AccountId: 011433970860
ContactId: ed264115-97b4-4fc1-b6c9-1b3cb033e621
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1249880 ms
Total Talk Time (AGENT): 342523 ms
Total Talk Time (CUSTOMER): 330946 ms
Interruptions: 7
Overall Sentiment: AGENT=0.3, CUSTOMER=-1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/ed264115-97b4-4fc1-b6c9-1b3cb033e621_20250314T13:17_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, my name is uh [PII]. I give you my policy number is 2,566,030.
[AGENT][NEUTRAL] Thank you for that. And Mr. [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you for that. And how may I assist you today?
[CUSTOMER][NEUTRAL] Yes, I got a letter from, uh, y'all mailed me out something on the [PII]. I got it in the mail today. It was saying something about uh.
[CUSTOMER][NEUTRAL] Uh, I guess the, uh, y'all gave me a claim number.
[CUSTOMER][NEUTRAL] You were saying something about uh that one I had 0 on one end of it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Kinda like uh
[CUSTOMER][NEUTRAL] I don't know what kind of thing this is. Esation of benefits.
[AGENT][POSITIVE] Alright, let's do this
[AGENT][NEUTRAL] OK, let me um go ahead and verify you and then we can get into the, the claims. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh [PII]. Mailing address [PII]. I'll get the [PII]. Zip code [PII], date of birth [PII].
[AGENT][NEUTRAL] Thank you for that. And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. So for the claim, um, this last claim looks like it was mailed out must be [PII]. It looks like this claim, well all of the claims that we've processed, they're not denied. It's just letting you know that we've requested the medical records from your doctor. So once we receive the medical records, we can keep processing.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Well, I already did that for y'all. I sent all that in to y'all. One was on [PII] and [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] I just faxed out one Monday. I just faxed off one to y'all, I think Tuesday.
[CUSTOMER][NEUTRAL] On Wednesday?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] So it looks like it's a total of 6 pages. Do you mind if I place you on just a brief hold? I'm just looking through the documents.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] These are notes.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] These aren't
[AGENT][NEUTRAL] Like, these aren't medical records. These are doc office visit notes. I mean, well, that's a part of the medical record.
[AGENT][NEUTRAL] So either they're requesting something specific.
[AGENT][NEUTRAL] Because this is just the and it might not be the friend, the time frame that they need it. Let me see if I can find the letter that was sent. Hold on.
[AGENT][NEUTRAL] So then that'll tell us everything.
[AGENT][NEUTRAL] Cause they probably have a date range, most likely that they're looking for.
[AGENT][NEUTRAL] Here you go
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Release the information.
[AGENT][NEUTRAL] Hello, Mr. [PII].
[CUSTOMER][NEUTRAL] Yeah, yeah, I'm still here.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for that wait. So I do see the records that you sent over, um, and those are, um, they are considered medical records. They are the doctor's notes, but what we're asking Dr. [PII] for is your medical records from [PII], so basically for the year of [PII].
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I didn't go see him in January.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I didn't go see him until January.
[AGENT][NEUTRAL] So this is the date range that they need to for the claim. If you weren't there in January, he'll just send them what he has.
[CUSTOMER][NEUTRAL] Well, you, uh, OK, no, I was there in January. I went in [PII]. I was in January, I was there in [PII]. I was in there uh [PII]. I was never there in [PII].
[AGENT][NEUTRAL] So you say you didn't see Dr. [PII], you didn't come to him until [PII], so there won't be any records.
[CUSTOMER][NEGATIVE] Like, no, no, you got [PII] record [PII], y'all got that on [PII]. You said [PII], right? You said December. No, I ain't gonna send in December at all.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Are you saying you weren't his patient or you just didn't see him in December?
[CUSTOMER][NEUTRAL] I want this patient in [PII].
[AGENT][NEUTRAL] OK. So whose care were you under in in [PII]?
[CUSTOMER][NEUTRAL] [PII] Dr. [PII], my my primary physician. His his name is on that stuff I sent to you on Tuesday.
[AGENT][NEUTRAL] OK, so let me do this. If you don't mind, I'm gonna place you on a brief hold. I'm gonna reach out to a claims examiner and let them know that and see um if they want to talk to you or what the next steps would be.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEGATIVE] Because it cause uh if you weren't his patient, then there's not gonna be anything to send back.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, hold on one moment. I'm going to try to reach out and see um if I can get a resolution for you, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Bring
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's not for
[AGENT][NEUTRAL] 59.
[CUSTOMER][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey, Ms. [PII], this is [PII] on the care team. How are you doing?
[CUSTOMER][POSITIVE] Oh I'm good how are you?
[AGENT][POSITIVE] I'm good. Um, I have a little doozy. Can you help me, please?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so it's policy number 2,566,030.
[CUSTOMER][NEUTRAL] 256-603-0.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's uh for [PII], it's claim number 3573386. Well, really it's all his claims, we're needing the medical records, but he, um he said he
[AGENT][NEUTRAL] The doctor that we're requesting the medical records from, he wasn't his patient during the timeframe that we're asking for, so I didn't know. I said, well, who, who was treating you in or in [PII]? He said, I was just seeing my primary care. So how do you want me to handle that?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It looks like they sent him a form. Has he already completed the form and send it back in to us?
[AGENT][NEUTRAL] Well, he said he got the letter and then he saw the dates and he, that's what made him call because he um
[AGENT][NEUTRAL] He wasn't the doctor's patient during this time.
[CUSTOMER][NEUTRAL] OK, so we haven't, we haven't requested the medical records yet. That's why we're sending him that form for him to uh give us the names, give him the names. He has to complete that form and return it to us, so that's probably asking for the names of the doctors. So that's what he would supply us with that information and then we would check.
[AGENT][NEUTRAL] Due to release
[AGENT][NEUTRAL] Wait, so we didn't send, OK, wait, so this letter to Dr. [PII] asking for the medical records for last year, the patient saying he was never his patient during last year, so there's no records. So what, what can he send to us?
[CUSTOMER][NEUTRAL] So we have a letter, we have a letter in OnBase that we send a letter to Doctor [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Give me 1 2nd to pull that up.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It says um [PII] if that helps.
[AGENT][NEUTRAL] Of this year.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, so maybe did we get something back?
[CUSTOMER][NEUTRAL] Maybe that's why.
[CUSTOMER][NEUTRAL] Because we just we just sent him on [PII] we sent him a letter, so maybe that's why we're asking him for the names of his doctors so that we can send it to the correct one because that information went out on [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, I will let him know. Thank you. I was just confused and wasn't, I'm not really confused. I just didn't know how that works.
[CUSTOMER][NEUTRAL] Um, yeah, that's, that's my guess, yeah.
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] OK, well, I'll let him know and then uh we'll just go from there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][POSITIVE] All right, have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] OK, hello, Mr. [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, ma'am, go ahead.
[AGENT][NEUTRAL] Alright, thanks so much for holding. So the letter that we sent to Dr. [PII] was on [PII], but we just sent you a letter. I don't know if you have it yet. Uh, we sent it out [PII].
[CUSTOMER][NEUTRAL] I got that letter yesterday.
[AGENT][NEUTRAL] OK, so that letter
[CUSTOMER][NEUTRAL] I gotta get I'm looking at right now.
[AGENT][NEUTRAL] So that letter is asking you to provide us with your list of doctors because we noticed that Dr. [PII] wasn't the doctor at the time that we're needing. So that letter that you received is is asking you for a list of your providers so we can reach out to the correct doctor.
[CUSTOMER][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Oh, OK, you can reach out to uh the paperwork you can reach out to and I can fax it over. I can mail it out to you.
[CUSTOMER][POSITIVE] And I see all the stuff y'all want right here. I got all at the house.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let's see, the first, that's what I've seen Doctor [PII] was on the [PII]. Y'all got there on the [PII], the [PII].
[CUSTOMER][NEUTRAL] Everything else is doctor [PII] for my pain.
[AGENT][NEUTRAL] OK, so then I
[CUSTOMER][NEUTRAL] And my my and all the way and then and my heart doctor. So the [PII] doctor [PII] the [PII].
[AGENT][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] [PII] Doctor [PII]. The first of [PII], Doctor [PII] again, the [PII] of [PII] was, no, I didn't see Doctor He judges for my medication and [PII] for my medication. 20, let's see, uh, 24 is for my
[CUSTOMER][NEUTRAL] Blood tests and stuff, the 24 blood tests and medication, 824 blood test. And I've seen Doctor [PII], which I'll get that on the [PII], like I said, the [PII] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Anything in [PII], like the [PII], y'all got that paperwork too.
[CUSTOMER][NEUTRAL] For uh the 2nd [PII] and y'all also should have the one for him again on the 1st [PII], the 1st [PII]. Y'all got that already. So the stuff I was sending y'all only for my pain though.
[AGENT][NEUTRAL] Uh, so all we need you to do is just fill out the letter that we sent on [PII] and send it back to us and then claims will handle the rest.
[CUSTOMER][NEUTRAL] So I
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh, OK, what I filled out is just one piece of paper.
[AGENT][NEUTRAL] Yes, sir, and then if you want to fax it to us, you can or you can mail it however you like to send it back to us and we'll go ahead and um send it to the doctor.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] So let me see. So what you want is paperwork.
[AGENT][NEUTRAL] We just want the
[CUSTOMER][NEUTRAL] For me seeing a doctor, he was.
[AGENT][NEUTRAL] So you don't have to send any paperwork. We just what we sent to you, we just need you to fill it out and send it back.
[CUSTOMER][NEUTRAL] OK, well, I fill it out at the back of the paper. I just signed my name somewhere, but I just want she the paper, I guess that's it.
[AGENT][NEUTRAL] This is
[AGENT][NEUTRAL] Let me, hold on, let me see if I can.
[CUSTOMER][NEUTRAL] If you got page on the front and then page.
[CUSTOMER][NEUTRAL] 2 on the back.
[CUSTOMER][NEGATIVE] This policy does not provide benefits, blah blah blah, this, this, this, that's all showing.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You got a reference number, extension number. That's all I got from y'all. I got this in the mail yesterday and it was mailed out on the
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] I think it is the [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That's when I got this, and I mailed it out and I received it.
[AGENT][NEUTRAL] OK, so you got the explanation.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] You got the explanation of benefits, but you didn't get the letter that was supposed to be enclosed with it.
[CUSTOMER][NEUTRAL] No, we don't let her in there, just this one sheet of paper and that was it.
[AGENT][NEUTRAL] OK, hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] That's all I got for now. Just one sheet of paper.
[CUSTOMER][NEUTRAL] Explanation of claim benefits, that's all I see.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, let me reach back out to claims so I can see about this form. Hold on one moment, OK?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Lord, just based on your effective day of coverage, it is necessary that we obtain your past medical please and close up the.
[AGENT][NEUTRAL] Yes, OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] The patient's on hold while you're doing this. This is why I help chats are not helpful.
[AGENT][POSITIVE] Thank you.