AccountId: 011433970860
ContactId: 8aa38347-9a4c-44e1-bee3-9c4c613031a4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 478720 ms
Total Talk Time (AGENT): 253935 ms
Total Talk Time (CUSTOMER): 232880 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/8aa38347-9a4c-44e1-bee3-9c4c613031a4_20250317T14:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling AL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], it's [PII]. I've got um Miss [PII] on the phone. I know I've talked to her a couple of times already, but she's calling because she needs help with claim number 357.
[CUSTOMER][NEUTRAL] 36
[CUSTOMER][NEUTRAL] 84.
[CUSTOMER][NEUTRAL] She got her letter in the mail stating that she needed to fill out sections A through E.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] She said there is no E on her claim form.
[CUSTOMER][NEUTRAL] But she has filled out she just needs somebody to go over and make sure that what she fills out is gonna be sufficient for her client.
[AGENT][NEUTRAL] OK, um.
[AGENT][NEUTRAL] What is the policy number?
[CUSTOMER][POSITIVE] Oh, good gracious. it's um.
[CUSTOMER][NEUTRAL] It's 497172.
[CUSTOMER][POSITIVE] And the number that she's calling from is a good call back number.
[AGENT][NEUTRAL] The 601.
[AGENT][NEUTRAL] Number that's listed 824.
[CUSTOMER][NEUTRAL] 824, yes.
[AGENT][NEUTRAL] And everything's been verified.
[CUSTOMER][NEUTRAL] Yes, everything's been verified.
[AGENT][NEUTRAL] And you said it was for the claim uh ending in 3684, right?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK. Um.
[AGENT][NEUTRAL] And she's stating that claim she.
[AGENT][NEUTRAL] She doesn't have a spot on her claim form for what we're asking?
[CUSTOMER][NEUTRAL] She doesn't have an E. She has an A. She has an A through D.
[AGENT][NEUTRAL] Let me see that.
[CUSTOMER][NEUTRAL] And then she has a G.
[CUSTOMER][NEUTRAL] And um she said that she just doesn't have an E on her client form, yeah.
[AGENT][POSITIVE] Oh goodness.
[AGENT][POSITIVE] It's just for wellness, OK, you can, um, you can send her through. I hopefully I can assist her.
[AGENT][NEUTRAL] I'm not sure.
[CUSTOMER][NEUTRAL] OK. Thanks, [PII]. OK.
[AGENT][NEUTRAL] You're welcome. There's a section D, section D is what we're asking for. Where the, where you put the doctor's or provider's name. So either the physician or hospital or wherever she had the test done.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Right, and she said
[AGENT][NEUTRAL] Just a year though.
[CUSTOMER][NEGATIVE] Right, she said she did not have that filled out and that she did fill it out this time, but what she's really upset about is there's no.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII]. Have a good day.
[AGENT][POSITIVE] You're welcome [PII] thank you.
[CUSTOMER][NEUTRAL] Mm bye-bye.
[AGENT][NEUTRAL] Bye.
[AGENT][NEUTRAL] Hello Ms. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hi, good morning. My name is [PII]. I'm in the claim support team. So [PII] transferred you over. Apparently we received a claim and we were missing some information. And so there's a little bit of confusion.
[CUSTOMER][NEUTRAL] The only thing
[CUSTOMER][NEUTRAL] Yes, because it says to fill out A through E.
[AGENT][NEUTRAL] Yeah, go ahead.
[CUSTOMER][NEUTRAL] But there's no we.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I've got it filled out. I did not put, I did not put the the doctor's name and her contact number, and I've got that on there now, but there, there's no E.
[AGENT][NEUTRAL] OK, so I, yeah, I understand so actually um.
[CUSTOMER][NEUTRAL] To fill out.
[AGENT][NEUTRAL] It looks like there's, they call it sections A through F, but that last um that last portion after you put the physician's name on that form.
[AGENT][NEUTRAL] Um, that section D and then EERF would be just your signature which you already have the signature on there so you can just um go ahead and sign and date that um a lot of times some of our other claim forms might have additional sections so I'm not certain, like I said on the front of it, um, and the very first page of the claim form it says to fix to complete sections A through F, um like frank.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So it looks like to me that.
[CUSTOMER][NEUTRAL] Well now.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] I did complete, well, it's nothing on else to complete. It's just writing, uh reading different states and then on G.
[CUSTOMER][NEUTRAL] I did complete that. The only thing I see I didn't complete was the doctor's name and contact number.
[CUSTOMER][NEUTRAL] And I've put her name on there so if I fax it back is it gonna fly?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It should, as long as, yeah.
[CUSTOMER][NEUTRAL] I just don't see it and the only part of see that, that is concerned me is just having the mammogram.
[AGENT][NEUTRAL] Yeah, so
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] All the other, the lab and all that, I didn't fill out because it didn't concern me, cause I hadn't had all that. The only thing I had was a mammogram.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yeah, so it
[AGENT][NEUTRAL] Right and it looks like that was the only thing actually missing was the name of the provider I think it just gets a little bit confusing because they mentioned those other sections of the claim form they're actually part of the instructions and then also that authorization form which you already completed.
[AGENT][NEUTRAL] That as well so I think that that's just a little bit they they include those sections of the claim form and they call it, you know, section E and F, um like I said that instruction for the different states that's actually section F and then that authorization portion is G.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A
[AGENT][NEUTRAL] So the only thing left would be uh like I said, after uh where the provider name goes, your doctor's name goes is where that signature is. So as long as you fill in that um provider information, meaning the physician or hospital where you had the mammogram done, um, I think that is sufficient and that's the only thing that's missing as far as I can tell by reviewing your documents.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm gonna fax it back to them again or to you are you in the claims department?
[AGENT][NEUTRAL] Yes, and what's gonna happen is that it will actually go to our um it will go to the once you fax it it will go to kind of like our mail room it's like where they um take and and um put your information on the as far as you know who the claim is for under your policy and then they push it out to your file so it will go kind of back into the line for processing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, do I need to put a face sheet on?
[AGENT][NEGATIVE] You do not, no, no.
[CUSTOMER][NEUTRAL] Like a no because it's got wellness claim form up there. Well, I'm gonna fax it back again. I've refilled uh well I added her name everything else was correct, but her name being on there, do I need to fax the whole thing back or just that that particular part?
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, since you have the claim form, you can go ahead and just fax the claim form with both, both of the.
[CUSTOMER][NEUTRAL] I was fixing to say because it might never get to my to my claim with just her name oh.
[AGENT][NEUTRAL] Yeah, it, it will, well, yeah, we'll find it. We could find it, but it's better if you just go ahead and just redo that claim form. Pages 1 and 2 is all you need. You don't have to send back the the um the signature page for the authorization. That's correct. So just send back that claim form and first page and second page and you should be fine.
[CUSTOMER][NEUTRAL] The other.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, well thank you so much.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're so welcome, Miss [PII], and did you have any other questions?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That was all. I just couldn't find it and I thought, well, am I overlooking it?
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] No, you're fine.
[CUSTOMER][POSITIVE] But anyway, thank you, and I'll fax it to you. OK, bye bye.
[AGENT][POSITIVE] You're so welcome.
[AGENT][POSITIVE] OK, you have a great day and thank you so much for being a valued customer. Have a great day.
[CUSTOMER][NEUTRAL] You too
[CUSTOMER][NEUTRAL] Yes ma'am bye bye.
[AGENT][NEUTRAL] Bye bye.