AccountId: 011433970860
ContactId: 749695cf-3598-4071-bae8-939091abb3c5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1658439 ms
Total Talk Time (AGENT): 335886 ms
Total Talk Time (CUSTOMER): 403957 ms
Interruptions: 4
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/749695cf-3598-4071-bae8-939091abb3c5_20250123T15:03_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling AP [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], it's [PII]. Good morning. I've got, uh, I've got Mr. [PII] on the phone. His policy number is 252-9577.
[AGENT][POSITIVE] Good morning.
[CUSTOMER][NEUTRAL] He received a letter stating that more information is needed to complete his claim and I looked in the remarks and it didn't specify what's needed, so he needs to speak to somebody to see exactly what he needs to send in to finish his claim.
[AGENT][NEUTRAL] OK, what's this callback number?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, you can go and send up there.
[CUSTOMER][POSITIVE] OK, thanks you have a good day bye bye.
[AGENT][NEUTRAL] You as well. Bye.
[AGENT][NEUTRAL] Good morning. Thanks for calling Eco [PII]. Am I speaking with Mr. [PII]?
[CUSTOMER][POSITIVE] Yes you are.
[AGENT][NEUTRAL] OK, the rep stated you had a question about what information you needed to send in to complete your claim.
[CUSTOMER][NEUTRAL] Don't know, uh, this is all new to me.
[AGENT][NEUTRAL] OK, give me one second, let me look into this for you.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] I'm still looking at it. Give me 1 2nd.
[AGENT][NEUTRAL] Hm.
[AGENT][POSITIVE] Bless you.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You.
[AGENT][NEUTRAL] Let me reach out to the examiner that process the claim and ask her um what she's requesting, um, if you can give me one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Sorry for the wait, Mr. [PII]. I'm just waiting for a response back. I'm thinking that since this is your first claim, um, she's probably trying to verify, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She's probably trying to get information so she can request some medical records, but I'm just trying to wait for her response.
[CUSTOMER][NEUTRAL] P
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] the sandwich that for fun. I really like the marinated chicken breast. They most great real fun and that wine sauce. They all work together.
[AGENT][NEUTRAL] OK, so, um,
[AGENT][NEUTRAL] She is, she forgot to put a note.
[AGENT][NEUTRAL] On the, the claim, um, but, so we are needing, um, if you have any EKG results, um, lab results, um, MRI, CAT scan, X-ray.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Um, we also need to admit and discharge summary summary and the history and physical from the hospital.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And with this cardiologist notes.
[CUSTOMER][NEUTRAL] Well,
[AGENT][NEUTRAL] Because the only thing you submitted was the only thing you submitted was the claim form, so we need to um.
[AGENT][NEUTRAL] Verify all the information. That's any time you send in a claim, we have to have that information.
[CUSTOMER][NEUTRAL] Hang on a second, yeah.
[CUSTOMER][NEUTRAL] Con
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Your EEG, your.
[CUSTOMER][NEUTRAL] Your CAT scan, everything the hospital has, OK.
[CUSTOMER][NEUTRAL] Um, yeah, I don't have copies of that information that's gonna have to come from the hospital.
[AGENT][NEUTRAL] Yes, so, so you would have to contact the hospital and obtain the information and send it in to us.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][POSITIVE] Oh my gosh.
[AGENT][NEUTRAL] And that's only because looking because you're um trying to um get a benefit for your first occurrence as far as um having a stroke and that's just information that we need um and then too since the policy just started, um, so we need more information to
[CUSTOMER][NEUTRAL] Well, hello, my name is [PII], and I live with my brother and I'm the one that's handling everything. Um, he has just
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Started coming.
[CUSTOMER][NEUTRAL] The benefits, I mean, his stroke.
[CUSTOMER][NEUTRAL] Affected his cognitive reasoning and his memory.
[CUSTOMER][NEUTRAL] So that's where I come in.
[CUSTOMER][NEUTRAL] And uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] No, so I was explaining to him. So um I'm not sure if you sent it in or he did, so the, we only received the claim form. So we need all the information to determine um the stroke and that's because this is the, the first claim that we received. So, um, y'all would have to request that information from the hospital and send it in to us so we can process the claim.
[CUSTOMER][POSITIVE] Sweetheart.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] No, no, ma'am. No, ma'am. That is your job.
[AGENT][NEUTRAL] No, ma'am. We don't, we don't call the hospital to request that.
[CUSTOMER][NEGATIVE] It is your, no, no, no, no, no, no, no, no, no, no, no, no, no, no.
[CUSTOMER][NEUTRAL] I cannot request them.
[CUSTOMER][NEUTRAL] I've already tried.
[CUSTOMER][NEGATIVE] I was told the insurance company has to fill in the information has to contact the hospital for the information because I threw a shoe. I was so upset. I'm like I need records of all of this we cannot give you the records. Only the insurance companies can receive the records.
[AGENT][NEUTRAL] So, no, ma'am, that is not correct. We don't, we don't request these documents. The member that sends a claim has to send us the documentation. The only time we contact the hospital is if we request medical records and we call to verify that they received our request, but however, the membe[PII] has to get these documents and send in to us. We can't call them to ask for his results, and that's how our claims are processed.
[CUSTOMER][NEUTRAL] So, we, we
[CUSTOMER][NEUTRAL] No ma'am.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Well, then you've got a problem with the state of [PII] because in the state of [PII], I cannot request, you just said you can contact them and ask for medical records. That's what all of this is.
[AGENT][NEUTRAL] No, ma'am, I didn't say that I can contact. I said once we received information from the member, once we receive information from the member.
[CUSTOMER][NEUTRAL] It's medical records.
[CUSTOMER][NEUTRAL] You just said that.
[AGENT][NEUTRAL] Regarding information that he has, the only time we contact a provider is to call in regards to information that we requested, but we cannot request the information that we're requesting currently. This has, when the claim comes in, we have to have all this information sent in because we have to verify that he, that he's had.
[CUSTOMER][NEUTRAL] I sent him everything.
[CUSTOMER][NEUTRAL] I sent in everything that your claim as it was the instructions to fill it out. I sent in all the information including all of the doctor's names for you to contact.
[AGENT][NEUTRAL] Ma'am, we don't contact and get the information. We, what we do, we process the claims. We don't, when you send in a claim, we have to have supporting documentation, and that's the documentation that we're requesting. We don't have that, ma'am. Only thing we have is the name showing that he had a stroke and we have the name of his position. Like I said, we don't call to request that information. When we see just a claim form, that's showing that this in
[CUSTOMER][NEUTRAL] That's what y'all are.
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEUTRAL] And you've got that.
[CUSTOMER][NEUTRAL] You got that.
[CUSTOMER][NEUTRAL] Can I speak to, can I speak to a supervisor?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you. I would like to speak to a supervisor.
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] Look at that.
[CUSTOMER][NEUTRAL] Look up at the bird feeder outside.
[CUSTOMER][NEUTRAL] You see that squirrel?
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Ms. [PII], give me 1 2nd. I'm trying to see if somebody's available to speak with you. 1 2nd.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] That's not be her desk.
[AGENT][NEUTRAL] Nope.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding. So my supervisor is in a meeting. I can um leave a message for her and have her um to call back when she's available.
[CUSTOMER][NEUTRAL] Well, let me tell you something.
[CUSTOMER][NEUTRAL] Y'all received this claim in October.
[CUSTOMER][NEUTRAL] Not one person from your company beyond the letter that we received dated [PII]. Not one time has your company reached out to us to find out any information to update us to say that, you know, there's more information that's needed, but in the state of [PII] a patient cannot request medical claims that is your job.
[CUSTOMER][NEGATIVE] And I want to know right now I will be calling every week from this point on because you've already proven that y'all do not work your claims. You've had his claim, excuse me, excuse me, excuse me.
[AGENT][NEUTRAL] No, ma'am, I didn't say that. I didn't say that, and we don't, we don't call the customer regarding claims.
[CUSTOMER][NEUTRAL] Excuse me. Do not interrupt me.
[CUSTOMER][NEUTRAL] I have taken care of my brother since he had his stroke, which is [PII] or [PII]. And I'm telling you right now, I've given you all 3 months.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] There's no reason that someone should not have contacted us or sent us a letter stating, look, we need more information.
[CUSTOMER][NEGATIVE] Y'all did not do that. We called you to find out the update of the status and then someone tells my brother, oh, your account needs more information. It's a game with y'all as long as y'all can hang on to that money that's what you do. Well, you've you've met the wrong person because I'm not gonna play that game.
[CUSTOMER][NEUTRAL] OK, my brother paid into your company for a long time and he had this.
[CUSTOMER][NEUTRAL] Now it's been 3 months.
[CUSTOMER][NEUTRAL] Y'all need to prove or get proof of the medical injuries and that requires y'all calling the hospital to get proof because a patient cannot in the state of [PII] request their medical records. It's not allowed.
[CUSTOMER][NEUTRAL] Now you can give.
[CUSTOMER][NEUTRAL] Your supervisor, my brother's phone number or you can give her my phone number.
[CUSTOMER][POSITIVE] But I will be calling back all day long.
[AGENT][NEUTRAL] Give me one
[CUSTOMER][NEGATIVE] Because I, I'm not gonna play with y'all.
[AGENT][NEUTRAL] Give me 1 2nd. Give me 1 2nd. Give me 1 2nd.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm mm mm.
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh my gosh, I haven't transferred him but.
[AGENT][NEGATIVE] Let me calm down.
[AGENT][NEUTRAL] So, um, [PII], she forgot to put the notes of the EOB and T, um, so the member's sister is taking care of him and so she gets on the phone and she's just talking all kinds of noise, but um.
[AGENT][NEGATIVE] So she's trying to say that we're supposed to be requesting all this information that is needed and I told her that's not what we're doing so she just butt in and she just talking all kinds of.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Yeah, so the insured was on the phone, um, and so the insured on the phone and like since she's in the background, like said she gets on the phone and it's like she.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I guess kind of almost like well put him back the phone, but she's the one that.
[AGENT][NEGATIVE] Saying everything, so, I mean, I can tell her that she needs to see him, but she still wants, well, she wanted to speak to supervisor because she's trying to say it took 3 months and we should have called them and I said, we don't call, she's like, what, let me finish talking and.
[AGENT][NEUTRAL] It's Miss [PII]. I forgot her first name, but it's Miss [PII].
[AGENT][NEUTRAL] OK, I
[AGENT][NEUTRAL] I think cause I don't know, I don't know how to transfer without, I mean, since I call, so I go ahead and do it the other way and um.
[AGENT][NEUTRAL] I mean, OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Bye. Uh-huh.
[AGENT][POSITIVE] OK, thank you for holding Miss [PII], um, and Mr. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, and what was your first name again?
[CUSTOMER][NEUTRAL] Darla
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And um, are y'all on speakerphone or um?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so, um, I'm gonna transfer you over to my supervisor. Give me one second.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Good morning. This is [PII] speaking. How may I help you?
[AGENT][NEUTRAL] I so her first name, her, her first name is [PII].
[CUSTOMER][NEUTRAL] Darla, OK.
[AGENT][NEUTRAL] Um, yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, I'm trying to remember how to, I'm sorry, I haven't done one in a minute.
[CUSTOMER][NEUTRAL] You're fine, you're fine. So you, you got the call on Amazon, you're trying to send it to me in Teams.
[AGENT][NEUTRAL] You see
[AGENT][NEUTRAL] Yeah, so it's, it's join. OK, join. OK, I see it now.
[CUSTOMER][NEUTRAL] OK