AccountId: 011433970860
ContactId: d7c14451-9738-4ba8-9536-495068c1a23f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 926119 ms
Total Talk Time (AGENT): 415793 ms
Total Talk Time (CUSTOMER): 473699 ms
Interruptions: 3
Overall Sentiment: AGENT=1.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/d7c14451-9738-4ba8-9536-495068c1a23f_20250428T18:24_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. How are you?
[AGENT][POSITIVE] Doing well, so thank you how are you?
[CUSTOMER][NEUTRAL] I'm good, thank you. Um, I have a member on the line that, um, he just, he needs information. Um, I, I was just giving him a reading, you know, everything that we have in the system, the notes and everything, but he's just a little bit, I guess, upset that he's not getting anything done yet.
[CUSTOMER][NEGATIVE] And even though I told him we got the information, he just want more in like he's like, well, why you send this to that doctor? I believe you sent it to the wrong doctor and he's just thinking that we send the medical records to the wrong doctor, the request, and we got the wrong one. So he's just a little upset about that. Um, the policy number is 259-799-4.
[AGENT][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] Yeah, and [PII].
[AGENT][NEUTRAL] And, OK.
[CUSTOMER][NEGATIVE] Now I let him know that we received his medical records because I see the note from [PII] and that it's being processed, but he's like, no, that was the wrong medical records. I don't know why you're asking for medical records for that one when it's supposed to be another doctor. So, um, yeah, I'm, I'm not sure what the hell because.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] OK, I will try to assist him now everything's been verified so.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Everything's been verified. The callback number is the same one in the system. Um, he didn't have the policy number, so, um, I just pull it up with the personal information, OK?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, so here he comes, you're ready for him?
[AGENT][POSITIVE] I am thank you.
[CUSTOMER][POSITIVE] OK. You're welcome. All right, here he comes. Have a good day.
[AGENT][POSITIVE] Right. Thank you.
[AGENT][POSITIVE] Have a good day.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you for holding and being patient for you, Mr. [PII]. I got Ms. [PII] on the line. She's in the claims, uh, support team. She's gonna assist you from here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So my question is, is when you guys.
[CUSTOMER][NEUTRAL] Ask for my primary doctor's.
[CUSTOMER][NEUTRAL] The surgeon for whatever reason put Carry Pitchford Carry Pitchford is not my main provider, so that was just emergency care.
[CUSTOMER][NEUTRAL] So she has no records on me so I was asking the lady if it was [PII] who the medical records was sent from.
[CUSTOMER][NEUTRAL] Because I've only been to the emergency care one time.
[AGENT][NEUTRAL] OK, and I'm checking on that, sir. My name's [PII], that's [PII] and I'm on the claims support team, so I'm gonna assist you further out from here. Um just give me one moment. I'm looking over the paperwork so um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're stating that we requested medical records from someone that was just a one, a one visit.
[AGENT][NEUTRAL] Is that right?
[CUSTOMER][NEUTRAL] Yeah, that's what we explained to you at the end of last week. Whoever I had to, I had to go do some medical stuff whenever we called and I gave you permission to talk to my wife and that's the information I got that you was asking for Carry Pitchford because.
[CUSTOMER][NEUTRAL] It was emergency care like it's like a different building from emergency room in [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I went in there just because my toe was swoll up the size of a cucumber and she, she referred me to go get it debris by a podiatrist so I'm assuming that the only reason her name is even involved is because.
[CUSTOMER][NEUTRAL] I went from emergency care that day to get a referral to go to a podiatrist to being admitted into the hospital in another town the next day because it even swelled up bigger.
[AGENT][POSITIVE] Oh my. I'm sorry to hear that.
[CUSTOMER][NEUTRAL] So [PII], I don't even know who she is.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII] is my doctor is who you're now if you've received records, I went and talked to the [PII]'s secretary after we talked to you last week and they said that they can't even send anything without uh release so that's what I was calling to find out.
[AGENT][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] If I needed to get the papers from you from a release.
[CUSTOMER][NEUTRAL] For the doctor, but my doctor [PII], I'm sure I've already signed releases, so if you've received releases, it's probably from [PII].
[AGENT][NEUTRAL] Yeah, and that's what I'm uh examining now. Mhm. Go ahead.
[CUSTOMER][NEUTRAL] But then the lady told me.
[CUSTOMER][NEGATIVE] The lady just told me that you guys was going to send me something in the mail. I have never not received one letter from you about my disability claim, not one.
[CUSTOMER][NEGATIVE] I've been on the phone with you 100 times but never received one letter I've received.
[CUSTOMER][NEGATIVE] 150 letters that says you won't pay nothing on the APO medical, but I've not received anything for the disability so I don't, you've got my address I don't know why I've not got anything from disability, but I've done leg work for 6 weeks with two cut off toes to get you guys all your paperwork.
[CUSTOMER][NEUTRAL] So I can get my money that I pay premiums on, so I'm trying to.
[CUSTOMER][NEUTRAL] Finish doing your leg work to get the paperwork you need so you can figure out that it wasn't a preexisting case.
[AGENT][NEUTRAL] OK, I, I.
[CUSTOMER][NEUTRAL] I went to Mount Vernon Hospital 25 miles away. I went to the hospital in town. I've been 30 miles to my employer.
[CUSTOMER][NEUTRAL] And I'm just trying to figure out what else I that you guys need.
[CUSTOMER][NEUTRAL] To uh
[CUSTOMER][NEGATIVE] Get this process going because my family is literally starving with you guys figuring out whether I had a preexisting case or not.
[CUSTOMER][NEUTRAL] This has been going on since [PII].
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] Yes, and I see that. And I, um, I do apologize that, you know, that it, it just, I'm sorry that you're going through all that and I know that doesn't make it any better. Um, at this point, we just, we, we did follow up and we're waiting for those medical records, um, and I believe that the last, uh,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Information that we received that that the request was processed. So, um.
[CUSTOMER][NEUTRAL] So you don't need any other paperwork?
[AGENT][NEUTRAL] At this point
[AGENT][NEUTRAL] It at this point, it doesn't look like we're needing anything else other than, uh, let's see.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] The fax was received. It looks like on the [PII], which would have been Friday I believe, um, and that's my understanding is that we're waiting for them to be uploaded. So basically what this comes down to now is that once they're received by that adjuster that's processing your claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Those medical records will be reviewed and there should be a determination. Now I can't give you an exact uh ETA. I went, you know, an estimated time when that will be done. However, though it does appear that the adjuster is aware that we're waiting for this information to be uh received so that we can make that determination. So it does look like you're not forgotten and it's not being uh put off. We're just waiting for that information.
[AGENT][NEUTRAL] So she can uh make that determination. um like I said, I don't wanna give you, uh, I don't wanna give you any um you know, kind of timeline of when it will be completed. However, I do know that it's being looked at and furthermore, um, it doesn't appear that we're needing anything additional uh and especially from you at this time. We were just waiting for the.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Medical records to be processed and then that's, you know, to be returned to us for that request.
[AGENT][NEUTRAL] And I do apologize for that delay and I'm I'm not sure if they explained it to you it even though it doesn't appear to be preexisting because your policy did begin on [PII], it is, you know, part of the process is going.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Through that preexisting we just have to rule that out being that the policy issue date was so new um that does have to be eliminated, you know that possibility so we we have to thoroughly you know uh make that determination via by requesting that information so.
[AGENT][NEUTRAL] I, I, I know it does sound like it's you're giving, you're getting the run around, but I assure you it's, it is the process of, you know, what's included in the policy language and the, you know, process we have to follow to eliminate the possibility that it was preexisting.
[CUSTOMER][NEUTRAL] OK, so if I don't, you can't give me no time limit on when to check back with you if you don't, if I don't hear nothing because you've got direct deposit.
[AGENT][NEUTRAL] Yes, I was, I was just gonna say that and do you um do you have you signed up on the online portal?
[CUSTOMER][NEUTRAL] My direct deposit.
[AGENT][NEUTRAL] Are you signed up through that portal?
[CUSTOMER][NEGATIVE] I, I'm [PII] old and using my phone. I, I don't have no access to, I don't even, can't even hardly get around.
[AGENT][NEUTRAL] You don't, you don't have a computer. OK.
[AGENT][NEUTRAL] Oh, I apologize OK, I'm sorry, um, and the reason why I was asking is because there is a, a claim, um, when you're signed up through there, there is an option to sign up for, you know, claim status update you would get a text message, but you'd have to opt in for that and if you know you don't have that computer access that makes it a little bit more difficult, um, but I, you are doing it through your phone, um, I would, um.
[CUSTOMER][NEUTRAL] So I'm just that.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Could you do me a favor and put in the notes that if there's any other questions that they could call me because I've not received one letter about my disability claim.
[AGENT][NEUTRAL] Now I don't understand it, but you did say you did receive information from us on some other information, is that right? Because I do see where there there should have been some.
[CUSTOMER][NEGATIVE] Yeah, I had $100,000 worth of medical bills that you sent one paper saying you paid $2000 and 150 papers that said you didn't pay $0.
[CUSTOMER][NEUTRAL] You sent me all kinds of papers about the medical.
[CUSTOMER][NEUTRAL] Surgeries and stuff but not one paper have I got not one letter about disability temporary disability.
[CUSTOMER][NEUTRAL] So I'm, I just, if you can put it in the notes that I've requested that they give me a call if they need anything that would just maybe hurry up because I'm willing to go do whatever I gotta do if they need more paperwork because I know it wasn't preexisting.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah and and like I said we just have to verify that information now I do show um I do show that we had some correspondence with you with the email asking for that disability claim form and then once we receive that disability claim form we process a letter out to you it's possible you may not have received it just yet but that what that letter says is it does tell you that we've received your claim.
[AGENT][NEUTRAL] And that there is a delay in processing it and the only meaning that it's pending for additional information and that letter should, you know, explain that to you. Unfortunately, like I said, it doesn't look like you've received it just yet, but I believe it was discussed because that's how you knew that uh there was information requested from the [PII] and then we also went ahead and we made that request to uh [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The [PII] or the nurse practitioner.
[CUSTOMER][NEUTRAL] OK, well, yeah, I've, I've been in.
[CUSTOMER][NEUTRAL] Very close touch with you. The only thing I can think is that you requested it from [PII] because she is my primary and I've signed papers like whenever I years ago when I start now [PII] would not have been able to send you anything, and she said that you would have to give me the paper in the email and I would have to go have her printed off. So I didn't even even done that. So I know it's not [PII].
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So it, it surely is [PII] in it.
[AGENT][NEUTRAL] Yeah, and is it [PII], is [PII] part of the Mount Vernon Primary care? Is she part of that group?
[CUSTOMER][NEUTRAL] So you have my number.
[CUSTOMER][NEUTRAL] No, [PII] is from [PII]. It's my primary doctor that's who has all my medical records.
[AGENT][NEUTRAL] OK, but it's not she's not part of the Mount Vernon primary care?
[AGENT][NEUTRAL] That you know of?
[CUSTOMER][NEUTRAL] Not that I know of.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that might have been the surgeon or the Carry Pittsburgh, but I might have signed releases through the Mount Vernon Hospital when I had a surgery.
[CUSTOMER][NEUTRAL] But I mean the reason my toes was cut off is because of bone infection and I've never been diagnosed with bone infection so I'm sure whatever files you got to show that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, and you know.
[CUSTOMER][NEGATIVE] It literally swelled up within 3 days and I would be getting my toe cut off.
[AGENT][NEUTRAL] Oh my.
[AGENT][POSITIVE] Well, I'm so sorry you're going through all that.
[CUSTOMER][NEUTRAL] Do those actually.
[AGENT][POSITIVE] I'm so sorry.
[CUSTOMER][NEUTRAL] It's all right. It's just God's got me. It's just my, I, I hate seeing my family struggle, and I'm sure if I sound grouchy to any of these girls I'm not meaning to it's just been the same thing over and over for six weeks and I'm getting frustrated with it. It's really not you guys' fault. I know you're doing your job.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Well, thank you for
[CUSTOMER][NEGATIVE] It's hard to be the provider and then and then go from being a provider to being the gimp that has to get rides and no money to give anybody. It's hard for me to deal with that.
[AGENT][NEUTRAL] Yeah, and again I, I'm sorry you're going through all that. I, I really do, um, wanna say, you know, my apo send my apologies to you. Like I said, um, I will make a, a note on your file, um, and like I said, because you're not signed up for that claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Uh, status inquiry, you, I would give it maybe another 24 hours and, and call us back tomorrow and see if there's any change.
[AGENT][NEUTRAL] Um, or you know, wait a day or two and, and then give us a call back so since you don't have access to that portal, um, and you can just inquire if there's.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I can do that.
[CUSTOMER][POSITIVE] OK, well you gave me more information than in 6 weeks, so I appreciate it. I'm, I'm glad to know that you're trying to work on it.
[AGENT][POSITIVE] Wow.
[AGENT][NEUTRAL] Yeah, and did you have any other questions at this time, Mr. [PII], that I could answer or try to help you with?
[CUSTOMER][POSITIVE] No, no, I hope you have a blessed day. I, I appreciate your help.
[AGENT][POSITIVE] You too, sir, and thank you for your patience and uh God bless you and, and take care.
[CUSTOMER][NEUTRAL] All right, but
[CUSTOMER][POSITIVE] Thank you bye.
[AGENT][POSITIVE] Thank you bye bye.