AccountId: 011433970860
ContactId: 9846eb49-692d-49fc-b262-cd984ee61762
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2076408 ms
Total Talk Time (AGENT): 513793 ms
Total Talk Time (CUSTOMER): 393661 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=-1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/9846eb49-692d-49fc-b262-cd984ee61762_20250501T18:40_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello [PII], how are you doing?
[AGENT][POSITIVE] I'm doing well. How are you?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I'm fine. I had uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Filed a claim.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] On [PII]?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And they're asking for additional information for my claim?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] But the additional information, the information they're asking for, I cannot get it.
[AGENT][NEUTRAL] And you
[CUSTOMER][NEUTRAL] For some reason they're not completing the, the report. They say they can't complete the report.
[AGENT][NEUTRAL] OK, let me pull up your policy so I can see what's needed and then I can um try to help you with the resolution. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 985
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. and Ms. [PII], may I have your policy number?
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 44
[CUSTOMER][NEUTRAL] 9508.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I have you here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] It's my date of birth. My email is [PII]. My address is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And so is this for your medical policy or
[AGENT][NEUTRAL] The accident or critical illness? Medical?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I guess it's accident.
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] I'm gonna check medical cause accident doesn't have a claim on it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on 1 2nd.
[CUSTOMER][NEGATIVE] Cause it's not for me, it's for my son.
[AGENT][NEUTRAL] Oh, then that's why I'm looking under you. OK, what's your son's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] I have the claim number.
[AGENT][NEUTRAL] OK, yes, ma'am. May I have that please? Part 3.
[CUSTOMER][NEUTRAL] 359 3.
[CUSTOMER][NEUTRAL] 652.
[AGENT][NEUTRAL] Alright, hold on one moment, so let me go under your son.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] Oh, OK. So,
[AGENT][NEUTRAL] So who won't complete the form, the doctor?
[CUSTOMER][NEUTRAL] The police, the, the case wasn't closed because they don't know who shot him, so they can't complete it, so they're telling me that I need a um a police report.
[AGENT][NEUTRAL] No, all this is asking for is just a a description of what happened. You can fill that out on the claim form. It's a box there. You can write it in. We don't need, they just need to know what happened.
[CUSTOMER][NEUTRAL] And when I went to the
[CUSTOMER][NEUTRAL] OK, I thought that and I thought they said they need of the process of your, your claim provide the police report.
[AGENT][NEUTRAL] Let me pull up your explanation of benefits. This
[AGENT][NEUTRAL] So I'm looking at the denial code. It just says we need the enclosed claim form completed by the insured, given a detailed description of the accident or diagnosis of sickness. They're just trying to determine if the accident happened or if this is a sick claim, because this is an accident policy.
[CUSTOMER][NEUTRAL] OK, yeah, it was a, but I guess a, a shooting is an accident, huh? He didn't do it himself.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh, yes, so you, yes, definitely. Um, just go ahead and fill out the, um, did you want me to send you another copy of the accident claim form or you have, you have it?
[CUSTOMER][NEUTRAL] I have the, I have the accident claim form right here in front of me, but I didn't know if I had to fill this out or call y'all or what cause I was confused.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, no, ma'am, it's OK. Um, let me pull up the form. Hold on one second, I went to the wrong place.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, cause they mail me a form in the mail.
[AGENT][NEUTRAL] Mhm. They're just wanting you to fill out here it is. I'm trying to um show you which section so you don't have to, I think it's about 5 or 6 pages, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So you see on that first page there section C?
[CUSTOMER][NEUTRAL] Section C, yes.
[AGENT][NEUTRAL] Now you can use that box if you need more, you know, uh, space, you can like write it on a page and just scan it and upload it or if it can all fit in there, but they just, they're just wanting to know what happened.
[CUSTOMER][NEUTRAL] OK, so that's the only he just have to fill out.
[AGENT][NEUTRAL] And then down there on D.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] So spell out C and on D with the put.
[AGENT][NEUTRAL] Um, there's a, um, I'm trying to say, a selection for gunshot wound.
[CUSTOMER][NEUTRAL] OK, I see that.
[AGENT][NEUTRAL] And then that should be it. That's all I'm asking for.
[CUSTOMER][NEUTRAL] And that's all
[CUSTOMER][NEUTRAL] OK, so I should be able to um.
[CUSTOMER][NEUTRAL] Send this in the APL.
[AGENT][NEUTRAL] Mhm. And then as soon as you receive it.
[CUSTOMER][NEUTRAL] Upload it. OK.
[AGENT][NEUTRAL] Since it asks for, since this is the additional information, as soon as we receive it, we'll just go ahead and keep processing it, the claim.
[CUSTOMER][NEUTRAL] OK, so don't, don't fill out the rest of the form, just, uh, section C and D.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] Let me pull up what was sent in and see if that's, if that's all that was missing or if you should just do it all. Hold on one second, let me see. I'm gonna pull up the documents that came in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, that's why I called because I was confused.
[AGENT][NEUTRAL] Well, that's what I'm here for.
[CUSTOMER][POSITIVE] Thank you so much. I really appreciate it.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I'm like, let me call because I don't know what I'm doing.
[AGENT][NEGATIVE] And it's confusing. And I'm, I work in it and it's still confusing.
[CUSTOMER][NEUTRAL] Yes, very.
[CUSTOMER][NEGATIVE] Me too. I'm a builder and a a medical biller encoder and this is these forms of confusing.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, 4:24, we received it. OK, this is it.
[AGENT][NEUTRAL] Hold on one second, it's coming up now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 120.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] OK, Ms. [PII], if you don't mind, I'm just gonna place you on a brief hold. I see the examiner who examined this claim. I'm just gonna make sure that's all that's needed.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] All right, hold on one moment for me, OK?
[CUSTOMER][POSITIVE] Thank you, no problem.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] I don't even see no claim form.
[AGENT][NEUTRAL] OK, hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, it's the entire form. Um, we don't have it on file, just the documents that were sent over with like the billing and everything from the hospital.
[CUSTOMER][NEUTRAL] OK, so is that for both forms or I mean for both claims cause look like the person that did my claim, I didn't do it myself. I sent it in to somebody at the um office and home in um [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] But she looks like she has two separate claims.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Normally I do it myself, but.
[AGENT][NEUTRAL] Well, OK, so there, no, so there's only one claim here. Now she may have submitted it like separately and then they, they all, they put it all together once they processed it, but it's just this one claim here for us, so you just need that fill out that one form completely, make sure um that you sign and date everything because it could be denied for something missing like that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So what is, does she have an email I can email this to them or I have to mail this form back?
[AGENT][NEUTRAL] Um, no, you don't have to mail it. Let me see how this one came in.
[AGENT][NEUTRAL] Oh, this one was mailed. But no, you don't have to mail it. You can fax it or you can um upload it to our online service center, our portal.
[CUSTOMER][NEUTRAL] OK, OK, so I could just talk.
[AGENT][NEUTRAL] Um, but we, we just can't accept it through uh email because of HIPAA laws.
[CUSTOMER][NEUTRAL] OK, well I'll, uh, upload it once I finish so fill out the whole complete the whole entire form.
[AGENT][NEUTRAL] Yes, ma'am, because we don't have one on file. If there's anything that doesn't apply, um,
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Like how section E has like local transport or non-local transportation and lodging. If you don't use any of or you didn't use any of that, just put N A on there, you know, like in slash A because if anything is blank, it could be denied to, so I just, I just don't want you to have any issues. Now, also on here, so there's a portion you fill out. Hold on, let me make sure I'm on the right. OK, yeah, this is the, uh, there's a portion that you fill out.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And then there's a portion that the doctor fills out.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Now, I do see just looking through here, that might be where they mentioned it, uh, for gunshot for the gunshot wound benefit, we do need the police report, but that's not why this claim was denied, that's just on the claim form.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So the doctor needs to fill out a form as well?
[AGENT][NEUTRAL] It's all on what I'm getting ready to send to you. It's about 5 pages. So, um,
[CUSTOMER][NEUTRAL] Yeah, I have the 5, I have the 5 pages.
[AGENT][NEUTRAL] So the doctor fills out, let me go, let me see, page 5 of 5, the last page.
[CUSTOMER][NEUTRAL] OK, that's gonna be a problem because he had like 4 or 5 different doctors. That's why I thought sending in the medical records would be sufficient.
[CUSTOMER][NEUTRAL] Oh, cause that, he was at a trauma hospital, and they don't have the same doctors all the time.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] That's why I thought when I sent in the medical records, that would have been fine.
[AGENT][NEUTRAL] So let me, um, if you don't mind, I'm gonna place you on a brief hold and reach out to claims just to see because sometimes that does work. Sometimes the medical records do um go in lieu of the doctor. So let me just make sure for you, OK?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. Hold on 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.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Ferring
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Oh, hey, [PII]. This is [PII]. How are you doing?
[CUSTOMER][POSITIVE] Hey, good. How are you?
[AGENT][NEUTRAL] I'm good. I just have a quick question. I have an accident policy and it's for a gunshot wound, and the form says that we need the police report and then the doctor's part.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But she's saying how, how did she get to the doctor because he was at a trauma unit, so it was never the same doctor. So, uh she said she sent in the medical records, all the records thinking it would be good, but she doesn't know who to get because he never had the same person.
[CUSTOMER][NEUTRAL] That's OK, so if we have the medical records just get the police report.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, if they're not um if they don't go to like a physician like that's treating them consistently and they're seen in a trauma ward or an ER or something like that, um, we don't expect being able to get the physician's report so the medical records are a really good replacement for that, um, but because it's a gunshot wound we do still have to have the police report.
[AGENT][NEUTRAL] I will let her know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Police report. OK. I got it. Well, thank you.
[CUSTOMER][NEUTRAL] Yup.
[CUSTOMER][POSITIVE] OK, you're welcome.
[AGENT][NEUTRAL] All right, bye bye.
[CUSTOMER][NEUTRAL] All right, bye.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for that wait. So she said, um, no, you don't have to worry about the physician's part um because of the type of facility he was in, uh, she said, we don't expect um you to try to get to the doctor because there's so many, but as long as you have the records and I say, yes, she sent the records and she says, so you'll be fine with that, and then, but we do need the police report only because it was a gunshot wound.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] Well, they told me they can't give me a police report because it's not completed.
[CUSTOMER][NEUTRAL] They couldn't find out who did it, so they can't give me a police report for it. That's why I sent them that form from the police stating that what happened.
[CUSTOMER][NEGATIVE] But that they couldn't give me.
[CUSTOMER][NEUTRAL] Uh, um, a police report, so they rolled up something.
[AGENT][NEUTRAL] Police report.
[CUSTOMER][NEUTRAL] Yeah, they wrote up something saying what happened, but they say like it's, it's an open investigation. They don't know who shot him, so they can't give, you know, give me anything saying that it's completed.
[AGENT][NEUTRAL] OK, let me um see, hold on one moment. I'm looking through the.
[CUSTOMER][NEUTRAL] Cause he was like, yeah, he put his name on there and he was like, if they have any questions, tell them to call me because I can't give you a police report because we don't know who shot him.
[CUSTOMER][NEGATIVE] He don't know who shot him. He just was riding down the street and somebody shot him.
[AGENT][NEUTRAL] Oh God, OK.
[AGENT][NEUTRAL] The police, the, the, um, the document that the police wrote up, that's on, you submitted at the same time with the records. I'm just trying to see if I need to look somewhere else or if it's in here.
[CUSTOMER][NEUTRAL] Yeah, I did, what happened was I normally do it myself, but being that it was a lot, I sent it to the lady like I said in [PII], and she submitted everything. Now whether she submitted everything for y'all or not, I'm not sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me, I'm just gonna go through each page then. Hold on one second because this is, this is a discharge paper.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I do think so.
[CUSTOMER][NEUTRAL] Cause that's why it took me a long time to get it together because it was a lot. So I want to make sure I send in everything at the same time.
[AGENT][NEUTRAL] Do you have a copy of what the police wrote up?
[CUSTOMER][NEUTRAL] Yes, I have that copy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] You want me to upload that when I upload the uh papers that I had to fill out?
[AGENT][NEUTRAL] Yes, it looks like I got um I got like 6 more pages to go. I didn't want to say yes, yes yet because I didn't go through it all. Hold on one second.
[CUSTOMER][NEUTRAL] And that he had.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, these are, this is um this is the discharge papers, the off the um facility notes and then the itemized bill. Yes, she didn't send it over. So yes, ma'am, when you send the um
[AGENT][NEUTRAL] The explanation, go ahead and send that uh police whatever they sent in. And do you want me to check and just make sure that that's OK? I mean, I, because I just don't, I'd rather do it now instead of you submitting it and then something else comes back, you know what I mean?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] You have to send
[CUSTOMER][NEUTRAL] But that
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] That's fine. You can check and see because I was about to upload it right, OK.
[AGENT][NEUTRAL] OK, hold on.
[AGENT][NEUTRAL] Hold on one moment, OK?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] You are on hold.
[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] What?
[AGENT][NEUTRAL] She can file what she has now as in the description of police station made for her or the client. She filed already, but the report.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, thank you so much for holding. So they said, um, overall, yes, we'll still need the police report, but for now, um you can just go ahead and submit what they gave you, um, you know, until everything.
[AGENT][NEUTRAL] It's final.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK. I, um, I'm trying to submit it, but it keeps it just ain't submitting.
[CUSTOMER][NEUTRAL] I tried to upload it.
[AGENT][NEUTRAL] Oh, give it a second. Um, it'll, you'll know when it's done, you'll get a confirmation number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, well, I submitted everything that so far that y'all asked for.
[CUSTOMER][NEUTRAL] So the uh the
[CUSTOMER][POSITIVE] The uh surgery report and everything that I sent in the EOB and all that, that was good enough.
[AGENT][NEUTRAL] Yeah, she said as long as you send in the medical records and all the billing and everything, that'll that'll take care of the uh doctor's part.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][POSITIVE] OK, alright, well, I'm just waiting for this, um, everything to go through. Thank you so much. I appreciate your help.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. You're very welcome. Was there anything I can help you with today?
[CUSTOMER][POSITIVE] Thanks. Bye.
[CUSTOMER][POSITIVE] No, ma'am, if that, if I need anything I'll call you back. Hopefully I'll get you because you're very helpful.
[AGENT][NEUTRAL] All right, well, we're here.
[AGENT][POSITIVE] Alright, well, thanks for calling APL. You're welcome. Have a great day and a great weekend.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] You too. Thank you. Bye-bye.
[AGENT][POSITIVE] Thank you, bye bye.