AccountId: 011433970860
ContactId: 5ef70172-3b1f-40ea-b980-d758c73af848
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1245000 ms
Total Talk Time (AGENT): 502362 ms
Total Talk Time (CUSTOMER): 545354 ms
Interruptions: 11
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/5ef70172-3b1f-40ea-b980-d758c73af848_20250403T14:27_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi so, uh, I am calling because we received an update on a claim, and I'm trying to understand, um, what is going on with it.
[AGENT][NEUTRAL] OK. And you're calling from a provider's office, or this is your personal policy?
[CUSTOMER][NEUTRAL] Uh, it's for my husband.
[AGENT][NEUTRAL] OK. All right. Um,
[CUSTOMER][NEUTRAL] And I am listed on there as third party authorization.
[AGENT][POSITIVE] OK, perfect. And may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Mhm my name is [PII]. Call back number [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the policy number, Miss?
[CUSTOMER][NEUTRAL] OK, the policy number is 2333213.
[AGENT][POSITIVE] Thank you. Let's see.
[AGENT][NEUTRAL] OK, I don't think I got that number right. Can you repeat the number one more time?
[CUSTOMER][NEUTRAL] Mhm 2333213.
[AGENT][NEUTRAL] What's the name of the patient?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Are you remember?
[AGENT][NEUTRAL] OK. What's his date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] I wanna check on his hospital identity claim and his.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Short term disability claim.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, let me see what's going on on the hospital indemnity. Let me pull the documents on this 11 moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so, um, for the hospital indemnity, it looks like they processed on yesterday, but they're needing additional information. It looks like we need either an itemized bill or super bill or office notes, but we need uh diagnosis codes, procedure codes and charge amounts to continue the processing.
[CUSTOMER][NEUTRAL] That was what I uploaded from the hospital.
[AGENT][NEUTRAL] Um, it looks like it didn't have all the information they need, so they're asking for an itemized bill.
[CUSTOMER][NEUTRAL] That was all that they
[CUSTOMER][NEUTRAL] That's what the hospital sent me.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, so that's what they're needing. Um, the only thing I can do from here will be to get them to call you back and explain to you um what exactly they need because that's the information I got here.
[CUSTOMER][NEUTRAL] OK, because I've seen it before. OK, and what was the date for that one?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was processed on yesterday.
[CUSTOMER][NEUTRAL] I know the date for the service.
[AGENT][NEUTRAL] The service date, OK.
[CUSTOMER][NEUTRAL] The hospitalization. Mhm.
[AGENT][NEUTRAL] All right, let me go ahead and go back to it. This was for Texas Health on [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, I'll try and get I'll see if they'll send me another one, but that's what they sent me when I called.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK, and then there's another one that also needs the same thing um for [PII].
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I said that, can you look at those what I said?
[AGENT][NEUTRAL] We don't, we don't process in this line. Um, the examiner is the one that goes through the paperwork and check and see what they have, um, but I can get an examiner to call you back. And, and she can go over the documents one more time and call you back. OK.
[CUSTOMER][NEUTRAL] Is it possible? Because it shows diagnosis codes on there.
[CUSTOMER][NEGATIVE] Yes, please, because this is, I don't understand because I've sent the same thing before.
[AGENT][NEUTRAL] OK, so let me call back.
[CUSTOMER][NEGATIVE] It's freaking frustrating.
[AGENT][NEUTRAL] OK, I can probably get somebody, see if I can get somebody right now on the line. Bear with me just a second, but let me go back to the, let me go to disability and check on that one, OK, before I get try to get somebody on the line.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh, the short term thank you mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, if they're available, we can probably get somebody but if they're not, then we'll have to wait for that call back, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, um, so the one for disabilities is on you. No, no, no, I understand, trust me, I understand. It's OK. Um, yeah, it looks like the one for the disability is under review. Let me check exactly if it's like in our end if we need anything else or if it's just under review.
[CUSTOMER][POSITIVE] And I appreciate your help. I'm not fussing with you.
[CUSTOMER][NEUTRAL] OK, because I got an email, a text message saying that it has been processed.
[AGENT][NEUTRAL] Yeah, they, they have looked at it, but it looks like they probably still working on it. Let me see.
[AGENT][NEUTRAL] Yeah, whenever they touch the claim, you will get a notification saying that um it's it's being worked on.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, yeah, but sometimes they just have to just continue like depending on how much, how many paperwork, sometimes they just go ahead and put on the review.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like this one is um we're requesting medical records, so we send the letter for medical records, so that's why it's under review.
[CUSTOMER][NEUTRAL] Send it to the doctors.
[AGENT][NEUTRAL] Um, VA clinics.
[CUSTOMER][NEUTRAL] How y'all need the VA clinic.
[CUSTOMER][NEGATIVE] Why I, I mean, I guess I don't understand why they're needing medical records for short term disability.
[AGENT][NEUTRAL] Oh, for disability, it's normal to get medical records.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Because he, but he wasn't treated by the VA.
[AGENT][NEUTRAL] OK, uh let me see.
[CUSTOMER][NEUTRAL] Why do they need all of his medical records for this?
[AGENT][NEUTRAL] Request via clinic mail to send OK.
[AGENT][NEUTRAL] Um, yeah, I, I will, I'll have to get an exam. I'm not, I, I just go by whatever they have in the system and um, yeah, that's all I got. I'm so sorry. I just had that they, yeah, to understand, I know. Yeah, that's, that's what I have that they ask for um medical clinic um medical records for VA clinic. So let me go ahead and try to get an examiner. Maybe the person that answers can answer both of them. I, I'll try to get somebody that can, um.
[CUSTOMER][NEUTRAL] I understand, yes [PII]'am.
[CUSTOMER][NEUTRAL] And I'm not fussing, I'm just trying to.
[CUSTOMER][NEGATIVE] Because they're never gonna get the medical records. VA is never gonna send medical records.
[AGENT][NEUTRAL] OK, let's see what.
[CUSTOMER][NEGATIVE] They're trying to go his medical records for the VA go back to [PII] because he was in the [PII], so they're never gonna get that. That's gonna take, I've been requesting medical records for.
[AGENT][NEUTRAL] Oh.
[AGENT][NEGATIVE] Oh no.
[AGENT][NEUTRAL] No, the
[CUSTOMER][NEUTRAL] Service records from them since, mhm.
[AGENT][NEUTRAL] Yeah, the medical records is gonna be like for a specific time frame. So it's not gonna be all the way to the beginning. No. It's gonna be from [PII].
[CUSTOMER][NEUTRAL] Right, but he hasn't even seen them during, but he hasn't seen them VA. He hasn't been to the VA since [PII] other than yesterday for a follow-up.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEGATIVE] So why are they, that's what I guess I don't understand.
[AGENT][NEUTRAL] Oh, OK. All right. Well, let's get an examiner and see exactly what was going on, what they need in that, OK? Let me see if I can get someone on the line. You're welcome.
[CUSTOMER][POSITIVE] All right, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Thank you for calling APO. This is [PII]. How can I help you?
[AGENT][POSITIVE] Hi, [PII]. How are you? Good morning.
[CUSTOMER][NEUTRAL] How are you?
[AGENT][POSITIVE] I'm good. I'm here.
[CUSTOMER][NEUTRAL] I know, right?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] It's like today, I don't know what's wrong with today.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I don't know either. I feel like it's been the longest, like 2 weeks of my life.
[AGENT][NEUTRAL] It feels like Monday. Yes, I'm like, oh, is it Monday?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, but I have a member, well, I have the wife of a member on the line. She is authorized. She, we do have the authorization paperwork for her, um, but it looks like, um, uh, she has some questions about two policies. One is the disability and one is the HI.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there are 2 claims, one, well, there's 2 claims on the HI and one on the disability. Uh, for the disability, she's just confused, uh, and she wanted to know why we're asking for uh medical records from the VA.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And um for the HI she wants to know why we're still asking for the itemized bill when she sent all this information in to us. So let me give you which one you want first. I'm sorry.
[CUSTOMER][NEUTRAL] It doesn't matter. It's OK it's OK just whichever one just let me know which one's which one you're telling me.
[AGENT][NEUTRAL] OK, so let me give you the disability first since that's the one she was asking about the VA medical records. Um, but that is 2605764.
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I had to guess it's probably like.
[CUSTOMER][NEUTRAL] Pre-existing.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] I'm not sure. I mean, um, [PII] just put that she asked for the medical records and where she asked it for and then for what time range, but that's all, that's what I was telling her like, you, uh, because she said, but why? I'm like, oh well.
[AGENT][NEUTRAL] Oh, I see here that they asked for it.
[CUSTOMER][NEUTRAL] Right, it's like, mm, hang on.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] I feel like I always give you the craziest call, [PII].
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] You know I'm gonna start screening y'all or something. No, I'm just kidding.
[AGENT][POSITIVE] You're gonna be like, oh it's so nice.
[CUSTOMER][NEGATIVE] Right, hang on, why are you calling? Nope, just kidding. I'm not busy or I'm too busy.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] They be like let me breathe before I answer.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Oh goodness. OK, let's see. Thank you.
[CUSTOMER][POSITIVE] OK, they've not had it. It was just effective.
[CUSTOMER][NEUTRAL] Yeah, so.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] In their policy.
[CUSTOMER][NEUTRAL] Let's see, I'm trying to remember the exact verbiage, so I'm just gonna pull it up.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, well, it may not be if it's disability.
[CUSTOMER][NEUTRAL] Let me see what they submitted.
[CUSTOMER][NEUTRAL] Cause
[CUSTOMER][NEGATIVE] I have received your request, uh, not.
[CUSTOMER][NEUTRAL] Yeah it is
[CUSTOMER][NEUTRAL] So they've requested medical records to just verify that it's not the result of a preexisting condition um under that claim 358-022-9 that DD 201 that is.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] That remark code that is exactly what it says we've received your request for benefits before we can consider it, we have to obtain records to make sure it's not due to preexisting. We'll contact you again, um.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Uh, so that's what it means.
[CUSTOMER][NEUTRAL] You know with needing names and addresses or whatever if we need it um and then if you have questions or concerns you know we can.
[AGENT][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] We can let you know, but that's what it is they were just effective on [PII].
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And um let's see when he's claiming that this started.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] It is so cloudy here at my house today and I'm just like this is sleeping with this is like.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] This is lay down and relax with her.
[AGENT][POSITIVE] Yeah, this is a, a hot chocolate moment.
[CUSTOMER][NEUTRAL] Yes, like, I mean, it's, it may be nearly 80 degrees outside, but I feel like it should be like, you know, I should be cozying up to a warm fire or something.
[AGENT][NEUTRAL] Ah
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Are you in [PII] or in [PII]?
[CUSTOMER][NEUTRAL] I'm actually in [PII].
[AGENT][NEUTRAL] Oh, you're in [PII]. Oh, yeah, almost, yeah.
[CUSTOMER][NEUTRAL] So I'm not too terribly far away um from [PII] at least. [PII] is a drive, but.
[AGENT][NEUTRAL] No. Yeah. Because I saw outside, I'm like, yeah, it looks like that a little bit here.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it does. It's very overcast but hot.
[AGENT][NEUTRAL] Yeah, yeah, it's hard. Mhm.
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][NEGATIVE] Very hot, humid, and pollen everywhere.
[AGENT][NEUTRAL] Mhm. Yeah. Yup, yup, yep.
[CUSTOMER][POSITIVE] Um, OK, so they were effective on [PII] and he's saying that he last worked his job on 32, so he became effective.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And he has degenerative disc disorder.
[CUSTOMER][NEUTRAL] So if it were like he was working and then on.
[CUSTOMER][NEUTRAL] You know, the next day or whatever, he had an injury that occurred at work or something like that. It may be a little different, but um I mean.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I have degenerated disc. So he was having surgery basically um for a disc herniation and acute on chronic low back pain.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] No, OK.
[AGENT][NEUTRAL] Mm, OK. So yeah, she just wants to know why um all that was asked for. And then on the HI um she just wants to know like uh why we need the documents because she believes she sent everything we needed. So I don't know if you want to look into those two and let her know.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, let me, yeah, I need to see what we got so I can better explain that for sure um what is the policy number for that one?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, let me go back to one moment.
[AGENT][NEUTRAL] I was finishing a note on another one.
[AGENT][NEUTRAL] Uh, OK, how are you?
[AGENT][NEUTRAL] Alright, that open already, OK.
[AGENT][NEUTRAL] And HI is 2333.
[CUSTOMER][NEUTRAL] Uh-huh
[AGENT][NEUTRAL] 213.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] No diagnosis code.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] That DM 400 on those two claims that were recently processed yesterday.
[AGENT][NEUTRAL] Mm, mhm. Yeah, that's it.
[CUSTOMER][NEUTRAL] It states no diagnosis code.
[AGENT][NEUTRAL] Oh, OK. All right.
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] In order to provide further consideration.
[CUSTOMER][NEUTRAL] Supporting documentation so it says that it's it may include but is not limited to an itemized bill so.
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It's really just that we don't have a diagnosis code because it says itemized bills with diagnosis codes, super bills office notes, hospital admission and discharge summaries or diagnostic testing results.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me know when you're ready for her.
[CUSTOMER][NEUTRAL] Let me see and they submitted for.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On that.
[CUSTOMER][NEUTRAL] I'm just gonna verify really quick that we don't have.
[CUSTOMER][NEUTRAL] Anything
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And then that way I can.
[CUSTOMER][NEUTRAL] I can be confident saying well I reviewed your documents and yes we did receive the bill, however, there is no diagnosis provider.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, I mean this examiner is usually pretty good about that. I don't doubt that, but just.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know, dotnet, um, huh, just kidding. There are diagnosis codes.
[AGENT][NEUTRAL] Oh, I guess.
[CUSTOMER][NEUTRAL] At the very end.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So I can send that back um on that one but this one's a different.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Let me check this one because there were 2 different ones.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh goodness, I'm glad I check because that examiner is usually pretty good. I'm gonna point that out to her and be like, really? And she's like, oh my God.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I know.
[CUSTOMER][NEGATIVE] Oh my God, I can't believe I did that.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, me either.
[CUSTOMER][NEUTRAL] Get it together.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] No wonder she's like I don't understand because it's it is there um let me see.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, and that's why she's like, I submitted everything. What else do you want?
[CUSTOMER][NEUTRAL] Yeah, I, I can understand why I'd probably be the same way um let's see now it looks like now one of them it looks like we we truly don't, um, let's see.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So we did for the one they were listed at the end.
[CUSTOMER][NEUTRAL] But this one.
[CUSTOMER][NEUTRAL] It looks like we have all of the charges and everything.
[CUSTOMER][NEUTRAL] And the admission date, but they did not include a diagnosis code so one did and one didn't um that's really where we're at with that. I don't think we have anything else in history.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, Ms. [PII], I'll have to put her in because it's been 10 minutes. Uh yeah, OK, yeah.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][POSITIVE] Yeah, yeah, yeah, go ahead. I, I think I have everything I need now, so you're good you're good.
[AGENT][NEUTRAL] OK, alright, alright, thank you, and I fully verify her the callback number is the same one in the system. OK, alright.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. Thank you for holding and being patient for me. I got Ms. [PII] on the line. She's gonna assist you with that information, Miss. [PII], OK?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much for your help.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Hey Miss [PII], how are you?
[CUSTOMER][NEUTRAL] I'm doing well how are you? I'm doing well a little confused with some of this process. Yes, and, and that is perfectly normal um you were not the only one I promise um OK so I'm gonna start with your HR because I have it pulled up currently and I know um I've looked at everything that's why it took us a bit to a little bit to get back to you um so for one of the claims that we processed yesterday.
[CUSTOMER][NEUTRAL] Um, I do see the diagnosis codes, so I'm gonna.