AccountId: 011433970860
ContactId: bfb02417-053e-4c17-8da7-d6418523c945
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 593719 ms
Total Talk Time (AGENT): 376047 ms
Total Talk Time (CUSTOMER): 130203 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/bfb02417-053e-4c17-8da7-d6418523c945_20250220T16:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you?
[AGENT][POSITIVE] I'm good. How are you, [PII]?
[CUSTOMER][NEUTRAL] Doing all right thank you. I've got an insured he's wanting to speak with y'all regarding an accident claim um looks like we're missing quite a bit of information and he just wanted to review what was submitted.
[AGENT][NEUTRAL] OK. What's that policy number?
[CUSTOMER][NEUTRAL] It is 02574933.
[AGENT][NEUTRAL] OK, give me just a minute.
[CUSTOMER][NEUTRAL] And it was for uh huh it was for part one.
[AGENT][NEUTRAL] Part one, OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, looks like that's the only claim we have on file anyways, OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, I have those documents pulled up. Let me get over to his policy real quick so I can see what all we denied for just to make sure I'm not.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] No, it's honestly I'm looking at all of it and I was like we're missing everything it looks like but.
[AGENT][NEUTRAL] Giving him any wrong?
[AGENT][NEUTRAL] Probably yeah OK so claim form we need the claim form.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, I have it all pulled up so I can go over that with him.
[CUSTOMER][POSITIVE] All right, I appreciate you. Bye bye.
[AGENT][POSITIVE] No problem. Bye.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hi, can you hear me?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hello. OK, yeah, my name is [PII]. I have a claim with you guys. They y'all just called me. I just called. They said my claim forms incomplete or something. I don't know.
[AGENT][NEUTRAL] OK, um, I'm looking now, let's see.
[AGENT][NEUTRAL] Let me.
[AGENT][NEUTRAL] OK, so it looks like we received your claim form but it's not signed.
[AGENT][NEUTRAL] And so we'll need it has to have a signature on it for us to be able to consider it um and then let's see.
[AGENT][NEUTRAL] Trying to see if there's any type of diagnosis or anything on your
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] On your billing.
[CUSTOMER][NEUTRAL] I mean, the attending physician said there was a diagnosis when they sent it to you.
[AGENT][NEUTRAL] Oh got you OK alright let's see.
[AGENT][NEUTRAL] It could be on the other page let me see here.
[AGENT][NEUTRAL] Pain of the left knee joint.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, since it doesn't look like we specifically requested diagnosis codes, I'm going to say that the examiner feels that they have enough it's just that um we do not have the claim form signed. So I know that seems trivial but unfortunately we do have to have um the claim form signed to be able to review that.
[CUSTOMER][NEUTRAL] You mean signed by me? You mean signed by me, the physicians.
[AGENT][NEUTRAL] Yes, signed by you, yeah, yeah, theirs is signed. Theirs is is taken care of um but your portion that you filled out um that is not signed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see what page is that?
[CUSTOMER][NEUTRAL] So do you wanna email me what you have? I'll sign it, scan it and email it back to you.
[AGENT][NEUTRAL] Uh, let's see, statement of insured.
[AGENT][NEUTRAL] Yeah, so it was your statement that's not signed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sign claim form is there anything else you guys need from me?
[AGENT][NEUTRAL] As far as I can tell, no, um, again I looked at the claim and how they processed it the note on there just says that to please ensure the accident claim form is signed and dated um it doesn't say anything about needing any additional information so based off of that I would say that the examiner currently feels like they have what they need um oh hang on, I am looking at something I went a little deeper just to make sure.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So the billing that was sent over, I don't know if this was sent by you or by them, but it it does not have diagnosis codes. That's what I was afraid of. Um, so we need something, billing, medical records, something that have a diagnosis code for your treatment with the orthopedic, um, that we have 17 of 25 and 114 of 25 where you're seen.
[AGENT][NEUTRAL] Because we have a bill, but it doesn't have your diagnosis code on it and we do have to have a diagnosis code to make sure that it lines up with your policy provision for an accident.
[CUSTOMER][NEUTRAL] OK, so where do I put the diag I mean I can just call him and get the diagnosis codes correct?
[AGENT][NEUTRAL] So we'll have to have like a physical something. It, and it can be, like I said, it can be medical records. Um, if that's easier for you to obtain for these visits, like an aftercare summary that says, you know, you were seen for and then it tells basically what your diagnosis was. Um, but it does have to be physical. It can't be a written or a called in diagnosis.
[AGENT][NEUTRAL] Does that make sense? Am I explaining that well enough?
[CUSTOMER][NEUTRAL] I mean, it, it, it makes sense. I don't know, I make sense. I don't know how I'm gonna, well, I mean, you know what I mean, like I like, like I'm not like trying to be rude, but like what y'all want me to call them and say give me a diagnosis code, but I need you to give me a diagnosis code on something other than what you guys sent to them already because the bill doesn't have a diagnosis code so you've gotta get.
[AGENT][NEUTRAL] No, yeah.
[AGENT][NEUTRAL] Right, which is why, yeah, which is why I was saying that like the medical records for like their your visit summary for those days would be OK.
[CUSTOMER][NEUTRAL] But what, what do they put on.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] So call them and say send them the my medical records.
[AGENT][NEUTRAL] I mean if they're if they're the ones submit it for you and you don't have access to your medical records online so that you can just download them like I don't know if they have something like a MyChart or something like that where you could just go in and obtain them um but.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so.
[CUSTOMER][NEUTRAL] Maybe it's maybe they have something. Is there something else that you need other than those two things?
[AGENT][NEUTRAL] I don't see anything. No, it looks like we just need that signed and then we need the diagnosis codes um for your treatment, basically.
[CUSTOMER][NEUTRAL] OK, and then typically how long does it take after receiving all the information?
[AGENT][NEUTRAL] Um, we ask that you allow 7 to 10 business days usually depending on what we have as far as um what's ahead of you, um, we.
[AGENT][NEUTRAL] Can get it done a little faster, but we ask that you at least allow 7 to 10 business days. Typically I would say um we can process within 3 to 5.
[CUSTOMER][NEUTRAL] 70.
[CUSTOMER][NEUTRAL] OK, 7 to 10 business days to do what?
[AGENT][NEUTRAL] To process the claim completely so if it's once we receive.
[AGENT][NEUTRAL] What we need and we've got everything we need we review it and we ask that after the day it's received so let's say you're able to obtain all that and you get it sent in today, you know, like they, they're like, OK, yeah, here you go it's sent today we ask that you allow 7 to 10 business days from the day that we receive it, which if it's received today, that would be anywhere between next Thursday or the following what? Tuesday?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, does that mean?
[AGENT][NEUTRAL] Yeah, so it, go ahead.
[CUSTOMER][NEUTRAL] Checks in 10 days or you're just having an answer in 10 days?
[AGENT][NEUTRAL] It if it's a payable benefit if we do find that we are able to pay benefits then we you would be issued the payment at that time it's not gonna take any additional time after that now if you're set up for direct deposit, you would need to allow possibly a few days for it to hit your bank account because that depends on your, your institution. If you get a check then obviously you have to wait on the post office to get that to you so that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Any extra time after it's processed would depend on what you're set up for and how long it takes for you to get it.
[CUSTOMER][NEUTRAL] OK, can you just email me that form then?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure, is um let's see, let me get over to that.
[CUSTOMER][NEUTRAL] What email do you have for
[AGENT][NEUTRAL] We have the [PII].
[CUSTOMER][NEUTRAL] OK, and I can just return this these documentations to the email that it's coming from now?
[AGENT][NEUTRAL] Yes, it'll come from our claims team email so um.
[CUSTOMER][NEUTRAL] OK, and I can just turn it my team email.
[AGENT][NEUTRAL] Yeah, you can just return it mhm.
[CUSTOMER][POSITIVE] OK thank you I'm sorry I'm just in a hurry right now I appreciate your time.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, you're fine, you're fine.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] I will get that over to you. You're very welcome have a great day.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Alright bye bye.