AccountId: 011433970860
ContactId: e68fe402-b871-404b-8857-7874cd65756a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 332380 ms
Total Talk Time (AGENT): 127390 ms
Total Talk Time (CUSTOMER): 170692 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/e68fe402-b871-404b-8857-7874cd65756a_20250124T22:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] in [PII]. How you doing? I'm a broker.
[AGENT][POSITIVE] I'm good, [PII] how are you?
[CUSTOMER][NEUTRAL] Doing great, doing great, um, we have a young lady that she's sending some information but she request, I, I think home office requested some medical information from her, um, well from her doctor. Would it be OK if I give you a policy number?
[AGENT][POSITIVE] Yeah, absolutely, [PII], go ahead whenever you're ready.
[CUSTOMER][NEUTRAL] 244-6222. Give me one second, I'm sorry. Hey, that's that's on the phone.
[AGENT][POSITIVE] No worries.
[CUSTOMER][POSITIVE] Sorry about that.
[AGENT][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] I have a [PII] here home from school for 4 days because of snow, so.
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] Oh yeah, good times.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Can I get the uh insured's name and date of birth?
[CUSTOMER][NEUTRAL] Let's see here.
[CUSTOMER][NEUTRAL] Yes, this is [PII], and let me see if her date of birth is on here.
[CUSTOMER][NEUTRAL] Sorry, I had everything ready to go and then.
[AGENT][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, she's [PII].
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] OK, and so this is in regards to I guess a claim is that?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yes, this is an accident that we sent in um on [PII], and I did send in the form with the itemized bill and the diagnosis, but they needed a little more clarification on the diagnosis, so they requested medical records, I believe, and the doctor's office said they sent them back to us.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEGATIVE] And I hate when doctors do stuff like this because they mess up claims all the time, cause what they'll do is they'll put, they put these diagnosis codes that are ridiculous. Like, it'll say in the notes, she came in because of a fall, we'll have the itemized bill and everything, but they'll put a, a diagnosis code of like unspecified knee pain. I'm like, she told you why she came in, y'all did X-rays, you treated her for an accident, you know what I mean? Like, I'm like, these doctors fumble more things, they fumble more claims, and number 2.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well, and also, I know for a fact because my wife works for a pharmaceutical company, they always put like 5 diagnosis codes because they're trying to maximize their reimbursement. So they put all this stuff on here and it's just, it's crazy. Yup.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, so let's see so they're saying that they submitted all of that did they say when they submitted it to us?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Supposedly the doctor's office sent it sent this to us, sent it to us like a week ago. I don't know if it was over fax or mail.
[AGENT][NEUTRAL] Hm, OK.
[CUSTOMER][NEUTRAL] Or if there's a fee, I don't know how y'all, when y'all request medical records, how do doctors normally send them back to you?
[AGENT][NEUTRAL] Yeah, I mean they can fax them or they can mail them. It just really depends. Most people will fax just because it's easier, you know what I mean? um.
[CUSTOMER][NEUTRAL] So do you show any records that came in for this young lady?
[AGENT][NEUTRAL] That's what, yeah, that's what I'm checking to see if we've received anything, but if it was sent in the mail, I mean that would make sense that it's not there quite yet, so let me see here.
[CUSTOMER][NEGATIVE] This is why, um, like we kind of proof every claim that comes in cause I don't trust the doctor's offices to even send it to the right person, much less send us.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um, what we need half the time.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, no, I just see that we faxed um a Loy Kemp.
[AGENT][POSITIVE] Uh, for medical records, we sent them a fax, and I see that that successfully went through.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But I don't see
[CUSTOMER][NEUTRAL] So the letter that y'all send, does it say you can fax it back to this number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Cause I've never seen one of those letters before yet.
[AGENT][NEUTRAL] Yeah, so gives patient name.
[AGENT][POSITIVE] Since we've been informed that this patient is receiving care from your facility in order to process benefits we need and it gives them exactly what we need. It does. It says please fax records gives the fax number or mail to and then gives the mail department like where they can send it in the mail and then it also gives a phone number for any questions or concerns from the claims examiner.
[CUSTOMER][NEUTRAL] OK, so I'm gonna reach out to her to reach out to the hospital and say did you fax or mail these because the company because APL still doesn't have them.
[AGENT][NEUTRAL] Yeah, so fax is definitely gonna be the quickest and it looks like the the claims examiner is [PII], that's who's working the claim.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] I know Miss [PII]. OK, OK, I will, I will reach out to the client now and uh we'll see if we can get those resent or find out how they were sent out.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK sounds good [PII].
[CUSTOMER][POSITIVE] I appreciate your time thank you very much.
[AGENT][POSITIVE] Yeah, no worries have a good night.
[CUSTOMER][POSITIVE] You too take care bye bye.
[AGENT][NEUTRAL] All right bye bye.