AccountId: 011433970860
ContactId: e93d733a-6ff4-4dd1-aefc-5070f923c6c2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 940159 ms
Total Talk Time (AGENT): 374350 ms
Total Talk Time (CUSTOMER): 389024 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/e93d733a-6ff4-4dd1-aefc-5070f923c6c2_20250313T20:42_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. Um, I'm just checking on a claim. Um, I think there was some more information that was needed.
[CUSTOMER][NEUTRAL] And I just wanna make sure that I submitted everything that I think I needed to submit.
[AGENT][POSITIVE] OK, well, I can definitely look at the claim for you and make sure everything's been received. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. Last name [PII]
[AGENT][NEUTRAL] And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][POSITIVE] Thank you, and your policy, I'm sorry. OK.
[CUSTOMER][NEUTRAL] Um, let me get that number.
[CUSTOMER][NEUTRAL] Yeah, well, that's OK. Let me get it for you, um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's it.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] 215
[CUSTOMER][NEUTRAL] 2602.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] All right, I have you here. Can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And what was the last one?
[AGENT][NEUTRAL] Your email address. It looks like it might be work.
[CUSTOMER][NEUTRAL] Uh, it might be what? Oh, work, yeah, it's uh [PII], yep.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alrighty, and thank you so much for verifying your information. All the information provided is a verification of benefits, not a guarantee of payment. So, the last claim that we received.
[AGENT][NEUTRAL] Uh, we received it on [PII]. We actually received two. Would it be this one of these claims or something, it would be something later than that?
[CUSTOMER][NEUTRAL] Uh, well, no, it was, I think it was that one. It was for my daughter. Um, she injured, well, she hurt her leg, um, and she went through a bunch of, yeah, I'm sorry, it's for my daughter, yeah.
[AGENT][NEUTRAL] Oh, your daughter, OK, hold on.
[AGENT][NEUTRAL] OK, [PII] is #4. OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So let's see.
[CUSTOMER][NEUTRAL] I think I submit, I just uploaded um some doctor information. I think that's what they were requesting um as far as the diagnosis and then what led to the physical therapy.
[CUSTOMER][NEGATIVE] I was struggling that one day I was trying to upload all the um files. It was like it would upload and then it would time out or it would say error it was it was a night yeah it was a nightmare and I had so many files to upload as well.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Oh Lord.
[AGENT][NEUTRAL] Let me see, the last, the very last claim that we processed, just finished processing today and it looks like
[AGENT][NEUTRAL] They wanted to know the like the like details of the accident or the sickness. Well, hold on one second, what's this?
[CUSTOMER][NEUTRAL] Right, and I, and I had submitted those not too long ago. I think it was um in um within a few within the past few days.
[AGENT][NEUTRAL] Oh, I understand. So the information that they're looking for may be in one of the previous, some of the previous documents that were submitted.
[CUSTOMER][NEUTRAL] Well, it's just the, the, yeah, the just, just the reason I don't know if I can see that on my end.
[CUSTOMER][NEUTRAL] Um, of which one it was.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] The document, see it's, it's the one I'm assuming.
[CUSTOMER][NEUTRAL] I'll
[CUSTOMER][NEUTRAL] I, I can't even tell you which one it, it's gonna be, um.
[AGENT][NEUTRAL] It's OK, no worries. This is what I'm gonna do. I see the um
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Hold on one second. I just
[AGENT][NEUTRAL] Let me first see what was submitted. Hold on one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because if I, if, if something was submitted on this last claim that could give the explanation, I could just have them pin I can just pinpoint it from there.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK, so this one is a total of 13 pages that was sent in. I'm just trying to see if I can see the, like a description that they're looking for.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Right, I, well, right, I know, and it, and it, it was, um.
[CUSTOMER][NEUTRAL] Like I said, it was a PDF it's an actual note from the doctor.
[AGENT][NEUTRAL] OK, so it's like a like an office note, like a clinical note?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, it's, it's everything that led up to uh.
[CUSTOMER][NEUTRAL] And the physical therapy.
[CUSTOMER][NEGATIVE] And I know I like I said, I submitted it the other day. It had to be like a week whatever and it would the unfortunate part is I can't see because it's already processed, so I can't see when that was uploaded.
[AGENT][NEUTRAL] It's OK. I have something here. What is this highlighted? They want the reason.
[CUSTOMER][NEUTRAL] Right. And it wasn't an EOB, but it was like um
[CUSTOMER][NEUTRAL] They said all the, all the forms, but I'm not even seeing it on here now.
[AGENT][NEUTRAL] So it's a track injury?
[AGENT][NEUTRAL] Possibly.
[CUSTOMER][POSITIVE] It's a what? I'm sorry.
[AGENT][NEUTRAL] So the doctor is saying it could possibly be a track injury to her leg?
[CUSTOMER][NEUTRAL] A leg.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So that's the reason. Hmm. Let me see if there's more that they're looking for than this because I, I mean, as soon as it came up, this was like the 3rd page.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So let me see if there's something more that they're looking for then.
[AGENT][NEUTRAL] Unless they wanted to know more of like how did she hurt her leg this time.
[CUSTOMER][NEUTRAL] Maybe it's
[CUSTOMER][NEUTRAL] OK. All right. All right, I found it. So it's gonna be claim number 357.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 5389.
[AGENT][NEUTRAL] Yes, that's what I'm on. OK. What page are you looking at?
[CUSTOMER][NEUTRAL] And it says
[CUSTOMER][NEUTRAL] Yeah, that, that goes with that goes, yeah, that well that that all those files go with.
[CUSTOMER][NEUTRAL] Uh, the one I, uh, submitted on the [PII]. So that, that goes, that goes in correspondence with the 356.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 9560.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 9560.
[AGENT][NEUTRAL] So this is what I'll do. If you don't mind, I'm gonna place you on a brief hold because I don't want you to have to um keep going back and forth with this. I'm gonna place you on a brief hold and get a claims examiner on the line so that they can give you more details, because from what I see that that's the explanation to me, but it must be something more that they're looking for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Right, and that's what I'm trying to figure out so I can get that submitted whatever they need so.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, I think that was the missing part for that first group of files that I sent in. They sent in all the EOBs and then the actual date that.
[CUSTOMER][NEUTRAL] Um, the physical therapy had taken place.
[AGENT][NEUTRAL] OK, um, before I get the um claims examiner on the line, was there anything else I can help with?
[CUSTOMER][NEUTRAL] No, that's just, no, this, this, this whole claim.
[AGENT][NEUTRAL] OK, so let me go back to that page so I can show her where I saw the explanation. I think it was page 3.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Yep, OK. Um, so hold on one moment and I'm going to get the representative for you, OK?
[CUSTOMER][POSITIVE] OK perfect thank you.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][POSITIVE] Good morning. Thanks. I'm sorry, good afternoon. Thanks for calling ATO. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII] on the care team. I just did the same thing on my other call. How are you doing?
[CUSTOMER][NEUTRAL] Look, you see how I'm doing, girl. I don't know who I am, morning or evening.
[AGENT][POSITIVE] Just ready to go, that's what it is.
[CUSTOMER][NEUTRAL] Exactly. How are you?
[AGENT][POSITIVE] I'm doing good. Um, can you, can you help me with this claim?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so it's policy number 2152602.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This is for part 4.
[CUSTOMER][NEUTRAL] Alright 4.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's um claim number 357-538-9?
[CUSTOMER][NEUTRAL] OK, let's see what we denied it for.
[CUSTOMER][NEUTRAL] Not accident related to an accident. Did they say it wasn't due to an accident?
[AGENT][NEUTRAL] It sounds like she hurt herself on track, but the note doesn't, it doesn't say that's what it says possibly.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I completed OK.
[CUSTOMER][NEUTRAL] See you're going to check.
[CUSTOMER][NEUTRAL] OK looks like they're sending her um a form, a claim form to complete.
[CUSTOMER][NEUTRAL] And so if it was an accident, uh, we probably just gonna need something.
[AGENT][NEUTRAL] Explaining what happened.
[CUSTOMER][NEUTRAL] Explaining what happened and so that's the form that they're gonna send to uh to them.
[CUSTOMER][NEUTRAL] And looks like they're also gonna send um the uh authorization form so um.
[CUSTOMER][NEUTRAL] With along with the name of her, the providers, the doctors and everything so when they send that back in, I'm not sure if they're gonna try to request medical records or not to see if they can get the information, but just let her know that um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That we're needing a diagnosis. It something showing that it was, it was diagnosed as an accident and that we're also mailing uh some forms out to her for her to complete and send back in to us.
[AGENT][NEUTRAL] OK, so let me ask you this because I explained, I went through the um reasoning, you know, the diag diagnosis code, [PII], the remark code with him. I told him all of that. He said, well, I already sent that in. I just sent in the notes from the doctor. So I pulled it up in on base. That's where I see the stuff about her track, a possible track injury.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Remarks, yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But it's a possible tract injury but not a serious injury, so it didn't say she wasn't injured, but I don't, so it's highlighted, but he's like, is that not good enough and I'm like, I don't know. I'm trying to examine it, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hold on, let me, let me see if it's coming up here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it just says leg pain.
[CUSTOMER][NEUTRAL] And see, I guess because it happened a month ago and it says possible track injury, it doesn't say that it was a track injury.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I guess they're trying to just figure out if it is related to something that she got try yeah.
[AGENT][NEUTRAL] Or
[AGENT][NEUTRAL] OK. Well, I just want to make sure because he asked me that and I'm like, um, I mean, it explains it to me, but that that that's not clear. So, OK.
[CUSTOMER][NEUTRAL] Well, but if it is possible, I mean, if I say we're going out to eat if I say, well, I possibly have enough money for both of us to eat.
[AGENT][NEUTRAL] Right, mhm.
[CUSTOMER][NEUTRAL] So I mix one of us might not eat that day. So.
[CUSTOMER][NEUTRAL] So, uh, yeah, tell him that's just what it is, uh, because it says possible it doesn't say that it's a definite, that it was a definite, definite track injury. Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Possible.
[AGENT][NEUTRAL] Right, it's nothing confirmed it was a true accident.
[CUSTOMER][NEUTRAL] Right, and so, but let him know that we are sending him some information to sign so uh that they're probably gonna request the records.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. Well, thank you very much.
[CUSTOMER][POSITIVE] No problem. Have a great rest of your day.
[AGENT][NEUTRAL] All right, you too. Bye-bye.
[CUSTOMER][NEUTRAL] All right bye bye.
[CUSTOMER][NEUTRAL] Uh, tortellin piece for dinner, OK.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. I was on the other line with claims, so they did um explain it to me. So, yes, that is somewhat of an explanation, but because it says possible, it and it was a month ago, it basically what they're looking for is the medical necessity. They're trying to prove that it was a real accident. So the
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Documents that they're sending from this, from processing it today, you should receive it um in the mail or if you have access to the online service center, you may be able to get it there quicker, um, but they're sending you a form to fill out, um, and then after you fill out that form, that'll that'll be the information that they need.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. All right. OK. I, well, I received two things in the mail, um, the other day, and I don't know if that, I mean, they're exactly the same, so I don't know if they're identical. I don't know if that's what I, I'm I'm.
[CUSTOMER][NEUTRAL] Like I said, I was kind of confused, but um trying to find where did I put it.
[AGENT][NEUTRAL] Whatever you received in the mail, it wouldn't be this because we just finished processing it today.
[CUSTOMER][NEUTRAL] Oh, OK. All right. OK, understood. Yeah, cause it was, it was 22 of the same letters and it was sent on the [PII].
[AGENT][NEUTRAL] Let me just double check.
[CUSTOMER][NEUTRAL] Um, yeah, please, in close, please find the documents that have been requested.
[AGENT][NEUTRAL] OK, so the ones on the [PII], yes, those have, um, so you received those, yes, so that, that's not.
[CUSTOMER][NEUTRAL] OK, so don't, don't disregard these.
[AGENT][NEUTRAL] That's not the same thing, but you still need to, no, no, no, still do those because that's a different claim number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK. All right.
[AGENT][POSITIVE] Alrighty. Well, if you have any questions or you need any help, just give us a call. I'm the only [PII] here, but anyone will be more than happy to help you.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] Sounds good thank you [PII].
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] Uh, no, that's it. Thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][POSITIVE] Thank you, bye bye.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] What's up bud?