AccountId: 011433970860
ContactId: ca6463f9-52fb-4f94-a172-413600fbb4f4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 717900 ms
Total Talk Time (AGENT): 312907 ms
Total Talk Time (CUSTOMER): 200656 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/ca6463f9-52fb-4f94-a172-413600fbb4f4_20250421T18:36_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, ma'am. Um, my husband submitted a claim for his ACL reconstruction surgery and we received like, um,
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] A notice stating that he needed to submit the enclosed claim form completed by the insured giving a detailed description of the accident or diagnosis of sickness.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I just need to know if I need to resubmit the entire claim form packet or if I just need to submit that one paper that asks for the detailed description.
[AGENT][NEUTRAL] OK, more than likely it's gonna be just that, but I can go over um the information that we have in the system and see exactly what they're needing. Um, do you have the policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] It's 02283769.
[AGENT][NEUTRAL] OK. And may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] My name is [PII]. Callback number [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Is Mr. [PII] available to give me permission?
[CUSTOMER][NEUTRAL] He is at work currently. Do you need to call and ask him for permission?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, we're gonna need permission to release information. I don't see an authorization here, um.
[AGENT][NEUTRAL] So yeah, we're gonna need his permission to go over the claim with you.
[CUSTOMER][NEUTRAL] Can you call him and call me right back? Is that something that we can do?
[AGENT][NEUTRAL] Um, I don't have, well, let me see what I can do. Is there any way you can do a three-way call?
[CUSTOMER][NEUTRAL] Uh, yeah.
[AGENT][NEUTRAL] OK, yeah, we can do that. You can do a three-way call and I'll just go ahead and ask him for his authorization.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, just give me 1 2nd.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Do I have Mr. [PII] on the line?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yeah, I'm here.
[AGENT][NEUTRAL] OK. um, Mr. [PII], I need to verify some information and get your permission to release information to your wife. This is [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. May I have your date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and I need to verify the mailing address and email address on file.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] In [PII].
[CUSTOMER][NEUTRAL] And the email address should be [PII].
[AGENT][NEUTRAL] OK, thank you. So this is a one time authorization and um to to go over the claims, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] [PII], thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, Ms. [PII].
[CUSTOMER][NEUTRAL] You'll still leave me on the line I can hang up.
[AGENT][NEUTRAL] OK, so let me look at the information of the claim, OK?
[CUSTOMER][NEUTRAL] OK, I'm gonna have him hang up now if that's OK.
[AGENT][POSITIVE] Oh, sure, yes, no problem, yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And let's see.
[AGENT][NEUTRAL] So this was an accident that he, he had.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Got you. OK, so let me look at the what you have found.
[CUSTOMER][NEUTRAL] An accident that resulted in very extensive surgery.
[AGENT][POSITIVE] Oh wow. OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And based on this, it's just this additional information. So let me go over the notes and everything, OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Did, um, did you receive an explanation of benefits from us recently that we sent on the [PII] or you have not received that document?
[CUSTOMER][NEUTRAL] Um, I, I received an EOB and it just states like remark and then it says that y'all need additional information.
[AGENT][NEUTRAL] OK, did you receive a claim form with that?
[CUSTOMER][NEGATIVE] No, not in the downloadable documents.
[AGENT][NEUTRAL] And the downloadable document um.
[AGENT][NEUTRAL] You mean on the online service center? is that what you're looking at?
[CUSTOMER][NEUTRAL] Yeah, so when I go, [PII] had received the text message that his claim had been processed, so I went on to the APL website to see just what it was saying and uh whenever I click on those, um.
[AGENT][NEUTRAL] Oh, OK, yeah.
[AGENT][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Claim numbers?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] There's a download that pops up with this EOB but there's no claim form attached.
[AGENT][NEUTRAL] Got you. Yes, um, on the OSC on the online service, I'm sorry, it's not gonna have that form. That form was mailed out and it went out on the [PII], on the [PII].
[CUSTOMER][NEUTRAL] It was mailed
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so it wasn't received by email.
[AGENT][NEUTRAL] No, no, it was mailed out. Uh, when we process the claim, uh, you can see the claim on the online service center, uh, for you to view, but whenever we send something, it's gonna go by mail. You still get the mail, the paper EOB because we have to send it. Um, so once you receive the paper one is gonna have that form attached to it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so we would just have to um fill out that form in detail and then I can submit it via the website?
[AGENT][NEUTRAL] Yes, you can upload it to the account. No, you, you can go ahead and upload it. If you have a way to scan it, you can go ahead and upload it. Mhm.
[CUSTOMER][NEUTRAL] Or would I have to mail it back?
[CUSTOMER][NEUTRAL] OK, uh, I'll.
[CUSTOMER][NEUTRAL] OK, um, can you confirm, I know that on the accident claim form on the first page it does state that like y'all would need an itemized medical bill and stuff like that along with the paperwork and we had this physician send it off so I just need to make sure that that's not something that I also need to send in that it was already sent in.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK. We have not received anything besides the claim form that you submitted, which it was just one page, the first page.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um, out of the 5 pages, and I think that's what they're needing. They're needing the whole 5 pages. So I, I don't know if you can just, you can go ahead and submit the whole claim if you want to, if you don't want to wait, um, for that, um, you'll be by mail. It looks like we're needing the whole claim. I'm just looking at the information you send in and it looks like we just got 11 page. Um, so more than likely they're asking for the whole claim.
[CUSTOMER][NEGATIVE] Huh, well, I'll be damned.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And they charged me $50 to fill out this paperwork for me.
[AGENT][POSITIVE] Oh, wow, I'm so sorry. Do you have the copies or do you send the original ones?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, I, like I said, they just faxed it in because they offered to do that with the $50 charge that they charged me to fill out the position statement. Um, I don't have the originals. They do have them at the doctor's office. I can go pick them up.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] And just resubmit it all if that would be easier.
[AGENT][NEUTRAL] Yeah, it sounds like it's probably gonna be easier like that because yeah we only received one document and it was just the first, well, let me see, uh, it's only the 5th page, so only the last page of the form was sent in to us, which it looks like is the information that we asked for them. Um, that's the only thing we have received, but we did not receive any additional documents attached to it. It was just that one page.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so what I need to also submit an itemized bill?
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] OK, alright, so I'll have to call them and have them get that ready for me then.
[AGENT][NEUTRAL] Yes, have them to have a fully itemized bill with diagnosis codes, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. So once we receive uh your portion, which is the form that I that we send, but you can also get that again on the website by clicking claim some forms. You can go ahead and get that accident claim form and you can fill it out and send it to us electronically if you want to do that, um, so you don't have to wait for the mail, um, but you can also go ahead and get that itemized bill and send it to us, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK all right I appreciate your help.
[AGENT][POSITIVE] You're welcome, Miss [PII], and is there anything else I may help you with today?
[CUSTOMER][NEGATIVE] Uh, no, ma'am, I don't believe so.
[AGENT][NEUTRAL] OK. And Ms. [PII], also there is a third party authorization form in the claims and forms in the website. So if you can have Mr. [PII] fill that out, he can authorize you to get information and not have to call him every time you call. Um, so if you want to do that, you can also send in that form, fill out, and he will have to sign it, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Appreciate that.
[AGENT][POSITIVE] You're welcome and thank you. Yes, you're welcome. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] We'll have him do that. I appreciate your time.
[CUSTOMER][NEUTRAL] That's it.
[AGENT][POSITIVE] OK, well have a good afternoon and thank you for calling ATL. Bye bye.
[CUSTOMER][POSITIVE] Yes ma'am you too bye.
[AGENT][NEUTRAL] Yeah.