AccountId: 011433970860
ContactId: 5c225938-66fb-400d-9f8b-9ae00f09c18f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1123089 ms
Total Talk Time (AGENT): 637285 ms
Total Talk Time (CUSTOMER): 476707 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/5c225938-66fb-400d-9f8b-9ae00f09c18f_20250318T14:29_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 [PII].
[AGENT][NEUTRAL] Good morning, [PII]. How are you?
[CUSTOMER][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 callback yesterday, but now she's calling back because she has more questions about it. Um, and the policy number is 2521406.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Do you happen to know what her specific questions are for today? Like what's going on? OK.
[CUSTOMER][NEUTRAL] Mhm. Yes. OK. So, the policies for Mr. [PII] that he did authorize her, um, he was on 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.
[AGENT][NEUTRAL] All right.
[CUSTOMER][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.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Let me get over here.
[CUSTOMER][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.
[AGENT][NEUTRAL] To all of their
[AGENT][NEUTRAL] OK. Um.
[AGENT][POSITIVE] Oh goodness, OK.
[AGENT][NEUTRAL] Requested from [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Did she provide you with the name or any information for the other physician that she's saying we should request from?
[CUSTOMER][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
[CUSTOMER][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.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][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.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][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.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][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.
[AGENT][NEUTRAL] And then we move forward with requesting from them, so.
[CUSTOMER][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.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, they didn't go because of referral, OK.
[CUSTOMER][NEUTRAL] Mm mm. No. Mhm. Yeah.
[AGENT][NEUTRAL] OK, OK, I mean I'll talk to her see if she has any information and I'll send it over to um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][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 kinda give her the rundown and let her know that she might need a request from them for that particular date span.
[CUSTOMER][NEUTRAL] Uh messy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Then you said.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][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 what 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 notes. Her name is Miss [PII] with the same last name. Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What was her name?
[AGENT][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you, so.
[CUSTOMER][POSITIVE] OK. You're welcome. Here she comes. Have a good day.
[CUSTOMER][POSITIVE] Thank you for holding and being patient for me is [PII]. I got Miss [PII] on the line. She's in the claims department and she's gonna assist you from here, OK.
[CUSTOMER][POSITIVE] Thank you. You're welcome. Have a good day.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Good morning, Ms. [PII]. How are you?
[CUSTOMER][POSITIVE] Fine, thank you, [PII]. How are you?
[AGENT][NEUTRAL] 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 physician prior. Is that correct?
[CUSTOMER][POSITIVE] That's right. We saw someone locally in Midland, but made the decision 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 he
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That, and that's how we found Doctor [PII]. But locally, 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] 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 a, an MRI done and an X-ray, and all that information has been forwarded to Doctor [PII].
[AGENT][NEGATIVE] Gotcha.
[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.
[AGENT][NEUTRAL] Oh my.
[AGENT][NEUTRAL] So he was more of a sit back and wait top physician, it sounds like, um.
[CUSTOMER][POSITIVE] Well, that's what I said, yeah, you know, you're gonna eventually have to have surgery, but just make a 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.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] Hey, word of mouth, especially for something like that. That's, that's your best, that's your best clue right there. It is finding someone that can, can do it and do it well. So, um, OK. Do you happen to have Doctor [PII]'s like office number by chance or the
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I do think I do. I don't actually have his email now. I could probably get the email for you versus sending paperwork through the mail, which takes far too long, um, but I do have the phone number for Doctor [PII], excuse me, Doctor [PII]'s office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let me get that phone number typically we try to fax over records requests because they'll get that faster and then whether they decide to fax or mail, you know, that's usually up to them but as far as sending it back, but we do try to fax if we can we just give them a call and and kind of ask for all that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so they, I actually have two numbers now this is, I believe is Doctor [PII]'s direct line to his staff. It is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the line to uh.
[CUSTOMER][NEUTRAL] His facility itself with other doctors in it is [PII].
[CUSTOMER][NEUTRAL] But the 4704 should be directly to Doctor [PII]'s staff.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so what I'm gonna do is I'm gonna pass along this information to the examiner that made the request to Doctor [PII] and let them know that you were not referred, so it's possible that Doctor [PII] wouldn't be providing that information. He might, you know, he may say they weren't referred, but they were seeing this physician prior, but there is a chance that he wouldn't provide that information, um, so we need to reach out to Doctor [PII] and request that information on our own.
[AGENT][NEUTRAL] Um, and then what they'll do is they can move forward with reaching out, getting that information and sending the request to them as well.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK, so how long do you think this process takes, [PII], uh, because we originally had submitted our forms that we were asked to submit on [PII], and I believe the [PII] or the [PII] now, so we're kind of, uh, you know, that's our source of income, this disability stuff.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, yeah, so typically as long as they respond, OK, so I'm gonna give you the numbers that we ask for you to wait just because it's hard to say for sure, you know, we can't say, oh well it's only gonna take them 2 weeks to respond because some facilities depending on how their office works or depending on how they process it could take up to 30 days.
[AGENT][NEUTRAL] We don't usually have requests that take that long um unless there's some type of issue like we didn't send.
[AGENT][NEUTRAL] The correct information or they have just not gotten to it maybe they're really backed up those are usually for really really really large facilities like hospitals and they're trying to find like ER information or something like that because they have so many patients that they see.
[AGENT][NEUTRAL] Usually for smaller specialists we can't guarantee it won't take the 30 days but they do tend to respond a little faster so we ask that you allow 30 days we do make multiple requests um.
[AGENT][NEUTRAL] The only way to get it to us faster because we're having to send it formally is for our insured to obtain it themselves. Um, so if this is something that, you know, you're seeing that they're not responding quite quickly enough and you're able to obtain that information, you know, you could take that request and say, hey.
[AGENT][NEUTRAL] I have an insurance company that needs records from 10-123 to [PII]. Can you, you know, get that for me? The thing is, is that whatever cost may be associated now falls on you instead of us. So when we formally request, we will pay the invoice for those records if there are any for that physician.
[AGENT][NEUTRAL] Um, if, if our insureds try to get them faster, which again they do provide them to patients a little faster.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] The any fees associated with obtaining those will now fall on them because they're the ones that requested it so that's the biggest difference is it is a little faster but any cost will fall to you instead of us um hopefully it doesn't take them that long especially with you providing this information so early on in the process maybe we can get it out to both of them they'll respond relatively quickly and we can move on we just we don't know.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I do, I do know that [PII] at Texas Health said she fill it out and send her information back that she could send for the time we met with Doctor [PII] today. So you're gonna get her Doctor [PII]'s information today. Just one second. [PII] has a question.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, OK, good.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] From Doctor [PII].
[CUSTOMER][NEUTRAL] Yeah, do you think they'd give it to me today?
[AGENT][NEUTRAL] It's possible. It depends. Sometimes they're like, hey, we may need 24 hours or something like that, but with us getting that information today and still needing to reach out to them and then having to put it in the mail or fax, you know, hopefully they have a fax that they'll accept um it could be end of the week before they even actually get to it, whereas you may be able to get it as early as today or tomorrow.
[AGENT][NEUTRAL] So it could be a couple of days difference but again they usually respond to their patients faster than they do us so that's really up to you you might have to call them and ask them what that time frame looks like if that's something you're interested in pursuing.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] Right. So, [PII], I think what I'll do, are you going to get a hold of Doctor [PII]'s office today?
[AGENT][NEUTRAL] We will yes we will reach out today and um attempt to get all of the information we need and as long as we get a response that shouldn't be an issue and that will be drawn up and we should be able to send that out today again if they have a fax that they'll accept then they'll receive that fax today um if they don't and they only receive requests through mail then it's gonna be early next week before they get it it'll get it put out in the mail by today but it may be early next week before they get it.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. So.
[CUSTOMER][NEUTRAL] Right, right, so I'm, I'm gonna give, uh, Doctor [PII]'s office a call and let give them a heads up that APL, uh, it it comes under APL. Is that how it's gonna be listed or is it, uh, customer?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, I believe it does come as through as APL um it may even show as American Fidelity, one or the other, um, because that's kind of our umbrella company, um, so it could be one or the other.
[CUSTOMER][NEUTRAL] American Fidelity.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh so just in the meantime they're doing, can we still go to the doctor's office and get it and and fax it to you or email it to? Well, there must be a form to fill out, is there, [PII].
[AGENT][NEUTRAL] There's not. If you request medical records, the only thing that we're gonna ask is that it's for the time frame that we would be asking, which would be [PII]. So it's about a year's worth of records. Now I don't know what that's gonna look like if you only saw them a handful of times for those injections and saw them, you know, they're in the office at the same time it may not be very much, um, so I guess it it.
[AGENT][NEUTRAL] That's gonna depend on how quickly they get that to you too honestly is how much did you see them during that time frame. So if you want to request as long as you request for that time frame, let them know that you're trying to get, you know, disability, um, and you need medical records for this particular time frame, um, then they should be able to let you know and if you are able to get those today or even as early as tomorrow.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, after you've spoken with them, if that's something you wanna ask like, hey, if I, if I request records for this time frame, can you tell me how long it would take me to get them and they say, oh well we can have that ready for you, you know, by [PII] or whatever and you decide to get them, just let us know because then we can cancel our request and then that way we're not still waiting or whatever the case may be, which if we get them from you first we're not going to postpone your claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You see what I'm saying?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, [PII], do you have a direct line?
[AGENT][NEUTRAL] Um, I don't have a direct line, but you can request to speak with me directly. You can just, I'm the only [PII] in the claims department. My last initial is [PII], um, so you can reach out and say, hey, I've been speaking with [PII] about my claim or about my husband's claim, whichever one of you it is that that contacts me, um, can I follow up with her and you can they'll get you over to me as long as I'm in the office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and what would be the fax number that I would fax this information to if I'm able to get it today?
[AGENT][NEUTRAL] Sure. So that's gonna be [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII] and you would just put attention claims on there and it'll come straight to the claims department and they'll get it uploaded to his uh policy.
[CUSTOMER][NEUTRAL] 94.
[CUSTOMER][NEUTRAL] OK, [PII]. So if you bear with me, [PII], I think I will give them a call right now and they could prepare it and then I'll go over and pick it up and fax it and as soon as I fax it I'll give you guys a call back so I don't think we need to double dip on this if I call them first that they might work a bit faster.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, they may they may indeed work with you faster and again that's gonna depend on how much that looks like as far as how often he was there um if they can have it by today or tomorrow and that's something you wanna do definitely give me a call back I'll withhold providing this information to the examiner for now so that she's not also sending or reaching out and then once I've heard back from you.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, we'll figure out what to do from there whether we're gonna continue waiting because you've been able to obtain it or whether we need to reach out and do it ourselves.
[CUSTOMER][POSITIVE] That sounds wonderful. Thank you, [PII]. I appreciate all your help and uh I will give you a shout back as soon as I have an answer from Doctor [PII]'s office.
[AGENT][POSITIVE] OK, you're very welcome, Miss [PII].
[AGENT][POSITIVE] OK, that sounds great.
[CUSTOMER][POSITIVE] Thank you now.
[AGENT][POSITIVE] You're very welcome. You're welcome. All right. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.