AccountId: 011433970860
ContactId: e1ba634d-a02a-4f79-9d6b-a7d10b0e7cbb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 386029 ms
Total Talk Time (AGENT): 182026 ms
Total Talk Time (CUSTOMER): 150699 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/e1ba634d-a02a-4f79-9d6b-a7d10b0e7cbb_20250131T18:01_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII]. I'm calling uh regarding a claim and um wanted to uh to see if I, I have got some information from one of the doctors. I think you guys were requesting more information on the particular claim and uh wanted to see if it was helpful, if you can help me out. I appreciate it.
[AGENT][NEUTRAL] OK, [PII], are you the insured or are you calling from the provider?
[CUSTOMER][NEUTRAL] I'm the insured and I can give you a claim number if you like.
[AGENT][NEUTRAL] Uh, first off, um, yes ma'am, I can take a look at your claim for you, but first off I'll need to pull up your policy information and verify some things with you for security. So first off, what is your last name, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], and it's [PII]
[AGENT][NEUTRAL] Thank you. And Ms. [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And your policy number, please?
[CUSTOMER][NEUTRAL] 02236928
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, and Miss. [PII], any information that I do provide for you would be a verification of benefits and not a guarantee of payment. So if you could first please verify your date of birth for me.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Also your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same it's the one that you provided for me, so that is your best contact number, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Thank you and lastly your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, and you said that you do have the claim number that you're calling in regards to?
[CUSTOMER][NEUTRAL] Yes, it's 3543615.
[AGENT][NEUTRAL] OK, let me pull that claim up to look at it.
[AGENT][NEUTRAL] And this is for data service in July of 2024, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, so this, so in looking at the remarks, one of them does state in order to, um, excuse me, receipt of your claim is acknowledged, however, in order to provide further consideration of this loss under this policy.
[AGENT][NEUTRAL] We will need supporting documentation to evidence this accident and when it occurred, supporting documentation may include, but is not limited to office notes, hospital admission and discharge summaries, and or diagnostic testing results.
[AGENT][NEUTRAL] That's one of the remarks.
[CUSTOMER][NEUTRAL] OK, I can forward you, um, can I forward uh email by email? Can I forward some documentation?
[AGENT][NEUTRAL] We cannot accept medical information, claims information via email due to security. Did you ever set up, you did set up your profile in the online service center with APL?
[AGENT][NEUTRAL] Have you tried to access that where you can upload it, but we can't accept it via email, so it could either be uploaded, faxed or mailed.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, let me see. So I go to [PII], is that right?
[AGENT][NEUTRAL] you can just type in [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Oh, I see, yeah. OK, I'm.
[AGENT][NEUTRAL] [PII]. Mhm.
[CUSTOMER][NEUTRAL] Yeah, uh
[CUSTOMER][NEUTRAL] I'm going into that.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so I could just, I'll just upload what I have. I don't know what the issue is because when I called um the doctor uh on the urgent care end of it, they got, they had information in right away so I'm not sure what the hold up is on getting are are you guys actually requesting information? I mean, because.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I got it in about a minute and I submitted this claim a while ago so I'm not sure what.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Are you guys requesting it from the doctors, the information that you need or, or what's happening?
[AGENT][NEUTRAL] Let me
[AGENT][NEGATIVE] We never received, we requested medical records, but they were, they have not been received.
[AGENT][NEUTRAL] By APL. Mm, no, ma'am. And that was back, um, let's see when this claim.
[CUSTOMER][NEGATIVE] They haven't been received.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment. And that was in December that that request.
[AGENT][NEUTRAL] Was done.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, so I guess I mean I'm not sure.
[AGENT][NEUTRAL] So it
[AGENT][NEUTRAL] Cause that is one of the remarks. Of course, you have your claim, so it has all of these remarks that I was reading to you on there.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But it should also, do you see where it's, you should see one remark that says medical records requested.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah I saw that so anyway I was just trying to yeah alright well I'll upload the latest thing that I have or that I that I had requested um I thought I had submitted this already but um this particular um.
[AGENT][NEGATIVE] Uh, we did, but we haven't received them.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Discharge report so um I'll go ahead and upload it into the system.
[AGENT][NEUTRAL] OK, and you may want to follow up also with the provider?
[AGENT][NEUTRAL] Regarding the medical records request.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Well, is there anything else, Miss. [PII]? Oh, certainly. Yes, ma'am.
[CUSTOMER][POSITIVE] Yeah, I appreciate your help.
[CUSTOMER][POSITIVE] No, that's it. I'll, I'll continue to work on it. I appreciate it.
[AGENT][POSITIVE] Well, you're very welcome and thank you again for calling APL and I hope that you have a nice weekend.
[CUSTOMER][POSITIVE] Thank you you too take care bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye-bye.
[CUSTOMER][POSITIVE] Thanks bye bye.