AccountId: 011433970860
ContactId: d7b3176b-a937-4f34-b7ae-033af760e548
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 425790 ms
Total Talk Time (AGENT): 152211 ms
Total Talk Time (CUSTOMER): 177872 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/d7b3176b-a937-4f34-b7ae-033af760e548_20250211T16:31_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. This is [PII], and I had a question about my claim, and I have the claim number if you need it.
[AGENT][NEUTRAL] OK, well, I can definitely help you with your claim, Miss [PII]. May I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Policy number is 2541314.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the members, I'm sorry. Can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] Yes, my date of birth is [PII]. Email email address is [PII]. My mailing address is [PII]. It might show is Fort Worth, but [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And um may I have the claim number for the claim you want me to look at with you?
[CUSTOMER][NEUTRAL] Yes, claim number is 3,561,320.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, um, and what questions did you have?
[CUSTOMER][NEUTRAL] OK, so I got the update this morning to check my, my claim status they process, but in the notes, remark description it says based on your effective date of coverage, it is necessary that we obtain your past medical history to determine if your claim is due to a pre-existing condition, and it said please complete the enclosed form and return to our office. I don't have a form. No form was attached to that, so I can send you all my, I guess, medical records or something.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, OK, so let me reach out to claims and see what we would do in that instance. I think they're the only ones that can send you those forms. If not, if it's something I can send, I'll send it to you. Um, do you mind if I place you on just a brief hold to um reach out to claims? OK, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK bye.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Sing
[CUSTOMER][POSITIVE] Good morning. Thanks for calling Ael. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey, [PII], this is [PII] on the care team. How are you?
[CUSTOMER][NEUTRAL] I'm doing OK, and yourself?
[AGENT][NEUTRAL] I'm doing good. Um, I don't know if you need the policy number. Basically, we need, um,
[AGENT][NEUTRAL] We need medical records and it says on her EOB that a form was enclosed, but she doesn't have a form, and I didn't, is that something y'all have to give or can I give it?
[CUSTOMER][NEUTRAL] So you said
[CUSTOMER][NEUTRAL] We were requesting medical records or?
[AGENT][NEUTRAL] Yeah, we're requesting medical records for her claim and it says please complete the enclosed form, but she says she doesn't have a form. So I know.
[CUSTOMER][NEUTRAL] What, what's the policy number?
[AGENT][NEUTRAL] It's 2541314.
[CUSTOMER][NEUTRAL] For [PII]. Let me see.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, what date was that?
[CUSTOMER][NEUTRAL] She probably just didn't get it, but hold on, let me see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So we just met her out yesterday, so that's why she hasn't received it, but we mailed her out uh um.
[CUSTOMER][NEUTRAL] A physician's form to fill out her doctor's information and then.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Oh, it's separate. OK, she probably thinking it was in there. OK, I'll tell her.
[CUSTOMER][NEUTRAL] Yeah, because we just processed the claim yesterday so she just wouldn't, she wouldn't have received it yet, um.
[CUSTOMER][NEUTRAL] So you need so we mailed it, we mailed them out yesterday when the claim was processed, the HIPAA form for her to fill out and sign, well, for her to sign and then the list um to fill out for her physicians.
[AGENT][NEUTRAL] OK, so she has to wait for it to be, OK, she has to wait for it to be mailed. It's not on online because she's looking on the online service center.
[AGENT][NEUTRAL] So it's actual paper.
[CUSTOMER][NEUTRAL] So let me see if it's on there. Hold on one second. Uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I know the HIPAA form is um and that's only because when we request medical records from the providers, we have to have that HIPAA form giving us permission to request it, so I know that form is on there.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, which I can give you the name of that one, she can download.
[AGENT][NEUTRAL] Oh, you're talking about, I know what you're talking about. I'm good. No, no, I mean, I thought, you know, like where their claims are on the OSC like I thought whatever is enclosed. I didn't know if it was there like electronically, you see what I'm saying? But no, she, I'm gonna just tell her it was mailed out yesterday and it just hasn't been received yet. She's just looking online, she got the notification, so.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh OK, yeah, she just got the notification that we process the claim, but, but yeah, that's what we sent out to her and she would just fill those documents out and send them upload them, yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Send it back.
[AGENT][POSITIVE] OK. Well, thank you.
[CUSTOMER][POSITIVE] You're welcome. Have a good day.
[AGENT][NEUTRAL] All right, you too. Bye bye.
[CUSTOMER][NEUTRAL] Alright bye.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes, I'm here.
[AGENT][POSITIVE] Thank you so much for holding. So the claim, yes, can you hear me?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] I can hear you.
[AGENT][NEUTRAL] OK, so the claim um just finished processing yesterday, so that's why you received the notification, but it was mailed to you, so you haven't received it yet, um, but when you do receive it in the mail, the form will be enclosed for you to fill out and send back to us.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[CUSTOMER][POSITIVE] OK perfect and then I, I get, I proceed whatever needs to happen so I can return everything back to y'all.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK then, well thank you so much for following back up with me.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, you answered my question. Thank you so much.
[AGENT][POSITIVE] You're welcome. Well, thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] OK, likewise, thank you.
[AGENT][POSITIVE] Thank you. Bye bye.