosis?
[CUSTOMER][NEUTRAL] Um, and pathology from the old claim that you all processed in two years ago?
[AGENT][NEUTRAL] OK. Let me look and see, um.
[CUSTOMER][NEUTRAL] I can't access it because
[CUSTOMER][NEUTRAL] It, I was clicking around it just gives me what my policy said. It doesn't tell me about any particular claims, but that's the year that it was.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] It turned in.
[AGENT][NEUTRAL] Right, I understand.
[CUSTOMER][NEUTRAL] For the diagnosis one.
[AGENT][NEUTRAL] Right, and what was the um month of the year of [PII] that you guys sent that first initial?
[AGENT][NEUTRAL] Diagnosis then.
[CUSTOMER][NEUTRAL] Well, um, I think we didn't until, we didn't send anything in until after surgery and all that kind of stuff. So I'm not sure when.
[CUSTOMER][NEUTRAL] Uh, that fall, it was probably closer to the.
[CUSTOMER][NEUTRAL] Probably August or September when we got all of the.
[CUSTOMER][NEUTRAL] Stuff back from the hospital and the ELBs when we sent that claim in.
[AGENT][NEUTRAL] OK. Um, cause you had two different
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] That was our only claim on the policy.
[AGENT][NEUTRAL] Right, OK, let me look and see.
[CUSTOMER][NEUTRAL] Oh, or do we have two different, I'm sorry.
[AGENT][NEUTRAL] You had 2 different policy numbers back then. Let me look and see.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, this one didn't have a claim on it, so it's probably gonna be the other one.
[CUSTOMER][NEUTRAL] See
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh that.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] All right. So, um, let me look.
[CUSTOMER][NEUTRAL] so that.
[AGENT][NEUTRAL] You had
[AGENT][NEUTRAL] If there's a way that you can reference your policy number that you had the first initial diagnosis paperwork on.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, I can see the policy number. Do I just click on it?
[CUSTOMER][NEUTRAL] And was it the 2231?
[AGENT][NEUTRAL] Yeah, the 7785.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Your, your policy number 778528.
[CUSTOMER][NEUTRAL] Um, these are
[CUSTOMER][NEUTRAL] I need people.
[CUSTOMER][NEUTRAL] I can't see anything like that on mine. They're all [PII] or [PII] or [PII]. That's how they begin.
[AGENT][NEUTRAL] OK, let me go
[AGENT][NEUTRAL] OK, let me look.
[CUSTOMER][NEGATIVE] But whenever I do on, on the notebook that I have that I kept written down, my policy number was 778528, but those numbers don't exist on my anymore so I don't know which one to reference.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yes ma'am, I understand. So you're gonna reference policy number 778528?
[AGENT][NEUTRAL] Because that's the one that I see that you said it was just one is the only one that would have a claim on it that's the one that I see that does have a claim on it for [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And it goes back to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] Yeah, that sounds right, yes, but what I'm saying is I
[AGENT][NEUTRAL] And the first initial claim.
[AGENT][NEUTRAL] The first initial claim number that's on that older policy is 319-5446.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Maybe if you can just refer back to the claim number 319-544-6, just make a note has the initial diagnosis.
[CUSTOMER][NEUTRAL] OK, those.
[AGENT][NEUTRAL] From pathology report.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, hold on, so my screen isn't showing me like I don't know how to get to that policy number because it doesn't exist on my screen.
[AGENT][NEUTRAL] Because the online service center wasn't there at the time that you did the claim, what I'm gonna do is I'm gonna go ahead and transfer you to the claims department. I'm gonna let them speak to you and let them, we can let them know that the first initial diagnostic report for first occurrence of cancer was on 319-544-6 claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK, let me write that number down and I know the old policy number now the claim number, say it again.
[AGENT][NEUTRAL] 319-544-6.
[CUSTOMER][NEUTRAL] 319.
[CUSTOMER][NEUTRAL] 46 OK.
[CUSTOMER][NEUTRAL] And that was in what month and year?
[AGENT][NEUTRAL] That was done in [PII] was when it was reported.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] And it was processed and paid on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, so that's what I just need to tell them is that they could reference that and pull that initial diagnosis over to this new claim? Is that what I'm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it's gonna be a brief hold while I transfer you on over.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, yes ma'am, thank you.
[AGENT][POSITIVE] Alright thank you you guys have a blessed day and thanks for calling APL.
[CUSTOMER][NEUTRAL] OK, uh-huh, right, bye bye.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. You're speaking with [PII]. How may I help you today?
[AGENT][NEUTRAL] Hello, [PII], it's [PII]. I've got, um, hi, I'm good. I've got Miss uh [PII] on the phone. [PII]. I've already spoke to her husband, [PII]. He has given consent for us to talk about his claims with his wife.
[CUSTOMER][NEUTRAL] Hey, how you doing?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The policy number, whoops let me go back to the first one is 2522544.
[CUSTOMER][NEUTRAL] Alright, and I got that one up, OK, and then they got another one or something?
[AGENT][NEUTRAL] Well, she, it's asking for the uh first occurrence diagnosis pathology report, which she's gonna tell you, she's on the other line. That's gonna be on policy number 778.
[CUSTOMER][NEUTRAL] I just this one.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 528.
[CUSTOMER][NEUTRAL] Policy 00, I'm sorry. Give me the other policy number 778528.
[AGENT][NEUTRAL] 528, yes, and then it's gonna be under claim number 3195446.
[CUSTOMER][NEUTRAL] OK. Yeah.
[CUSTOMER][NEUTRAL] 46. OK, let's see who did this. OK, so you're saying somebody asking for the path report, right? OK.
[AGENT][NEUTRAL] Yes, but it's on this old policy.
[CUSTOMER][NEUTRAL] OK, [PII] 19916 2024. I, I guess that's [PII]. OK, can you, uh, send me, well, I'm gonna see who did this so they can review it because they would have to have time to review it to talk to her. So let me see who did who did this, uh.
[CUSTOMER][NEUTRAL] Uh this is.
[AGENT][NEUTRAL] And I've got her on the other line. She just needs to know.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, [PII]. So let me get with [PII]. You give me her phone number and tell her that the adjuster that's handling this gonna give her a call back and what OK.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Awesome. OK, good deal. Alright, her phone number is [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Alright, I'm gonna call [PII] now and I'm gonna give her both of those policy numbers and that mail number that you that uh claim number you said that that passes on and to see see if that's what she needed because it could have been something else she needed. I don't know so I'm gonna let her give her a call back and that number is [PII], correct?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, OK.
[AGENT][POSITIVE] Yes, that's correct. All right.
[CUSTOMER][NEUTRAL] OK, yeah, you tell her that uh just gonna give her a call back once she can review it, OK?
[AGENT][POSITIVE] OK, I sure will. All right, thank you. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. All right. Bye-bye.
[CUSTOMER][NEUTRAL] It.
[AGENT][NEUTRAL] Hi, Ms. [PII], this is [PII] back with you again. So I just got off the phone with the claims department.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Um, and I'm so glad that I called over there because Ms. [PII] does cancer claims and she's just awesome. And she is getting in touch with the girl that uh processed your claim that said that it needed the initial pathology report.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Oh, I'm sorry.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I gave her the information of the policy number that the original was on and the claim number that the original was on.
[CUSTOMER][NEUTRAL] Do you like it?
[CUSTOMER][POSITIVE] Good.
[AGENT][NEUTRAL] She's gonna let the claims examiner look at it and they're supposed to call you right back.
[CUSTOMER][NEUTRAL] OK. All right. Yeah.
[AGENT][NEUTRAL] I gave her, I gave her your phone number.
[AGENT][NEUTRAL] And they're supposed to call you right back after they look at it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, well that'll be great. I'll I'll be sure to answer.
[AGENT][NEUTRAL] We just don't want to have to have you hold on the right. We didn't want to have to have you hold on the phone for that long because it's gonna take a little bit, so they're gonna call you right back.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yes ma'am, thank you. Every time I call you guys I get every time I call you guys, it y'all are just the best to work with, so kind and so patient and everything. I mean, I have, I've over the years I've talked to probably 5 or 6 of you and you're all the same, just amazing, so I appreciate that part.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh,
[AGENT][POSITIVE] Oh, well, you're so sweet. Thank you, Ms. [PII]. Well, that's a very big compliment because we sure try hard to do our jobs the best we can.
[CUSTOMER][NEUTRAL] Um, and then,
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] You do well and it's consistent with everybody but um one reason that I didn't send the initial diagnosis with this one is because when on the claim form when it says, it says when it's a reoccurrence.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Then it just lists the things you need to send, but it doesn't say the initial diagnosis when it's a reoccurrence.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So anyway, um, and so that's why I was confused about that, so.
[AGENT][NEUTRAL] Yes, yes, and.
[AGENT][NEUTRAL] Yes, and we, and when they call you back you can mention that to them so so that they know that that's why you didn't send it in was because the um claim information was confusing for you.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Yeah, OK, OK, well, not too bad because I know if if we mess up anything y'all are always willing to.
[CUSTOMER][NEUTRAL] Work through it so even my mistakes have had 3 claims.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Yes, ma'am. That's OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right well thank you and I'll just answer when they call.
[AGENT][NEUTRAL] All right, Ms. [PII].
[AGENT][POSITIVE] OK, well, you have a good rest of your day and we thank you so much for calling APL ma'am.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Uh-huh. Thank you. All right, bye-bye.
[AGENT][POSITIVE] All right. You're welcome. Bye bye.