AccountId: 011433970860
ContactId: c903c01b-98e9-4755-a834-8231f39123ca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 425329 ms
Total Talk Time (AGENT): 123731 ms
Total Talk Time (CUSTOMER): 215613 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/c903c01b-98e9-4755-a834-8231f39123ca_20250226T21:36_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], it's [PII]. I have Ms. [PII], um, policy number 740,240.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] She's calling in regarding to the claim for [PII] participant 5.
[CUSTOMER][NEUTRAL] And she is stating it looks like on claim number 353-5266 we requested.
[CUSTOMER][NEUTRAL] Medical records.
[CUSTOMER][NEUTRAL] And she's stating that she can go and pick those up and wants to make sure that it would be acceptable if she goes and picks them up and submits them online.
[AGENT][NEUTRAL] OK. I mean, yeah, they can always send in medical records for us to review, um.
[CUSTOMER][NEUTRAL] That's fine. I told her that. She said, well, I just wanna make sure cause it's over 30 minutes one way, you know, and so I said, OK, hang on.
[AGENT][NEUTRAL] Yeah, I mean,
[AGENT][NEUTRAL] Yeah, I mean, I mean as long as I mean we we'll still review it if we would need any additional information I mean they, I mean I'm not saying it's like a guarantee whatever she's gonna send in it's going to be gonna process the claim, but I mean we will always review whatever they send in, yeah.
[CUSTOMER][NEUTRAL] And to get it.
[CUSTOMER][NEUTRAL] Yeah, that's what, uh, do you mind just telling her that so she will be feel comfortable with it?
[AGENT][NEUTRAL] Uh sure. She has to speak to a supervisor?
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] Not a supervisor, but she wants to make sure and you know, sometimes being told the same thing from someone else.
[CUSTOMER][NEUTRAL] It's just, but I mean, if you don't want to tell her that, I can go back to her and tell her because I've already told her that we would accept it.
[AGENT][NEUTRAL] OK, I mean, yeah, if you, if you need me to tell her again, then that's fine.
[CUSTOMER][POSITIVE] Alright, if you don't mind, hang on just a second, thank you, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Miss [PII].
[CUSTOMER][POSITIVE] Yes, ma'am. Thank you for your patience. I do have [PII]. She is in our claims department. I did ask her and she stated that she can that we can receive medical records submitted by the insured, but she will be happy to tell you that as well if needed.
[CUSTOMER][POSITIVE] Oh yes, thank you. You're welcome, Ms. [PII]. Here's [PII].
[CUSTOMER][POSITIVE] Thank you, thank you.
[AGENT][POSITIVE] Yes, Ms. [PII], thanks for holding. Uh how can I help you today?
[CUSTOMER][NEUTRAL] Hi [PII], I got a letter in the mail today and I apparently I guess AdventHealth is not cooperating with getting you guys the records for [PII]'s claims that I submitted back in November.
[CUSTOMER][NEUTRAL] Um, I was telling the, the lady on the phone I can go pick them up at the hospital. Um, it's faster if I request them because we get them right then and there from them, but I don't know if the hospital's 30 minutes away from me, so I don't know if you guys, I didn't want to go make the trip and then you guys not accept them because they're coming from me, um, so I wanted to verify that if you guys will accept them for me coming from the hospital, I don't mind picking them up.
[AGENT][NEUTRAL] Oh yes ma'am. Uh, so yes, whatever documentation you send us, we will review as a part of your claim, um, and so it once the adjuster reviews them, I mean if there's any additional information that they need, then they will probably should be sure to reach out to you or the provider, but yes, we will accept and review any documentation that that you send for your claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, because I did submit the medical records for me. If I'm correct, I believe I did, and they came from the facility.
[CUSTOMER][POSITIVE] Are you able to look to see what was sent? I, because I, I'm positive I sent them.
[AGENT][NEUTRAL] OK, did you have a a
[CUSTOMER][NEUTRAL] It's the claim that was submitted back in November.
[AGENT][NEUTRAL] OK, uh sure. Bear with me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so the one I see that was in November. I see that that claim is still pending. It looks like for the records.
[CUSTOMER][NEGATIVE] Yeah. Yes, yes, but I think I did send them. Like I think I, I remember sending, downloading his records and, and I sent them, but I, can you, I just want you to verify cause if it's the if it's gonna be the same thing, if I send you all the records and they didn't honor it, then it's gonna be pointless for me to go get them again and it's and they're not gonna, they're they're not gonna honor it.
[AGENT][NEUTRAL] OK, let me see what we received on November, uh, bear with me just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I would have sent them two different times because it would be November with the original claim and then I think I sent them again later on another set of records.
[CUSTOMER][NEUTRAL] I don't know what I don't mean I'm not the.
[AGENT][NEUTRAL] OK, you see it on November, do you see where we received the claim form and an itemized bill and then it looks like there was also an after visit summary as well.
[AGENT][NEUTRAL] Um, but it looked like the, uh, adjuster was needing some additional information and so that's why they reached out to the provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so the actual medical records were not sent then, correct?
[AGENT][NEUTRAL] Well, it looks like we have an after visit [PII]ary, um, but sometimes that does not give a complete information and so we would do request additional information if we're not able to confirm all the information that we need for the claim as such as like treatment or diagnosis, um, those types of information.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, yes, OK, what I'm gonna do is I'm gonna go over, I'll break the drive because like I said it's it's an hour round trip which I don't mind making it, but I wanna make sure you guys are gonna honor what I send first.
[CUSTOMER][NEUTRAL] Um, but I guess it's not a guar like you say, it's not a guarantee.
[AGENT][NEUTRAL] Well, well, yeah, so.
[AGENT][POSITIVE] Oh, of course we'll review um whatever it is that that you send for us to to um to the company yes we'll definitely review it and if it has all the information that we need then we'll definitely be able to use that for the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, I'll go request them and um tomorrow and I'll get it and I'll send it to you guys on Friday.
[AGENT][NEUTRAL] OK, sure.
[CUSTOMER][POSITIVE] All [PII]. Well, thank you for your help. I appreciate it you have a good night.
[AGENT][NEUTRAL] Uh, sure, Ms. [PII]. Is there anything else I could do to help you today?
[CUSTOMER][NEUTRAL] No, no, ma'am, here's your mind, no, ma'am, that is it. 3.
[AGENT][POSITIVE] OK, thanks for calling AP. I hope you have a good day.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye. Bye-bye.
[AGENT][NEUTRAL] Bye bye.