AccountId: 011433970860
ContactId: a431aab3-2ced-40bb-b002-adf5481e5cd8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1010059 ms
Total Talk Time (AGENT): 454691 ms
Total Talk Time (CUSTOMER): 331924 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/a431aab3-2ced-40bb-b002-adf5481e5cd8_20250122T22:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. With whom am I speaking? How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] in the care team. I've got, um, hey, I've got [PII], um, I'm gonna say his name wrong let me let me do this again.
[AGENT][NEUTRAL] Hi, [PII].
[CUSTOMER][NEUTRAL] This is the spouse of the insured. The insured's name is [PII]. This is [PII] on the other line. He, the policy is lapsed because Ms. [PII] passed away. He said sent in a claim on January.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The 6 that was reported, the claim number is 3552119 and it.
[AGENT][NEUTRAL] Can you give me the policy number?
[CUSTOMER][NEUTRAL] Yes, I'm sorry. It's 15927007.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 2707. OK, alright, mhm, and what were you saying now about that claim?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes, um, the remarks on it say that.
[CUSTOMER][NEUTRAL] There's different remarks and notes on it, miscellaneous correspondence, um, the notes on the policy state that the claim was submitted in error and that was done by [PII], I believe.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And there's anyway he needs assistance with this claim and the status and what what is.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Well, do we have permission to speak to him? Because I don't see he is the beneficiary and is he listed on the third party screen? Mhm.
[CUSTOMER][NEUTRAL] He's
[CUSTOMER][NEUTRAL] I do not see that.
[CUSTOMER][NEUTRAL] No, I looked on the third party screen. He says that he is the one that sent in the claim that he spoke to people before, so.
[CUSTOMER][NEUTRAL] I did not see him on CLHIP.
[AGENT][NEUTRAL] OK, alright, well, it's gonna, he'll, uh, da da. OK, just go ahead and send him over. Did you verify his information? What is the callback number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I did, I did the call back number is [PII].
[AGENT][NEUTRAL] OK, alright, thank you. OK, go ahead and send him over. Mhm.
[CUSTOMER][NEUTRAL] And he was able, and he was able to give the um.
[CUSTOMER][NEUTRAL] Miss [PII]'s information he was able to give the address, the phone number and everything he did verify out.
[AGENT][NEUTRAL] OK, alright. Go ahead and send him over. Mhm.
[CUSTOMER][POSITIVE] OK. All right. Thank you, Ms. [PII]. All right, bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. Is this Mr. [PII]? Is it [PII] or [PII]?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] OK. I just want to make sure. OK, thank you for that information, sir. So I understand that she states that you're calling uh about a claim that was um submitted and um my condolences for your loss, your spouse passed away, so the policy is lapsed. Now, let me take a look at this and see what might have transpired with that claim. Is that what you're calling regarding?
[CUSTOMER][NEUTRAL] Yes, I did receive a text message stating that the claim had been processed and it gave me a number of codes in that text message.
[CUSTOMER][NEUTRAL] And I believe that was about 3 days ago I received that.
[AGENT][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] And it's it's it's in regard to charges from UT Southwestern Hospital.
[AGENT][NEUTRAL] Alright, let me see if I can get, take a look at it. I see someone answered some notes. Um, I'm gonna place you on a brief hold while I take a look at it, OK? Is that alright?
[CUSTOMER][POSITIVE] No, that's fine. Thank you.
[AGENT][NEUTRAL] Thank you. And I do understand she verified, she had to verify your late spouse name, date of birth, address, is that correct?
[CUSTOMER][NEUTRAL] Yes, I don't believe she got my date of birth. She got the address.
[AGENT][NEUTRAL] No, her date of birth, her date of birth.
[CUSTOMER][NEUTRAL] Oh, my wife is uh [PII].
[AGENT][NEUTRAL] Yeah, yes.
[AGENT][NEUTRAL] OK. All right. So I'm gonna place you on a brief hold for one moment, OK? Thank you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK. Thank you for uh patiently waiting, mister um
[AGENT][NEUTRAL] Uh, [PII], now I've looked at the claim number that you discussed with the previous rep. That's not a claim that was submitted by you all, so that's why I had to place you on hold because it really wasn't making sense to me. Uh, that claim number she gave you that she discussed with you 3552119 was a medical records invoice that UT Southwestern sent us for payment for medical records, OK, uh, prior to that.
[AGENT][NEUTRAL] The only other claim I see that was received on this account was in December and again that was it it was the medical records from UT Southwestern and we didn't, we didn't request any medical records so I don't see where what claim are you referring to that you sent in and when did you send it in?
[CUSTOMER][NEUTRAL] OK, well, it, it, when you say it's a claim, it's the records from UT Southwestern.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it was like maybe 15 or 20 pages.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Which identified all of the services that they provided and the codes that, you know, that you needed to have the codes.
[CUSTOMER][NEUTRAL] And that was sent by USPS to your locatio[PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And received at your location on the [PII] at [PII]
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] That was the invoice, but prior to that it was medical records, and they reviewed those medical records and
[AGENT][NEUTRAL] Um, let me, let me finish looking at this first because I don't even see that these are nothing, but we never received the medical records unless you're telling me you sent them. Now if you sent them we have not received them. All we have received again is an invoice from UT Southwestern.
[AGENT][NEUTRAL] Telling us they are requiring $60.28 to release medical records. We did not make that payment because we have not requested any medical records, so we denied that that claim DM 41, which states we did not request medical records and then we also called UT Southwestern. They also called UT Southwestern on let me see the notes when they called, um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let's see here.
[AGENT][NEUTRAL] Uh, they call UT Southwestern on [PII] of this year, and the representative spoke to a [PII] at UT Southwestern Medical record department. She advised them at that time that, uh, they did not request any medical records, that the hospital is not requesting any medical records, and they're gonna void that invoice.
[CUSTOMER][NEGATIVE] OK, well just forget about all of that. That has nothing to do with why I'm calling.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I sent, I sent you a copy.
[CUSTOMER][NEUTRAL] Of the actual medical record printout with the codes for the services provided, the entire year of medical records was sent to you.
[CUSTOMER][NEUTRAL] It was sent by USPS and I've got confirmation back from USPS, the tracking number.
[CUSTOMER][NEUTRAL] That you received that on the [PII].
[CUSTOMER][NEUTRAL] The actual
[CUSTOMER][NEUTRAL] Printed out medical records.
[CUSTOMER][NEUTRAL] Forget about the request and what you were talking about getting the fee paid by UT Southwestern.
[CUSTOMER][NEUTRAL] They sent the medical records to me, so I in turn sent them to you.
[CUSTOMER][NEUTRAL] In an envelope from USPS United States Postal Service.
[CUSTOMER][NEUTRAL] And again it was received at your location.
[CUSTOMER][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] Of this year
[AGENT][NEUTRAL] And what address did you send it to?
[CUSTOMER][NEUTRAL] It would have been your [PII] City address that you've got on all of your documentation.
[AGENT][NEUTRAL] OK, well, I, I have to ask you that because as I previously stated to you before I got into what UT Southwestern with the invoice as previously stated to you we have not received it so I'm telling you again we have not received it so I have to verify what address you sent it to because I have to make a note of this and then you can give me UPS tracking number so that they can investigate this and somebody will have to call you back. What's the tracking number?
[CUSTOMER][POSITIVE] Yeah, I can give you.
[CUSTOMER][NEUTRAL] The tracking number for UPS is 9505.
[CUSTOMER][NEUTRAL] 5105
[CUSTOMER][NEUTRAL] 777 8
[CUSTOMER][NEUTRAL] 5010.
[CUSTOMER][NEUTRAL] 987 3
[CUSTOMER][NEUTRAL] 60.
[CUSTOMER][NEUTRAL] And remember I told you I received, I received a text.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just about 8 days ago.
[CUSTOMER][NEUTRAL] With several, like 7 codes on it.
[CUSTOMER][NEUTRAL] Indicating that you had in fact received those records.
[AGENT][NEUTRAL] I'm seeing that you would have received notification that we denied a claim on uh on uh I'm sorry, [PII], they denied one claim.
[AGENT][NEUTRAL] And then on [PII] they denied a claim.
[AGENT][NEUTRAL] So uh sir, I don't see it and it has to be investigated. I'm not seeing that we have it and there's something they'll have to investigate. So I'm gonna read that tracking number back to you for USPS 9505510577785010987360, is that correct?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, and what is a good number where someone can return a call to you once they finished doing an investigation?
[CUSTOMER][NEUTRAL] And by the way, the records were sent to [PII].
[AGENT][POSITIVE] Mhm. OK. Thank you.
[CUSTOMER][NEUTRAL] [PII], Oklahoma, and I also put on the envelope to the cancer section.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And verify your phone number.
[CUSTOMER][NEUTRAL] So all that
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, alright, thank you. Alright, so I will have to, uh, send the email for them to investigate what might have happened with this package because it has not been scanned in the system. We do not have any medical records and I'm not sure what you receive notification of, but I'm not seeing any medical records on the, the, the, the, um, file, but let me check one more thing and make sure, Miss [PII], she has another policy, maybe it's under this policy we'll see.
[AGENT][NEUTRAL] So like she has two policies.
[CUSTOMER][NEUTRAL] Well, that would be odd because like it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It might be up under this other policy.
[CUSTOMER][NEGATIVE] I'm not sure why they would send a text.
[AGENT][NEUTRAL] No, I don't see it under your eyes.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Give me 1 2nd.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] No, I don't see it. And she definitely uh had two policies, but
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] That just means that it looks like.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] It looks like there might have been an upgrade to her employer and sometimes when you upgrade or downgrade you get a whole another policy number and it starts with a different date.
[AGENT][NEUTRAL] And that's what has happened, um, that, that's, that's just the way APL does it, but I do not see them, and I'm gonna, uh, send the email to the schedule for them to, um, investigate this, OK.
[CUSTOMER][NEUTRAL] No, there's, yeah, they're gone.
[CUSTOMER][NEUTRAL] Well, there should be only one policy number. It was through the Arlington Independent School District.
[CUSTOMER][NEUTRAL] My wife was a teacher.
[CUSTOMER][NEUTRAL] And it was through the Arlington Independent School District, and there was only one policy.
[AGENT][NEUTRAL] And as I explained, Mr. [PII]?
[AGENT][NEUTRAL] This is the way APL did it. This is the way we do it, um, apparently there was an upgrade or a downgrade at the school district at some point. When that happens there is a new policy number that that is issued for the new benefits to start on whatever date you're supposed to start on.
[AGENT][NEUTRAL] That's all it is. The old policy she had ran from [PII]. The new policy ran from [PII]. That's all, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, no, I just need to get this resolved because I need the funds in order to pay bills, so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I don't know. I think this happened before again. I sent something to [PII] City and they, they lost it the last time too.
[AGENT][NEUTRAL] OK, well, I apologize and yeah I don't know what's going on that's why I said I have to send it to someone, uh, for them to investigate unfortunately because I don't see the records loaded on the file.
[CUSTOMER][NEUTRAL] I don't know why
[CUSTOMER][NEUTRAL] So how do I follow up?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Um, I'm sending a message to the individual that to the department that's supposed to handle this. They will return a call to you. Someone from here will return a call to you.
[CUSTOMER][POSITIVE] OK, very good.
[AGENT][POSITIVE] OK, alright, OK, well thank you for calling APL, Mr. [PII]. You have a great day and stay safe. Bye bye.
[CUSTOMER][NEUTRAL] Bye-bye