AccountId: 011433970860
ContactId: bb2d54c6-893c-4f8b-96a6-9bcf09c54562
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 796260 ms
Total Talk Time (AGENT): 302308 ms
Total Talk Time (CUSTOMER): 251681 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/bb2d54c6-893c-4f8b-96a6-9bcf09c54562_20250320T20:22_UTC.wav
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[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] APL, this is [PII].
[CUSTOMER][NEUTRAL] Hello, my name is uh [PII]. Let me give you my account number. It is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mm
[AGENT][POSITIVE] OK, and how can I help you today?
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh my date of birth is [PII].
[CUSTOMER][NEUTRAL] Uh, email address is [PII]. Mailing address [PII].
[CUSTOMER][NEUTRAL] Mm
[AGENT][POSITIVE] OK, thank you for providing all of that. I was gonna ask you all of those things, so, OK, how can I help?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, I just wanna know. I'm, I'm just checking on the status of because the day I got paid and I had to pay out like 16 days on one of my medical bills with uh, oh, I saw you all this one was 47, another was [PII] and one was 104.
[CUSTOMER][NEUTRAL] So I was just trying to get the payment plan, I guess, so I would, I was just trying to see what if they say anything on.
[CUSTOMER][NEGATIVE] Uh, what I filed for, what I can't think what you call it.
[AGENT][NEUTRAL] OK, did you file some claims with us on your um on our portal?
[CUSTOMER][NEUTRAL] No, I'm fine with y'all. I fax it to y'all. I did one on them.
[CUSTOMER][NEUTRAL] [PII], [PII], [PII], and the [PII]. I was just trying to see if they say yeah and nay or do I need to just keep paying it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's all I wanna know.
[AGENT][NEUTRAL] Let's see, sure.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Were they for yourself?
[CUSTOMER][NEUTRAL] Yes, ma'am, for myself.
[AGENT][POSITIVE] Uh, OK, perfect.
[AGENT][NEUTRAL] Let me see what's
[AGENT][NEUTRAL] On here.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, cause I only get paid once a month. You take like 5 $400 out of my check.
[CUSTOMER][NEUTRAL] Got a little light water and gas, yeah.
[AGENT][NEUTRAL] Yeah, I understand.
[CUSTOMER][NEUTRAL] Yeah, I'm trying to see what they say, yes or no or anything.
[CUSTOMER][NEUTRAL] So I've been waiting over a month.
[AGENT][NEUTRAL] Uh, it says.
[AGENT][NEUTRAL] Yeah, um, based on the effective date of coverage it's necessary that we.
[AGENT][NEUTRAL] retain your past medical history to determine if your claim is pre-existing. Have you received any correspondence from us?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Ma'am.
[AGENT][NEUTRAL] Have you received any letters from us recently?
[CUSTOMER][NEUTRAL] Repeat again.
[AGENT][NEUTRAL] In the mail?
[CUSTOMER][NEUTRAL] I just see one, so I got, uh, the one with the doctor's names and stuff. I got that, but I've been texting y'all on the [PII].
[AGENT][NEUTRAL] OK, let me look at another one. Hold on one moment, OK?
[CUSTOMER][NEGATIVE] Yeah, so basically they're not gonna give me anything.
[AGENT][NEUTRAL] Well, let's see, um.
[AGENT][NEUTRAL] I'm checking each one that you've sent in to see what what the status is.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Sorry bear with me.
[CUSTOMER][NEUTRAL] Yeah, cause I need to I need to find a second job so I can pay all these bills off.
[CUSTOMER][NEGATIVE] Yeah, they're not gonna help me with anything.
[AGENT][NEUTRAL] It it looks like we've requested medical records, um.
[CUSTOMER][NEUTRAL] They've been had all that stuff.
[CUSTOMER][NEUTRAL] It's be the 5th time if they ask for it again, it would be the 5th time I didn't send it to them.
[AGENT][NEUTRAL] Try to
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull up what we've received if you'll bear with me for just a moment, do you mind if I place you on a brief hold?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, I'm trying to navigate through this one I.
[AGENT][NEUTRAL] I guess he submitted all these things, but I'm kind of trying, having a little bit of a hard time deciphering.
[AGENT][NEUTRAL] Should I guess should I pull this up in on-base to see.
[AGENT][NEUTRAL] I mean you don't do claims research that's what you said so I.
[AGENT][NEUTRAL] I don't really know he's, I don't know what.
[AGENT][NEUTRAL] Um, it's 25,030.
[AGENT][NEGATIVE] Yeah, critical illness, uh, well, GCI is that, you know, it's, it's group cancer, it's cancer, yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yes, it's for [PII].
[AGENT][NEUTRAL] Well, I'm looking at all of these ins because he rattled off [PII] [PII] um.
[AGENT][NEUTRAL] All of these ones that he, these insured submissions.
[AGENT][NEUTRAL] And I'm trying to decipher what is he.
[AGENT][NEUTRAL] What are they denied for? Some of these don't have a denial.
[AGENT][NEUTRAL] Code on them, so.
[AGENT][NEUTRAL] Trying to figure out what.
[AGENT][NEUTRAL] What, what's going on?
[AGENT][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, does he have to get that or we've requested it from the healthcare provider?
[AGENT][NEUTRAL] OK, OK, OK.
[AGENT][NEUTRAL] OK, OK, got it.
[AGENT][POSITIVE] OK, OK, I will let him know thank you so much.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] OK, OK, awesome. OK, thank you. OK.
[AGENT][POSITIVE] OK, thank you, bye.
[AGENT][NEUTRAL] OK, are you there, [PII]? Sorry.
[AGENT][NEUTRAL] But that just trying to get clarification of what's happening. So we, we, it looks like we're waiting on medical records from.
[CUSTOMER][POSITIVE] Yes, ma'am, no problem.
[AGENT][NEUTRAL] One of the providers that you had seen.
[AGENT][NEUTRAL] You had sent us a list of providers that you've seen and we're still currently waiting for them to provide medical records to us so it's it's still kind of in a, it's in a determination status based on when we get those medical records.
[CUSTOMER][NEUTRAL] OK, what kind of American records y'all need so I can.
[CUSTOMER][NEUTRAL] Mail them, mail them to y'all.
[AGENT][NEUTRAL] So there's a preexisting policy on your plan.
[AGENT][NEUTRAL] And so it would be whatever you were treated for in that pre-existing policy or period. Let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What that is
[CUSTOMER][NEUTRAL] Well my uh my blood, my blood count was, what do you call it, stuff was high.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's what the doctor sent me over there in January.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They get my prostate checked.
[CUSTOMER][NEUTRAL] And 3 weeks later, he called me back and he said, oh, we want to do a prostate exam. That when they take tissue from the prostate diagnosis you have cancer. So 3 weeks I went back and I done that.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] And boom, that's when I found that I had it.
[AGENT][NEUTRAL] OK so what we're requesting from is.
[AGENT][NEUTRAL] is we have to get the medical records from your doctor. It's not something that you can submit to us. It has to come directly from the doctor and that's what we've done is we've sent them a letter requesting that information.
[CUSTOMER][NEUTRAL] OK, which doctor did you send it to?
[AGENT][NEUTRAL] And so we're waiting on them.
[AGENT][NEUTRAL] Um, whatever doc, um, let me see.
[CUSTOMER][NEUTRAL] Which one you send it to?
[AGENT][NEUTRAL] Whatever doctor you had listed that.
[AGENT][NEUTRAL] That you had seen prior to [PII].
[CUSTOMER][NEUTRAL] Doctor.
[AGENT][NEUTRAL] I can't see the.
[CUSTOMER][NEUTRAL] Doctor Who.
[CUSTOMER][NEUTRAL] That would be him. So let me get you a fax number, get on the phone and call them and tell them.
[AGENT][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEGATIVE] I can't do anything. Y'all can't help me with anything until they get that sent to y'all.
[AGENT][NEUTRAL] OK, let me give you our fax number.
[CUSTOMER][NEUTRAL] Am I right?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just let me know when you're ready.
[CUSTOMER][NEUTRAL] OK. Give me a fax number, ma'am. I'm ready.
[AGENT][NEUTRAL] OK [PII].
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] 876365, go ahead.
[AGENT][NEUTRAL] Sorry.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 9423 [PII].
[CUSTOMER][NEUTRAL] So let me call Doctor [PII], and they need to fax that over to y'all and what do y'all need the medical records from January?
[AGENT][NEUTRAL] Yeah, yeah, and
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So we need medical records if you were seen for anything prior to [PII].
[CUSTOMER][NEUTRAL] Well, that was him.
[AGENT][NEUTRAL] OK, so yes.
[CUSTOMER][NEUTRAL] My doctor, my, my main provision is [PII].
[CUSTOMER][NEUTRAL] Sent me over there to him.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So do y'all need from Doctor [PII], the radiation doctor, or Doctor Yeah, which one y'all would need it from?
[AGENT][NEUTRAL] It it would be from whoever you listed when you responded to our questionnaire that you saw prior to [PII].
[AGENT][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Doctor [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Doctor, Doctor [PII]?
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] It's like [PII].
[CUSTOMER][NEUTRAL] Uh doctor [PII].
[AGENT][NEUTRAL] [PII]. Sorry.
[CUSTOMER][NEUTRAL] Oh, so you need from Doctor [PII].
[AGENT][NEUTRAL] Yeah, the look back, yeah.
[CUSTOMER][NEUTRAL] So you, what day, what day would you need?
[AGENT][NEUTRAL] So anything that you saw him for in the entire year of [PII], that's the medical records we're looking for.
[CUSTOMER][NEUTRAL] Just give me a date.
[CUSTOMER][NEUTRAL] OK, those what you're looking for is for my knee pain.
[AGENT][NEUTRAL] OK, but we still have to have it?
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] So, and from Doctor [PII].
[CUSTOMER][NEGATIVE] But that's the only thing you're gonna see just knee pain. You're gonna just see knee pain.
[AGENT][NEUTRAL] Right, but
[AGENT][NEUTRAL] Right, but.
[CUSTOMER][NEUTRAL] So you need my knee pain, medical records?
[AGENT][NEUTRAL] Yeah, anything that so he has, he knows we've sent him that letter asking specifically what you're seeing for and they'll know to fill.
[AGENT][NEUTRAL] That out based on whatever you were seen for and Doctor [PII], so.
[CUSTOMER][NEUTRAL] So he needs to let me call Doctor [PII] and get it from him. Then I get Doctor [PII]. I call his nurse or somebody else sign some papers, but all you gonna see is my, you gonna see only the one you gonna see is in.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] December when he sent me to see him in January.
[AGENT][NEUTRAL] Right, I understand, yeah, and that's fine. We just have to have that documented, that's all.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So you gonna have one sheet of paper from him when he told me to go see him.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then you gonna see one when he had me over that did just, he just checked my prostate. Then he want me to come back in 3 weeks. That's to be for January. So that's one sheet of paper you need from him.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, so we just, like I said, it just has to come from the doctor, that's all, um, and when we receive that, we can start, we can start the process and continue on, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So what you say with the, the, the paper y'all sent out, which one did it go, Doctor [PII] or Doctor [PII]?
[AGENT][NEUTRAL] Both of them. I went to both of them.
[CUSTOMER][NEUTRAL] OK, well let me get on the phone and call the nurses and uh let them know.
[AGENT][POSITIVE] OK, yeah, and if you have any issues just give us a call back and we'll be happy to help OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, [PII], thank you for calling APL.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye.