AccountId: 011433970860
ContactId: a4c6de28-66ad-48a5-8e3f-a425fae192f6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2441530 ms
Total Talk Time (AGENT): 980321 ms
Total Talk Time (CUSTOMER): 705504 ms
Interruptions: 9
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/a4c6de28-66ad-48a5-8e3f-a425fae192f6_20250422T14:16_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey Ms. [PII], my name is [PII]. I'm calling to check on a couple claims that I have.
[AGENT][NEUTRAL] OK, well, I can definitely help you with your claim status. And may I have a good number in case we're disconnected and your policy number?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Yeah, the one I'm calling you on now [PII].
[AGENT][POSITIVE] Thank you and the policy number whenever you're ready.
[CUSTOMER][NEUTRAL] OK, let me find it here. I'm looking at the, uh, I'm on the APL my app right now.
[CUSTOMER][NEUTRAL] I know it's on here somewhere.
[AGENT][NEUTRAL] You're on the site, like the portal?
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, the portal. Let's go with the first and I need the uh short term disability.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, policy number 2506754.
[AGENT][NEUTRAL] OK, hold on one moment.
[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] Alrighty [PII].
[CUSTOMER][NEUTRAL] His date of birth, mailing address is [PII].
[CUSTOMER][NEUTRAL] And what else would you needed?
[AGENT][NEUTRAL] The just the email.
[CUSTOMER][NEUTRAL] Oh, [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. OK, so for this one, let me see. So it's not requested saying that we'll need the medical history and then I see something was submitted on [PII]. Was that the history or that's a new claim?
[CUSTOMER][NEUTRAL] Uh, that was the pathology report from, uh, back in [PII].
[CUSTOMER][NEUTRAL] Uh, I got that from the doctor down there. I don't know why y'all need that, but.
[CUSTOMER][NEUTRAL] Uh, I did send that in.
[CUSTOMER][NEUTRAL] And what's the and I don't understand what's taking so long. I've been, you know.
[CUSTOMER][NEGATIVE] Waiting now this is my 4th week being off work and I need money. I don't have any money. Uh, do you know what's going on with this?
[AGENT][NEUTRAL] Hold on, I'm looking into the claims now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I'm getting very desperate here.
[AGENT][NEUTRAL] Based on the effective date. Let me look, do you mind if I place you on just a brief hold?
[AGENT][NEUTRAL] I'm just looking into everything. OK, hold on one moment.
[CUSTOMER][NEUTRAL] Please go right ahead.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, wait a minute now. Based on the effective date of coverage, it is, I thought Ms. [PII] said.
[AGENT][NEUTRAL] That only happens if it's the 1st 12 months.
[AGENT][NEGATIVE] Oh, it is the 1st 12 months. This wasn't effective until [PII].
[AGENT][NEUTRAL] So that's why.
[AGENT][NEUTRAL] She said every policy, every short-term policy, the 1st 12 months, that's what's happening. OK.
[AGENT][NEUTRAL] And then he said, well, I understand that, and then he said, OK, wait a minute now.
[AGENT][NEUTRAL] What date was that?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 13 pages Lord.
[AGENT][NEUTRAL] Wait, before I even do that, where's the.
[AGENT][NEUTRAL] No, that's not it.
[AGENT][NEUTRAL] So we haven't requested the?
[AGENT][NEUTRAL] What is this for?
[AGENT][NEUTRAL] Oh, that's that.
[AGENT][NEUTRAL] That that it'll be 4358.
[AGENT][NEUTRAL] 35898, that one.
[AGENT][NEUTRAL] 358, yeah, that's that. OK, that sounds different.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on.
[AGENT][NEUTRAL] These are just office notes, I mean.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh no, this is the uh written report.
[AGENT][NEGATIVE] I just skipped the first page look like.
[AGENT][NEUTRAL] Just explain I make sure it's present.
[AGENT][NEUTRAL] It's what it looks like. Well, let's see what this is. Yeah, it's the imaging report. I know it.
[AGENT][NEUTRAL] OK. Well, I don't know if that's what they asked for, but the answer to the question is he has to go through this because, OK, so let's go.
[AGENT][NEUTRAL] Oops.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for that wait. So I was looking at the claim, the denial reason and just trying to get caught up. So, the reason that there that the claims examiner is asking for all this is because of the time that the policy has been opened. So any disability policy that's less than a year, we have to check for pre-existing.
[AGENT][NEUTRAL] Um, and this policy wasn't active until [PII], so that's why you're having to do this because by law we have to prove.
[AGENT][NEUTRAL] Hey, this happened after he was covered with us, we can pay him out or this happened before you got covered. So that's what's happening. But I do see the um documents that were received on the [PII]. I looked at them all. I don't know if they're asking for particular dates, um, but, but I mean this does show the medical history. I didn't see where something was like sent out to a doctor or anything. So this is in processing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, I looked.
[CUSTOMER][NEUTRAL] OK, now I was told there was uh they were gonna mail, um, maybe it's called it maybe it was my other one I needed uh uh another form filled out the, uh, critical illness, maybe that's what I'm thinking about, but anyway, on the disability, how long does it take? I mean, I've sent you every paperwork that y'all requested.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] So any claim
[CUSTOMER][NEUTRAL] I'm sitting here going on 4 weeks.
[CUSTOMER][NEUTRAL] Well, no money.
[AGENT][NEUTRAL] So, all of our turnaround times except for cancer claims is 7 to 10 business days.
[AGENT][NEUTRAL] Um, we
[AGENT][NEUTRAL] We received the first claim on [PII]. That's the one.
[AGENT][NEUTRAL] That was denied for the pre-existing and then we have the one that's in processing now. So it's typically 7 to 10 business days.
[CUSTOMER][NEUTRAL] Wait a minute.
[CUSTOMER][NEUTRAL] We, we still talking about the short term disability? You're talking about the critical illness? OK, all right.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] No, no, short-term disability.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEGATIVE] Right, so it was denied and then I sent the paperwork in y'all needed and now it's still in process.
[AGENT][NEGATIVE] Yes, it was denied. Yes, it was denied on [PII] and on [PII], the pathology report and everything was submitted, so now it's in processing.
[CUSTOMER][NEUTRAL] Is that what you're telling me?
[AGENT][NEUTRAL] So Thursday, Friday.
[CUSTOMER][NEUTRAL] So we're talking 7 to 10?
[CUSTOMER][NEUTRAL] Yeah, go ahead, I'm sorry.
[AGENT][NEUTRAL] It's OK. Um, [PII], we're off on the weekends and then today is probably the 3rd day working on it.
[CUSTOMER][NEUTRAL] Oh my God.
[CUSTOMER][NEGATIVE] You know this is just not right. Why couldn't that paperwork been requested at the beginning when I sent the whole packet and all, all the paperwork y'all requested.
[CUSTOMER][NEGATIVE] From the beginning, and that one, but the pathology report, all that was not even requested at that point. And so now you're talking the 7 to 10 day period starts over.
[AGENT][NEUTRAL] Well, no, I never said that. I was just telling you that.
[CUSTOMER][POSITIVE] You know that's all well and good.
[CUSTOMER][NEUTRAL] Because that stuff was sent in the 2nd or 1st week in March.
[CUSTOMER][NEUTRAL] I'm sorry, first week in April, my mistake to y'all.
[CUSTOMER][NEUTRAL] And here it is the 3rd week in April. This is going on the 4th week.
[CUSTOMER][NEGATIVE] That I've been out of work with no income and no money coming in. I pay for this as an insurance policy, and I, you know, depend on it or something like this happens. I've got stage 4 cancer.
[CUSTOMER][NEUTRAL] All right, I need, you know, of course I have money to pay my bills, what little I can pay for a little y'all gonna pay me, but I still need the money to eat off of as well.
[AGENT][NEUTRAL] I understand that and I've had to use disability myself, so I definitely get how it feels when the bills are coming in. I mean, I don't know when it was sent, but we received it on the [PII] and it processed in 3 days, or less than 3 days because we don't even work the weekend. So we received it on the [PII], it was done on the [PII]. So I mean that's faster than they usually process, but we have to ask for what we need.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] The pathology report typically is not asked for, so I don't, I don't know where that information came from. All I know is the first claim was denied for the history and then the pathology report and everything was sent in. So I, I understand your frustration and I know how it feels when the bills are coming in, but I also know that we need to process these correctly as well. So we received it on the [PII], it was done.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We received it on Friday, it was done on a Wednesday, and we don't work the weekend, so that is.
[AGENT][MIXED] Abnormally fast, but now because of it was denied for the um medical history.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEGATIVE] It what was sent in on the [PII], which was last Wednesday, is now being processed. Thursday, Friday, we just came in yesterday. So I mean it's not like anyone sitting on it or it's being, you know, neglected, it's actually being processed fairly quickly. That was, that wasn't even 4 days.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] All right, well, the.
[CUSTOMER][NEUTRAL] Critical illness is the other policy I have.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] Uh, do you have any information update on that one? Let me get you the number here.
[AGENT][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Policy number 259 0 I'm sorry.
[AGENT][NEUTRAL] No, no, you're OK. If I have one, I can get to them all. I have it. You don't have to look for it.
[AGENT][NEUTRAL] Yes, sir. Hold on one moment. 2593.
[CUSTOMER][NEUTRAL] Oh, you got it? OK.
[AGENT][NEUTRAL] 784.
[CUSTOMER][NEUTRAL] And remind me before we get off the phone if I don't get too upset and you don't get too pissed off at me.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I want
[CUSTOMER][NEUTRAL] Uh, I need, I need some help with this portal, this app here. I can't get to pull up the documents of that.
[CUSTOMER][NEUTRAL] The PDF files associated with both the critical illness and the uh short term disability.
[AGENT][NEUTRAL] Like your, like things you've sent in or like a breakdown?
[CUSTOMER][NEUTRAL] It it says it.
[CUSTOMER][NEUTRAL] No, the breakdown on the very bottom of it says view files when I hit that.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] It shows a PDF uh symbol there.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] So when I click on it, all I get a blank pop up.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We can look into that.
[CUSTOMER][NEUTRAL] But go, go ahead with the critical, yeah, go ahead with critical illness first. It may be my phone maybe my internet. I don't know, but.
[AGENT][NEUTRAL] Oh, I see what's, OK, wait, wait, wait, wait, wait, hold on. I need to let claims know, so wait a minute.
[CUSTOMER][NEUTRAL] I can pull up the other files that I sent you.
[AGENT][NEUTRAL] So there's a cross between the two. This critical illness policy, that's what was asking for the pathology report. So I need to let
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on, let me see what this is.
[AGENT][NEUTRAL] Maybe they put it over here.
[AGENT][NEGATIVE] Because I see that first class, just like the disability, this critical illness came in on [PII], but this one was denied requesting the pathology report.
[CUSTOMER][NEUTRAL] Is that what it was?
[AGENT][NEUTRAL] So let me see what this
[CUSTOMER][NEUTRAL] I thought that was a critical illness, yeah.
[AGENT][NEUTRAL] Hopefully this is the same. Hold on one second, 2593784.
[AGENT][NEUTRAL] If not, I can see who's processing the claim and let them know that this did come in, but it was put on disability. Hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's what was confused me when you were talking about that.
[CUSTOMER][NEUTRAL] Uh oh, did you just.
[CUSTOMER][NEUTRAL] OK, so it's timed out so I gotta log back in again.
[AGENT][NEUTRAL] This looks like the
[AGENT][NEUTRAL] OK, I see. So it's the same documents, but it looks like you uploaded it to both. OK, so claims has everything they need for this one because this is the one that was asking for pathology. So yes, they have that.
[AGENT][NEUTRAL] But then now for the short-term disability,
[AGENT][NEUTRAL] Wait a minute. Let me go back to that because now is this correct medical records or is this not what they need? Because this is a pathology report. I was wondering why does short-term disability need a pathology report. OK, now that makes sense because it was supposed to be for critical illness, but it's on here also, so that's in processing under critical illness as well. So that's already in the works. So I just pulled up all those documents and it's the same. So they have what they need for that one. Let me
[CUSTOMER][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is that all you needed for critical illness or can I go back to disability?
[CUSTOMER][NEUTRAL] For the, for the critical illness?
[CUSTOMER][NEUTRAL] Well, either or I'm just trying to figure out what's going on with all of it, you know, with both of them, so, uh, as long as you.
[AGENT][NEUTRAL] OK, so critical illness is fine.
[CUSTOMER][NEUTRAL] OK, everything's in processing?
[AGENT][NEGATIVE] Yes, they denied the first one requesting the pathology report and that was sent in on the [PII] and that's in processing, but now I'm worried about the disability because, wait a minute, let me go back to disability.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] 7545. OK.
[AGENT][NEUTRAL] 25067554.
[AGENT][NEUTRAL] So this is what I'm going to do. Let me reach out to claims just to have somebody that actually examines the claim, look at this and tell me if the
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] pathology report on here is, is.
[AGENT][NEUTRAL] What's the word I'm looking for, satisfying what they're looking for for the pre-existing or if there's something else.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That they need
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, do you mind if I place you on just a brief hold while I call over to claims?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Go right ahead please do.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Need past medical history, yeah, and usually when you go here, it'll show that we requested medical records or whatever, but I don't even see that, oh Lord, I hope they didn't get them. OK, that's not my business. Let me call claims.
[CUSTOMER][NEUTRAL] Ferring
[AGENT][NEUTRAL] I wanna say that.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] and thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey Ms. [PII], this is [PII] on the care team. How are you doing?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] I'm good how are you?
[AGENT][NEUTRAL] I'm good. Um, I don't think I need to transfer, but I do need, can you look at this with me?
[CUSTOMER][NEUTRAL] Mhm. It's the policy number.
[AGENT][NEUTRAL] Um, it's 250-6754.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I was confused at first because I didn't know why the disability was asking for a pathology report, but then he also said that he had a critical illness claim, which was denied requesting the pathology report. So, critical illness has what they need, but this disability claim, you see what came in on the [PII], that's the pathology report, but it was denied because of preexisting. So is that pathology report and everything, is that
[AGENT][NEUTRAL] What, I'm trying to make sure what that [PII], the pathology report is satisfying what we requested because it
[AGENT][NEUTRAL] Looks like he uploaded it to both policies, the critical illness and disability, but disability never asked for a pathology report.
[AGENT][NEUTRAL] It just said medical records.
[CUSTOMER][NEUTRAL] Whenever they upload it through the online service center, it puts the uh information on any active policies that they have.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So it's not necessarily that we need it um if she doesn't need it, she'll deny it for whatever reason but whenever it doesn't matter if they have active policies, lap policies or whatever because it doesn't know which policy the charges would be processed under so that's why so it's not necessarily that we need anything under this disability, uh, if she can use it, she will.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Uh, but this remark code states let me see.
[AGENT][NEUTRAL] Because he's asking me because the, the denial reason is saying that we need the medical records for pre-existing, I guess because it's less than a year. Yes, ma'am.
[CUSTOMER][NEUTRAL] And this
[AGENT][NEUTRAL] So he was asking me is the pathology report, the medical records and I'm like, um, I don't think so, but let me have somebody look at this with me.
[CUSTOMER][NEUTRAL] Based on your.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] No, that's not, that's gonna be something different. So did he sign and date the the forms and turn and and send them back to our office?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, he just sent, he just uploaded this. Oh, sorry.
[CUSTOMER][NEUTRAL] Cause he should have.
[CUSTOMER][NEUTRAL] Yeah, um, that's OK, um, this claim, um.
[CUSTOMER][NEUTRAL] Bay probably send him the authorization form to sign and send it back to us so that they can obtain the medical records and uh and review them for PX.
[AGENT][NEUTRAL] OK, so let me start there then and I'm gonna see if he um signed it and sent it back. Well, I know he didn't because it's not here, but I'm gonna ask him anyway. And then if he has it, I'll tell her to go ahead and tell him to go ahead and send it in and then because I was looking on home base and I'm like, I don't even see the medical record request. I don't think this is it. So, OK, I got it. I'm clear.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm she hasn't, she hasn't sent it out yet, yeah.
[AGENT][NEUTRAL] Because he didn't send in the authorization for us to be able to, right?
[CUSTOMER][POSITIVE] Mhm. That's correct, yes.
[AGENT][POSITIVE] OK, I got it. Thank you.
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][POSITIVE] Alright, have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.
[AGENT][NEUTRAL] Lord
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, hello, Mr. [PII].
[CUSTOMER][NEUTRAL] Hey.
[AGENT][NEUTRAL] All right, thank you for holding. So, on your, the disability claim, the explanation of benefits, it had a
[AGENT][NEUTRAL] Request for authorization um that needed to be signed so that we can request the medical records. I remember when I was looking and I'm like, I don't even see the request for medical records. That's why. When you, have you received the paper explanation of benefits or you're just working on the portal?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I'm just working on the portal. I've been, I was told there was something coming in the mail, but I've never received anything.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEGATIVE] What are you talking about? I don't understand what you're asking about though as far as uh explanation benefits.
[AGENT][NEUTRAL] Oh, because when we send, so anytime we process the claim, you'll receive an explanation of benefits. We mail it out automatically, but some people use the online service center too, so in that case, they'll see it first.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So if you're on the online service center now though, right?
[CUSTOMER][NEUTRAL] Right, well, maybe that's what's attached that PDF, yeah, yeah, maybe that's what's attached, but I can't, there's nothing pulling up when I click on it though.
[AGENT][NEUTRAL] Yes, that's
[AGENT][NEUTRAL] OK. Let me see.
[CUSTOMER][NEUTRAL] When I click on let's see the.
[CUSTOMER][NEUTRAL] I get a it's like a blank pop up file viewer.
[CUSTOMER][NEGATIVE] It's got a puzzle piece in the very dead center of it and the green clothes signed on the bottom right hand corner and that's it. There's nothing else showing up.
[AGENT][NEUTRAL] There's a puzzle piece in the middle, so a plug-in is not updated. What's the, um, can you click on the puzzle?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Peace
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] I said I've done that before, but uh yeah, I'm trying and I want there's nothing happening because it's, it's a faded. It's not a stand up.
[AGENT][NEUTRAL] Do you have
[CUSTOMER][NEUTRAL] I can or anything.
[AGENT][NEUTRAL] OK, so that's probably what it is and it's not downloading. Let me send her a message. Hold on.
[AGENT][NEUTRAL] Let me go.
[CUSTOMER][NEUTRAL] So it's saying I need more paperwork then?
[AGENT][NEUTRAL] No, no, no. So for that, anytime the medical records are needed, we have to, you have to sign a release of information for us to be able to request your records. So that's what was sent with the
[CUSTOMER][NEUTRAL] I've sent copies.
[CUSTOMER][NEUTRAL] Which medical records do you need? I mean, I've sent medical records from the cancer doctor from the pathology report from my old doctor back in the [PII].
[CUSTOMER][NEUTRAL] What other medical records do you need?
[AGENT][NEUTRAL] Well, I'm not sure, but when they send the request out, they'll put specifically what they need, um.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] I, I mean, I don't know, but we can't request the records unless you say, and that's what, that's what they're asking for, that's what that PDF it sounds like, that's what that PDF is.
[AGENT][NEUTRAL] Um, I'm asking them now if there's a way that if there's a form I can access to send to you so that we don't have to wait and
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] You're right, right.
[AGENT][NEUTRAL] Um, so I'm just waiting for the answer.
[CUSTOMER][NEUTRAL] Email it directly to me or something, yeah.
[AGENT][POSITIVE] Right, so that we can get this back.
[CUSTOMER][NEUTRAL] Yeah, they
[CUSTOMER][NEUTRAL] Yeah, because I don't, I mean, I have gotten, you know, medical records.
[CUSTOMER][NEGATIVE] Uh, from my cancer, ah, most of my start had to get on my dog.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have got medical records.
[CUSTOMER][NEUTRAL] Uh, from both cancer doctor, you know, and from my, uh, the old when I, you know, originally back in the [PII], the pathology, which is, you know, pathology report you see there. I'm just trying to understand what other medical records you might need.
[AGENT][NEUTRAL] I can't answer that question, but I am writing in the um
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The examiner to see if there's something that I can pre, pre-existing medical record request is needed, but sure.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] In mail and
[AGENT][NEUTRAL] Is there
[AGENT][NEUTRAL] OK, Mr. [PII], I'm waiting for her to respond. I'm just gonna place you on another brief hold, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Sure, no problem.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] policy this email record request is needed but insurer has not received the mail and says on OSC when he clicks pay up it just has a faded puzzle piece and close option.
[AGENT][NEUTRAL] Is there a way for me to email the form?
[AGENT][NEUTRAL] For him to sign it.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] That
[AGENT][NEGATIVE] I don't think none of them is for real. I think that just comes from claims, but these are claims form.
[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.
[AGENT][NEUTRAL] OK, hello Mr. [PII].
[CUSTOMER][NEUTRAL] Hey
[AGENT][NEUTRAL] All right, thanks again for holding. I'm sorry for that wait, but I got the answer. So I am getting ready to email you a copy of the authorization, um, and then you can either just reply back to the email and, you know, attach the completed copy, or if you wanted to, you can upload it to the online service center as well. Um, but I did speak to the claim.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] OK, can I e-sign that?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, OK, so I can sign it I'm, I'm on the phone right now or on my.
[CUSTOMER][NEUTRAL] Email right now so I'll do it while we got while we're on the phone together here.
[AGENT][NEUTRAL] OK, hold on one second, I'm getting ready to send it to you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm an old fart so.
[CUSTOMER][NEUTRAL] Bear with me on the phone stuff.
[AGENT][NEUTRAL] Well
[AGENT][POSITIVE] Oh my goodness.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Oh, I'm, I'm, I'm pretty good.
[AGENT][POSITIVE] We're gonna get it together Tuesday.
[CUSTOMER][MIXED] I'm pretty good on the on the computer system but not expert by any means.
[AGENT][NEUTRAL] It's OK. We're gonna fix it. Hold on one moment. All right, so I just attached it and let me hit send. I didn't put anything in the message or anything. I just sent it.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] Make sure if it comes in.
[CUSTOMER][POSITIVE] Uh, and bless your heart. Thank you so much for staying with me on this and just trying to figure all this out.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEGATIVE] Because I'm hurting, uh, uh, I, I mean, I'm really struggling right now so.
[CUSTOMER][NEGATIVE] No money, no way to buy food and groceries and
[CUSTOMER][NEUTRAL] I just feel like everybody's forgotten about me.
[AGENT][NEUTRAL] Well, we definitely have not, and it's, it's a scary process. I was, um, I was in a bad car accident, two cars hit me head on and the engine dropped down in the car and broke my leg. I have like plates and screws and stuff. Yeah, that is good. I had to learn how to walk and everything, but I had to use this ability. So when I and I have a a little one too, so I, I was, it was bad.
[CUSTOMER][NEGATIVE] Oh, no.
[CUSTOMER][NEUTRAL] Oh my God.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] I am so sorry to hear that. I, I can almost feel for you because I've got an artificial knee and an artificial foot both on the same leg and uh.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] Well, I definitely understand what you're feeling.
[CUSTOMER][NEUTRAL] And and not only that, I
[CUSTOMER][NEUTRAL] I broke my back, it's been 15 years ago, I guess now. I had to have uh rods and pins and everything put in my back, and I was paralyzed on the right side.
[CUSTOMER][POSITIVE] And was able to had to work through, like you said, learn how to walk, you know, and finally got the feelings but my, my spine twisted.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] And luckily never, never broke the uh spinal cord.
[CUSTOMER][NEUTRAL] And but the one of the little wings on your uh vertebrae was, um, push it up against my spinal cord.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And that's why I lost my right side and end up having to.
[CUSTOMER][NEUTRAL] And once they put it back in place and everything, I uh had to learn how to walk again.
[AGENT][NEUTRAL] It's a whole, it's literally a journey. You see it? OK.
[CUSTOMER][NEUTRAL] OK, I'm looking at it right here.
[CUSTOMER][NEUTRAL] It is uh author authorization to disclose protected information. What do I gotta do here? Where am I at?
[AGENT][NEUTRAL] So, um, you, so right click that and put uh save all attachments or save as.
[AGENT][NEUTRAL] And it'll save it to your computer or if you
[CUSTOMER][NEUTRAL] OK, let me
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] I'm on the phone here, you know, I've got, I pulled it up on my phone, yeah, yeah, I pulled it up on my phone here. I'm, I'm not sitting on the computer.
[AGENT][NEUTRAL] Oh, you're on the phone.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, operation to disclose. I mean how much is it I gotta fill out?
[AGENT][NEUTRAL] Everything and make sure you sign and date it.
[AGENT][NEUTRAL] But we're gonna go through it together if you want to, um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] It's not letting me.
[AGENT][NEUTRAL] It's probably because you're on the phone. Do you have a laptop?
[CUSTOMER][NEGATIVE] It's not letting me.
[CUSTOMER][NEGATIVE] I do, but it's gonna take a thing an hour and a half to boot up. It's an old laptop.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'll do it that way and where do I let's see the structures up here where I send it back to.
[AGENT][NEUTRAL] Well, you can either reply back to my email and just send it back or you can, um, once you fill everything out, you can upload it to the online service center, whichever one is easier for you.
[CUSTOMER][NEUTRAL] Which
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh-huh, OK.
[CUSTOMER][NEUTRAL] Either either or? OK.
[AGENT][NEUTRAL] Mhm. But just make sure.
[CUSTOMER][NEUTRAL] Yeah, is this not
[CUSTOMER][NEUTRAL] I've got one in uh huh go ahead.
[AGENT][NEUTRAL] She said, make sure you fill it out to its entirety and make sure you sign and date it.
[CUSTOMER][POSITIVE] Yeah, that's no problem, um.
[CUSTOMER][NEUTRAL] Yeah, this I got a fold phone, uh, you know, one of those folds out so it's almost as big as a.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Tablet, uh, but it's for some reason the attachment it's not letting me fill in the blanks on the form, so I'll have to uh get my computer out and download it I guess.
[AGENT][NEUTRAL] Mhm. Download it, fill it out, and then reupload it.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Yeah, I may have to print it out and do it.
[CUSTOMER][NEUTRAL] And then take a picture of it like I did the uh uh pathology report what have you.
[AGENT][POSITIVE] Oh, no, you can do that too.
[CUSTOMER][NEUTRAL] And then send it over with the uh to the portal.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But either way, as soon as we hang up I'll start getting on that now. Did she, did you ever get a uh.
[CUSTOMER][NEUTRAL] An answer as to what medical records y'all needed?
[AGENT][NEUTRAL] No, no, no, she, I was talking to the supervisor, not the.
[CUSTOMER][NEUTRAL] Because I thought I'd sent everything.
[AGENT][NEUTRAL] Yeah, I wasn't talking to an examiner, but um,
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] That's hard to say. I wasn't talking to the examiner, I was talking to the supervisor um to get the form for you, but
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Just to be on the safe side, I'm gonna say from September to today, but there may be specifics that they're looking for just for this claim. I'm, I'm not sure. On the once this comes back to us, then we send out um like the request and it like bullet points, exactly what we need, but because that's not here yet, I'm not sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, right, right, right.
[CUSTOMER][POSITIVE] OK, no problem. Well, let me get off here so I can get on this and, uh, uh, just so I get it filled out and signed and uh I'll get it back to you.
[AGENT][NEUTRAL] Alrighty, well, I'm the only [PII] here. If you need anything, any of us will be more than happy to help you, but if you want to get back to me, it won't be hard. Um, was there anything else I can help you with today, Mr. [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Not right now, dear. I sure appreciate your supervisor have any status update on, uh, on the disability or the uh critical illness by the by by chance this year.
[AGENT][NEUTRAL] Critical illness is, is processing the pathology report. The disability is kind of on hold until we get this in and can request the records and then the ball gets rolling.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Not a problem, let me get it done then.
[AGENT][POSITIVE] Alrighty. Well, thank you for calling APO. You're very welcome. Have a good day.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Alright bye bye.
[AGENT][NEUTRAL] Bye bye.