AccountId: 011433970860
ContactId: 7fcd6020-7326-4282-9b07-1944d25ad3b8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1225400 ms
Total Talk Time (AGENT): 484048 ms
Total Talk Time (CUSTOMER): 501285 ms
Interruptions: 4
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/7fcd6020-7326-4282-9b07-1944d25ad3b8_20250529T15:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. Um, my policy, I don't have my policy number, but hold on, I can get it for you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One second.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] Ms. [PII], while you're getting that, what is a good callback number for you in case we get disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] I found the policy number whenever you're ready.
[AGENT][POSITIVE] Yes, ma'am. I'm ready.
[CUSTOMER][NEUTRAL] It's 234-042-1.
[AGENT][NEUTRAL] OK, thank you. So give me a moment to get your information pulled up. Um, once I do, I will have to verify several things with you first for security and then also any information provided would be a verification of benefits and not a guarantee of payment. So while this is still loading, how can I help you today, Ms. [PII]?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Um, well, on my, um,
[CUSTOMER][NEUTRAL] I, I just, well, OK, two things. Um,
[CUSTOMER][NEGATIVE] On the last claim that I made, they finished it, but I should have received a benefit for crutches. So I faxed them the report from the hospital stating that they ordered me a pair of crutches. Is that all I needed?
[AGENT][NEUTRAL] OK, so you're needing to verify what additional information you were needing to submit to us on a claim, is that correct?
[CUSTOMER][NEUTRAL] Well, according to the benefits plan, I should have received benefits for crutches, but I don't think they knew I got crutches cause it didn't state it originally.
[CUSTOMER][NEGATIVE] It's not, I, it wasn't stated on the forms I sent them.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] OK, so yes, I'll be able to help you with answering that question. So once I verify your information. But yes, ma'am, I can help you with that.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Oh, sure honey, I'm sorry.
[AGENT][NEUTRAL] That's OK. So first off, um, as I stated before, any information provided would be a verification of benefits and not a guarantee of payment. So if you could first please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then also your home mailing address please.
[CUSTOMER][NEUTRAL] It's um mailing address is [PII].
[AGENT][NEUTRAL] OK, thank you. The phone num, yes, ma'am, it is. Uh-huh, and the phone.
[CUSTOMER][NEUTRAL] Is that what you have?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 814931
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then the last thing to verify is your email address?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's um [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, Ms. [PII], so um if you were going to, you can.
[AGENT][NEUTRAL] Now I see you're set up in the online service center.
[AGENT][NEUTRAL] Let me look at one thing.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. So, yes, ma'am. I can see now on the most recent claim, yes, so we received for you, yes, I do not see where it was indicated that there was any type of, you know,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it's not, it wasn't on there. um, but yeah, I sent.
[AGENT][NEUTRAL] You said crutches. So you and you would just need to submit that. Mhm.
[CUSTOMER][NEUTRAL] I did, I was, well I submitted like after I guess.
[CUSTOMER][NEUTRAL] After they put your initial like visit on their patient portal, then a couple of days later, like the doctor writes something longer usually.
[CUSTOMER][NEUTRAL] And that's the one I submitted that says it. Is that OK?
[AGENT][NEUTRAL] Uh, let me, let me look at the accident claim form on here. Give me just a second to see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is it an itemized bill?
[AGENT][NEUTRAL] Is that what they, is it?
[CUSTOMER][NEUTRAL] No, it just says
[CUSTOMER][NEGATIVE] The patient had ordered crutches. It's not on the itemized bill either. I called the hospital. It's not on there.
[CUSTOMER][NEUTRAL] They do it differently, I guess. It goes to a uh
[CUSTOMER][NEUTRAL] I guess a supplier.
[AGENT][NEUTRAL] OK, so just a moment. I'm trying to look up some additional information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So for the appliance benefit, there, you do have to provide the prescription or your, your doctor that's prescribed the crutches for you, that were to order.
[AGENT][NEUTRAL] You would have to present a copy of that, which the doctor.
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] That ordered those for you would have that's who you would contact for that.
[CUSTOMER][NEUTRAL] You mean the hospital?
[AGENT][NEGATIVE] Whoever ordered you to be able to get crutches. They had to order those unless that's something you just went and did on your own.
[CUSTOMER][NEUTRAL] No, no, I got him at the hospital.
[AGENT][NEUTRAL] Right, so the order for them.
[AGENT][NEUTRAL] Prescribing those to you, we would have to have a copy of that.
[CUSTOMER][NEUTRAL] But it wouldn't be enough saying that the doctor
[CUSTOMER][NEUTRAL] I'm going to put her on crutches for this long, that wouldn't be enough.
[AGENT][NEUTRAL] I do not believe so. No, ma'am, but I will be happy to check that for you. Do you mind? Let me see if I can get an answer to that.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, all right, so give me just a moment please, Ms. [PII]. One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], it's [PII]. How are you today?
[CUSTOMER][POSITIVE] Oh, I'm good how are you?
[AGENT][NEUTRAL] Oh, I'm all right. Can you please pull up a policy and just answer two questions for me? I don't plan on transferring this insured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, what's the policy number?
[AGENT][NEUTRAL] Um, the policy is 234-042-1.
[AGENT][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, the first question is on the most recently received claim that we processed for her, the last one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That was issued via check. Can you tell me why it wasn't direct deposit?
[AGENT][NEUTRAL] Why would it have
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Direct deposit to TID1.
[AGENT][NEUTRAL] And I don't know what that see if you look on CUDAT where it has active Y and N, there's a number 2 on my screen. I've never seen that.
[CUSTOMER][NEUTRAL] Yeah. Somebody probably, they probably put a.
[AGENT][NEUTRAL] I don't know what that is.
[CUSTOMER][NEUTRAL] A 2 in there instead of a Y.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We probably need to.
[AGENT][NEUTRAL] Is that something you could change?
[AGENT][NEUTRAL] I mean,
[CUSTOMER][NEGATIVE] No, I can't. It's gonna be, uh, I don't even know who put the direct deposit information in.
[CUSTOMER][NEUTRAL] I wonder does it say who did it changed the address.
[AGENT][NEUTRAL] Oh, no, I'm sure not. Well, it wouldn't be a change of address.
[CUSTOMER][NEUTRAL] O
[AGENT][NEUTRAL] I mean,
[CUSTOMER][NEUTRAL] No, I'm saying usually they, if they put uh
[CUSTOMER][NEUTRAL] You said they, you know, updated uh claim stated uh DD direct deposited in process to be released today.
[CUSTOMER][NEUTRAL] Uh, so that was additional notes the premium.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I don't know, so that would probably be something that customer service I guess would have to change because we claims can't do that, we can't do it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, let's see. Hold on one second.
[AGENT][NEUTRAL] OK, verify.
[CUSTOMER][NEUTRAL] I want to know this and I.
[AGENT][NEUTRAL] Yeah, so I'll, I'll send a request over to customer service.
[AGENT][NEUTRAL] About that, cause, you know, and then the next thing.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, but that's the reason, probably the reason.
[AGENT][NEUTRAL] OK, and the next thing is, is, so there are benefits for crutches on this policy, but she didn't submit that. So she's wanting to verify what she has to send us for that.
[AGENT][NEUTRAL] And it was the doctor at crutches.
[CUSTOMER][NEUTRAL] Benefits for what now?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So when she's at the hospital being seen, she says that the doctor said he was putting her on crutches for 10 number of times.
[AGENT][NEUTRAL] What does she need to send to us?
[AGENT][NEUTRAL] For that benefit to be.
[CUSTOMER][NEUTRAL] Did she have to pay
[CUSTOMER][NEUTRAL] Did she have to pay for them or did she go, what did, you know, did they charge her for the crutches?
[AGENT][NEUTRAL] Oh, well, I'm a, uh, I don't know that [PII]. I did not specifically ask her that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Let me pull up her claim and see if I.
[AGENT][NEUTRAL] I mean, the claim form says, you know, that we would have to have a prescription for an appliance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] I mean that's what the claim form says anyway.
[AGENT][NEUTRAL] I've never been asked that question.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Appliance benefit provide a prescription.
[AGENT][NEUTRAL] But again, this was
[AGENT][NEUTRAL] When she was seen at the hospital.
[CUSTOMER][NEUTRAL] So usually they prescribe her, if they do a prescription, she would need to go to the uh like uh you know, kinda like we got here.
[AGENT][NEUTRAL] Right, but she was at the hospital, so they didn't.
[CUSTOMER][NEUTRAL] And they just gave him to her there.
[AGENT][NEUTRAL] Let me, do you mind letting me put you on hold? I was trying to, I thought this would be pretty easy because I didn't wanna transfer her.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] I was just gonna try to answer a question. Let me ask her that instead of just releasing her to you.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Um, give me just a second, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thanks, [PII]. All right, one moment.
[CUSTOMER][POSITIVE] OK, no problem.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Miss [PII].
[CUSTOMER][NEUTRAL] Yeah, I
[AGENT][NEUTRAL] Hi, this is still [PII]. So I have a question. I'm still looking at this for you. So you went to the hospital and you said it was the doctor at the hospital that put you on the crutches. Is that correct?
[CUSTOMER][NEUTRAL] Right, yes.
[AGENT][NEUTRAL] Now, did you, did they give them to you there at the hospital or did you have to purchase them yourself?
[CUSTOMER][NEUTRAL] No, they gave them to me, no, they gave him to the hospital.
[AGENT][NEUTRAL] OK, they gave them to you at the hospital?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, alright, so do you mind letting me put you back on hold for just a moment?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] OK, great. Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey, [PII]. All right, so she was given the crutches at the facility.
[AGENT][NEUTRAL] When she was there, they gave them to her when she was there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Did she know she was, did they bill her for the crutches?
[CUSTOMER][NEUTRAL] I'm sorry, cause that's what, you know, if she was, if they gave her a bill if they send her something, you know, where she has to pay out of pocket.
[AGENT][NEGATIVE] Uh no.
[CUSTOMER][NEUTRAL] Oh she was, I would say send that in.
[CUSTOMER][NEUTRAL] Uh, or something showing that she was issued the crutches.
[CUSTOMER][NEUTRAL] Uh, we need something from that facility.
[AGENT][NEUTRAL] OK, so that would just
[AGENT][NEUTRAL] So just like her notes.
[AGENT][NEUTRAL] Would an itemized bill, I mean.
[AGENT][NEUTRAL] That's
[CUSTOMER][NEUTRAL] You wanna send it to me?
[AGENT][NEUTRAL] Girl, I thought this was gonna be so simple, [PII], and that was never my intention. I was like, I was just gonna say, oh no, tell her to send this and that'll be fine. So, OK, well, let me just um join her in cause I did not tell her that I was transferring her. So instead of putting you on hold again, I'm just gonna bring us all together and then I'll leave the call, but her callback number is the one, [PII] that you see up on the screen.
[CUSTOMER][NEUTRAL] Mmm. You're fine. You're fine.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If something happens during this connection here. OK. And actually I may stay on the call to just hear this since I have not had one like this before, if that's OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright.
[AGENT][NEUTRAL] But I won't see any. OK, so give me one second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Hi, Ms. [PII].
[CUSTOMER][NEUTRAL] Yeah, fine.
[AGENT][NEUTRAL] Hi, this is [PII], and I also have one of our examiners on the line, [PII], and [PII] is going to help you um with answering your questions regarding what you would need to provide us for this benefit. So before I just turn it over to [PII], is there anything else that I can help you with?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, sounds great.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, yes, um, you guys issued me a check, I believe, but I already have direct deposit signed up.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So I'm not sure why you went to that.
[AGENT][NEUTRAL] That is correct and I'm going to send a request to have that looked at um as to why it was done because I could also see that this was, this last claim was processed on a check instead of direct deposit, but I will have.
[CUSTOMER][NEUTRAL] With that, yeah, I thought that was strange.
[AGENT][NEUTRAL] Yeah, so I.
[CUSTOMER][NEUTRAL] Did you already send out the text?
[AGENT][NEUTRAL] Yes, ma'am. That check would have already been sent out because that claim was processed, I believe on the. Yes, ma'am. It was actually um processed, I believe on the [PII], which means that would have, yes, so it would have mailed on yesterday.
[CUSTOMER][NEUTRAL] Already been mailed. OK, yeah, no.
[CUSTOMER][NEUTRAL] OK, that's fine. I mean, I can use the check, but I just don't normally want, you know what I mean? I didn't know why I did that, but.
[AGENT][POSITIVE] Correct. Yes, ma'am. And I'm not 100% sure. I think I know why, but they just need to look at it and correct one piece of information, I think that was typed in incorrectly. But we'll get this taken care of for you. And I, cause I'm fixing to work on that.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] OK, no problem. Thank you. I appreciate it.
[AGENT][POSITIVE] Well, you're welcome and thank you again for calling APL. I hope you have a very nice day. And [PII], are you able to hear Ms. [PII] and Ms. [PII], can you hear [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. All right then.
[CUSTOMER][NEUTRAL] I can hear.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Hi, good morning. This is [PII]. How are you? Good morning. Good, how are you, honey?
[CUSTOMER][POSITIVE] I'm doing well thanks for asking. OK, uh, so I had a couple of questions and, and instead of her keep going back and forth between us, you know, she just, uh, sent it to me. OK, so for this probably a good idea.
[CUSTOMER][NEUTRAL] OK, so for the crutches that you have, uh, when they gave them to you at the at the facility, uh, did they give you anything, uh, like any documentation?
[CUSTOMER][NEUTRAL] Uh, you know, stating that uh why you needed the crutches. OK, so that's what we're needing we needed, um, we need something, some documentation from them like a prescription for the crutches so that we would know, uh, you know, that, that you would actually prescribed those crutches and that, you know, they are needed, they were prescribed by the physician.
[CUSTOMER][NEUTRAL] OK, so I had backed the form.
[CUSTOMER][NEUTRAL] I had faxed a um a report from
[CUSTOMER][NEUTRAL] I'll tell you what it says and you can tell me if that would be acceptable or not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One second. It's from, um, it's just from the hospital portal like their report.
[CUSTOMER][NEUTRAL] Is that the information from Mount Nitney Health, is that correct? OK.
[CUSTOMER][NEUTRAL] Alright, so it does say that.
[CUSTOMER][NEUTRAL] Uh, let's see. It doesn't list anything about the crutches.
[CUSTOMER][NEUTRAL] I, I just faxed it this morning.
[CUSTOMER][NEUTRAL] You probably don't see it, yeah, there were other notes that were in the portal that I was able to pull that off of, so I just did that.
[CUSTOMER][NEUTRAL] OK, alright, well is there any way?
[CUSTOMER][NEUTRAL] Well, honey.
[CUSTOMER][NEUTRAL] Is there any way that I can watch for this documentation to come over and then I'll review it and then I can give you a call back to let you know if that's something that we can use or not?
[CUSTOMER][NEUTRAL] I could, yeah, you could do that or I could, I mean, I'm looking at it right now. I could tell you what it says.
[CUSTOMER][NEUTRAL] OK, yeah, but we still gonna have to review it anyway once he gets. Oh, of course, yes, I did. I just wanted to know if I needed to get anything else. If I did, then I would work, you know what I mean, I.
[CUSTOMER][NEUTRAL] Probably have 12,000 people for that, but
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Being it's being stupid with me. I apologize.
[CUSTOMER][NEUTRAL] That's OK. OK, you can go ahead and tell me what it says. That's what I'm trying to get to here, sorry.
[CUSTOMER][NEUTRAL] OK, you're fine.
[CUSTOMER][NEGATIVE] I it's being stupid for me today.
[CUSTOMER][NEGATIVE] Oh no.
[CUSTOMER][POSITIVE] One second, sweetie. I appreciate your help.
[CUSTOMER][POSITIVE] Oh, no problem.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I did fax it, but I'll tell you what it says anyway. If not, if you don't think it'll work, I'll get you, I'll go work on trying to get something else.
[CUSTOMER][NEUTRAL] It just says.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] As I discussed with the patient that we would put an ace strap on her foot to help with swelling and that she could continue to wrap the ice and elevate it at home to help with symptom control, patient requested crutches to help with minimum weight bearing until it was tolerated. The patient was ordered a set of crutches. Patient was encouraged to follow up with orthopedic and her symptoms not resolved over the next several days.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that sounds like we should be able to use it, but I'm gonna wait until it gets here and then I'm gonna review it.
[CUSTOMER][NEUTRAL] OK, uh, I think there's more. I just read you, I just read you the stuff that, uh, that actually pertaining to that, but there's more I can fax two pieces of paper.
[CUSTOMER][POSITIVE] OK, yes ma'am, I'm gonna watch for it and as soon as I uh review it I'll give you a call back and let you know.
[CUSTOMER][POSITIVE] OK, thank you. I appreciate it.
[CUSTOMER][POSITIVE] OK, did you have any other questions for me today? No, I didn't thank you so much. Alright, alright, have a great day bye bye bye bye. You too, bye bye.