AccountId: 011433970860
ContactId: b6c0421d-c4d6-4ed7-bb00-dc84d5583df0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1085219 ms
Total Talk Time (AGENT): 400842 ms
Total Talk Time (CUSTOMER): 247023 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=-1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/b6c0421d-c4d6-4ed7-bb00-dc84d5583df0_20250224T18:30_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], how are you? This is [PII].
[AGENT][NEUTRAL] Fine, how are you?
[CUSTOMER][NEUTRAL] I'm good, thank you. I got Ms. [PII] on the line. Uh, she asked us for a claim, uh, specialist out of the blue, and she wants to speak to somebody, um, but the policy number is 254-5851.
[AGENT][NEUTRAL] OK, you said it's it's who on the line?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Miss [PII], and she's has a question regarding a claim.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] She wanted to speak to a claims adjuster. That's, that's what she asked for.
[AGENT][NEUTRAL] OK, so you don't know if it's a claims question?
[CUSTOMER][NEUTRAL] It is a claim and it looks like it's on part two based on what she was telling me. Um, I think it's regarding claim 356-5473 if I'm not mistaken.
[AGENT][NEUTRAL] OK, for the 2325 data service?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so she has questions about that one?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, you can send it to me.
[CUSTOMER][POSITIVE] OK, you're ready? OK, thank you. Here she comes. You're welcome.
[AGENT][POSITIVE] Thanks.
[CUSTOMER][POSITIVE] Thank you for holding and being patient for Ms. [PII]. I got Miss [PII] on the line. She's gonna assist you from here. Thank you so much. You're welcome have a good afternoon.
[AGENT][NEUTRAL] Hi, Ms. [PII].
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] Hi how are you? OK, so I, OK, so I have another form that I need to send in the the doctor's um.
[AGENT][NEUTRAL] I'm fine. How are you?
[CUSTOMER][NEUTRAL] The doctor's note.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The doctor's the doctor's statement, who do I send it, send it in since the claim was denied because that was not attached.
[AGENT][NEUTRAL] OK, you'll just need to submit it to our claims, um, you, you can mail it to us. We can, you can also submit it online or you can fax it to us.
[CUSTOMER][NEUTRAL] Well I uploaded it but I had to upload it as a whole another claim.
[AGENT][NEUTRAL] OK, that's fine. Let me take a look and see if we got that you recently uploaded it online.
[CUSTOMER][NEUTRAL] It says received that's it.
[AGENT][NEUTRAL] OK, let me take a look.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I sure we did receive something on today it's looks like it's a total of let me see how many pages is here.
[CUSTOMER][NEUTRAL] I just want to hit on a um a fix attached the claim, um, the initial claim form as well.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yes, I do see we got the claim form and.
[AGENT][NEUTRAL] Let's see what else we got here receipts looks like we got a billing receipt and then.
[AGENT][NEUTRAL] Pre-op appointment information looks like was submitted.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Patient information.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Because you have to have a surgery if you see, I just sent that in as well.
[AGENT][NEUTRAL] OK, yeah, it looks like we got the receipts and then this pre-op um appointment information. Let me take a look and see.
[CUSTOMER][NEUTRAL] No, you should have got a doctor's statement as well.
[AGENT][NEUTRAL] I don't see the, let's see what else we got here, the claim form, the attending, OK, the attending physician statement you're referring to. OK, yes, we did get that as well, so we did receive that information today.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so what happens next?
[AGENT][POSITIVE] So it takes at least 7 to 10 business days for processing, so we did receive it. Um, once it is, um, everything's been provided, benefits and it's approved benefits will be paid at that time.
[AGENT][NEUTRAL] If there's additional information.
[CUSTOMER][NEUTRAL] Because do you see, because I sent this in what two weeks ago and y'all, I didn't receive nothing else from you. I just checked and then when I called she told me that I needed to send any additional information, but how do you know what additional information you need to send in if you're not saying.
[AGENT][NEUTRAL] OK, it will listed on the explanation of benefits. So let me look at the previous claim that we could.
[CUSTOMER][NEGATIVE] I never got that.
[AGENT][NEUTRAL] OK, on the previous claim looks like that was processed on the [PII].
[AGENT][NEUTRAL] Uh, let me take a look and see what we requested on that one.
[CUSTOMER][NEUTRAL] See, don't tell you what you need to send in.
[AGENT][NEUTRAL] So on the EOB if you're looking on the explanation, it does tell you on the remark code it says receipt of.
[CUSTOMER][NEUTRAL] I don't have an explanation, no.
[CUSTOMER][NEUTRAL] I don't have a remark code either.
[AGENT][NEUTRAL] So are you looking at the EOB that was mailed out to you? Did you receive that in the mail?
[CUSTOMER][NEGATIVE] I never got anything I called in.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I never got anything from you guys.
[AGENT][NEUTRAL] Were you able to pull it up online, the EOB that was sent out to you by mail?
[CUSTOMER][NEUTRAL] No, you can't pull it up online either that's what I'm telling you. I called in and they told me that I needed to send in more documents.
[AGENT][NEUTRAL] OK, so on the explanation, it looks like it was mailed out to, let me verify your mailing address. It was mailed out to [PII] and I'm gonna spell the name because I don't wanna mispronounce it. It's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Dare
[AGENT][NEUTRAL] [PII] and that's [PII]. I'm sorry.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Show me
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, so.
[AGENT][NEUTRAL] OK, so yes, it looks like that's where it was the explanation was.
[CUSTOMER][NEUTRAL] What else do you guys needed?
[AGENT][NEUTRAL] So it looks like we requested.
[AGENT][NEUTRAL] Medical records.
[AGENT][NEUTRAL] Looks like and based off the information we had, we needed additional information in order to consider benefits. We needed supporting documentation of evidence that supports the accident when it occurred, and supporting documents may include, but is not limited to either office notes, hospital admission and discharge summaries, and or diagnostic testing results or medical records.
[CUSTOMER][NEUTRAL] OK, can y'all get that from them? Or do we or do we have to get that from them?
[AGENT][NEUTRAL] Let me take a look and see if.
[AGENT][NEUTRAL] If anything has been.
[AGENT][NEUTRAL] I'm gonna put you on a brief hold, Ms. [PII], and I'm gonna further review this. Give me one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey, [PII], how are you?
[AGENT][NEUTRAL] Fine. Do you have a moment to glance at a claim?
[AGENT][NEUTRAL] OK. It is on policy 254-5851.
[AGENT][NEUTRAL] And it's on part two, [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] And I'm looking at that claim that we recently denied. So did we request medical records? I've seen that remark code on there.
[AGENT][NEUTRAL] The remark code cause I see the second remark code you have is for medical record is for medical records requested, but I didn't see any requests out here, so that's what I was trying to verify.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] So, cause on this new mail she sent, it has the physician form completed, but it looks like part of it is cut off. But it looks like the doctor is Doctor [PII].
[AGENT][NEUTRAL] Yeah, looks like she sent some receipts and a pre-appointment stuff and that's, so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Not so far.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yes, and that's what's on this position form too.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Cause
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I have her on the phone, so that's why I was just trying to double check before I let her go that we were, cause she just wanna know if we could send send it to them. OK.
[AGENT][NEUTRAL] OK, so get his contact information. OK, I'll do that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, cause even on this position form, there's no, he put this diagnosis was diagnosed back in [PII], so yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah, he didn't work. It was due to the accident, but I wonder when.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, I will let her know. Thanks.
[AGENT][POSITIVE] You're welcome. Bye.
[AGENT][NEUTRAL] Thanks for holding, Ms. [PII]. So we, we can submit a medical records request on this physician form completed. It looks like part of the attending physician information was cut off. Do you have their contact number?
[AGENT][NEUTRAL] For Dr. [PII].
[CUSTOMER][POSITIVE] Yeah, I do.
[CUSTOMER][NEUTRAL] I do and I think um wait I do hang on I'll give it to you.
[CUSTOMER][NEUTRAL] Was it cut off? Cause
[AGENT][NEUTRAL] Yeah, I'm looking at the page and I kept looking around and part of it is cut off, so I don't even know, is, is it, does the document have his contact number listed below? Because it looks like I just see part of his name and address. It cuts off where the 2731 on my on the document.
[CUSTOMER][NEUTRAL] I could send it let me see because I.
[CUSTOMER][NEUTRAL] Wait, I could see
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I could send another copy.
[CUSTOMER][NEGATIVE] A better copy.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] But let me give you his number. It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And how could I send a better copy of this? Do you need this?
[AGENT][NEGATIVE] Yeah, if you can send us a better copy, it just, I'm not sure how you uploaded it online, but part of it was cut off.
[CUSTOMER][NEUTRAL] OK, how do I send a better cop copy?
[AGENT][NEUTRAL] When you uploaded it, did it show the full document on your screen when you uploaded it?
[CUSTOMER][NEUTRAL] Uh, probably I'm, I'm not sure, um, but I could send you another copy, um.
[AGENT][NEUTRAL] OK. Just
[AGENT][NEUTRAL] Yeah, just resubmit it online. Hopefully, when you resubmit, just, just only resubmit that document.
[CUSTOMER][NEUTRAL] But then it's like you're doing a whole another claim.
[CUSTOMER][NEUTRAL] I'll just re OK um.
[AGENT][NEUTRAL] Any, any, it wouldn't be a whole another claim. It'd be another uh claim number how, however, that's just how the system processes them. It'd be just still the same claim though.
[AGENT][NEUTRAL] It'll be in regards to the same claim.
[CUSTOMER][NEUTRAL] OK, um
[CUSTOMER][NEUTRAL] OK, so then what, OK, I'm, I'm just did it again.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So once I do this, what's next?
[AGENT][NEUTRAL] So, once we receive them, once we submit the medical records request, we'll just have to wait till they provide those to us. Once we receive them from Dr. [PII]'s office, then the claim will be further reviewed.
[AGENT][NEUTRAL] And if from that information, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If we, if they provide all the requested information, then it will be further reviewed at that time.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To determine if the claim will, will be um
[AGENT][NEUTRAL] Covered or not covered based on the information.
[CUSTOMER][NEUTRAL] OK, so I just submitted the um the the another copy of the physician statement that's not cut off.
[AGENT][NEUTRAL] OK. OK, so I'll look out for that.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Is there anything else I can assist you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Nope, that's it.
[AGENT][POSITIVE] OK, well, thanks for calling APO. You have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye.