AccountId: 011433970860
ContactId: ef9304b9-99e9-4df6-b19d-5cecc77f7432
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 628599 ms
Total Talk Time (AGENT): 230515 ms
Total Talk Time (CUSTOMER): 365314 ms
Interruptions: 11
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/ef9304b9-99e9-4df6-b19d-5cecc77f7432_20250422T20:59_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Quick, oh
[CUSTOMER][NEUTRAL] Um, this is [PII], and I had faxed a, a bunch of papers to you all with uh hospital bills, records of PSA test, etc. uh, for my husband. And uh I got uh just one sheet of paper in the mail and it just says.
[CUSTOMER][NEUTRAL] Non covered services and on the back it says claim information received but could not process needed additional information to complete so I needed to give you my policy number and speak to someone who might could help me with that.
[AGENT][NEUTRAL] OK, uh, may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. And what
[CUSTOMER][NEUTRAL] I have the policy number and I have the claim number on this piece of paper if that would help you.
[AGENT][NEUTRAL] Go ahead with the policy number.
[CUSTOMER][NEUTRAL] The policy number is 00408307.
[AGENT][NEUTRAL] OK, thank you, Ms. [PII] and for security, may I have your date of birth, mailing address and email address or just the mailing address? I'm sorry.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And the um mailing address is [PII].
[AGENT][POSITIVE] OK, thank you. All right, let's see where we at.
[AGENT][NEUTRAL] OK, let me just go ahead and um get this pulled up for the I'm gonna.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I had spoken with someone earlier.
[CUSTOMER][NEUTRAL] Who had told me exactly which form to send you.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] And so I got that form from the hospital, and I got it was copies of all the bills, etc. etc. And then my husband is covered under the cancer policy for PSA test. And so I sent copies of those with the dates on them, etc. So I'm, I'm just not understanding this thing I got in the mail.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, and yeah, I, yeah, I don't see much information either. So let me go ahead and get a um claims um support specialist to see if they can see what's, what's going on or what, what is needed because, yeah, I don't see what is needed here.
[CUSTOMER][NEUTRAL] Maybe, maybe all the facts didn't go through, you know, it was like 15 pages of facts. So it could be something with the facts, so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK. So let me go ahead and get them on the line for us. OK, one moment.
[CUSTOMER][NEUTRAL] OK, thank you. Well, you are on hold.
[AGENT][POSITIVE] You're welcome. Thank you.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], how are you? This is [PII].
[CUSTOMER][POSITIVE] Hey, so I'm good. How are you?
[AGENT][NEUTRAL] I'm good, I'm good. Um, I have a member on the line that she spoke to [PII] uh about the [PII], and [PII] told her to send some information, but it looks like we still denied the claim stating that we need additional information to complete, but it doesn't list what is needed. So she's confused and I don't see anything that I can tell her because I don't see anything either. So I don't know if you can help her with that.
[AGENT][NEUTRAL] Um, the policy number is 408307.
[CUSTOMER][NEUTRAL] OK, let's see what we got going on for [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, uh-huh, now I got Ms. [PII] on the line.
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah, there's not a note, is there?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh God, OK, give me just a second, let me.
[CUSTOMER][NEUTRAL] Let me see if I can find this claim if there's like a note.
[CUSTOMER][NEUTRAL] Did you check in on base to see if there was a note on the claim itself?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Oh, I pulled the EOB and the only thing it's saying is claim information received but cannot process need additional information to complete. That's all.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But it doesn't say what, what information is needed, like, you know, usually has a list itemized bills so it just they have nothing, so I'm like, OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, it's just like, hey, we need info, read our minds.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What if when he.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Oh my goodness. OK, let's see what we could possibly be asking for, OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Because uh I mean there's like when I look at the actual document was submitted there's not there's not any any information there either.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, let me.
[CUSTOMER][NEUTRAL] We're gonna figure this out, so we're gonna figure it out.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know how we're gonna figure it out, but we're gonna figure it out.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh gosh darn it.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so 48.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Let me put in the mail number.
[CUSTOMER][NEUTRAL] Why is this not the report.
[CUSTOMER][NEUTRAL] So normally for claims that are processed.
[CUSTOMER][NEUTRAL] They put them on like a.
[CUSTOMER][NEUTRAL] Like a spreadsheet for this product, but recently they've changed that.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] For only certain circumstances and this just so happens to be one of those that is not out there.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Maybe one of them.
[CUSTOMER][NEUTRAL] Of course it is.
[AGENT][NEUTRAL] Yup. That will be my call.
[CUSTOMER][NEUTRAL] That would be too easy.
[AGENT][NEUTRAL] Yeah, that will be my call.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] What the heck, so I'm trying to leave here in about an hour. OK.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Me too, trust me, I'm like, oh yes, I get the difficult ones.
[AGENT][NEGATIVE] I don't have that much patience, you know.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Right, so I guess my question is the last thing we have on file for them is from [PII].
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] And then this comes 6 years later.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Is it for part one?
[AGENT][NEUTRAL] Mhm. It is for part one, yeah.
[CUSTOMER][NEUTRAL] OK, that's what I was thinking.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But like
[CUSTOMER][NEUTRAL] We, I mean
[AGENT][NEUTRAL] Did, uh, this is a question that she asked that probably I, I, I should have just pulled that. And she said maybe you didn't get all the papers. Um, let me, let me pull the papers.
[CUSTOMER][NEUTRAL] May not have our new address. This is our current address.
[CUSTOMER][NEUTRAL] Yeah, because I only see one.
[AGENT][NEUTRAL] Yeah, that's it. We didn't get all the papers. Yep, OK, yeah, there's an answer, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Yeah, I would just tell her only one of them came through. I don't know how she sent it but only one came through or only one was uploaded on whatever the case is we only got one. I can see her note on here that's or his note that's talking about like PSA test results and stuff like that, but we ain't got nothing.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Gotcha. Yeah.
[AGENT][NEUTRAL] Mm, yeah. Got you. Yeah, I see. I should have pulled this, that's it. Yeah, she said it was 15 pages. It's just one. So yeah, that's the, that's the reason. OK.
[CUSTOMER][NEUTRAL] Yeah, but that's it.
[CUSTOMER][NEUTRAL] It's just one
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] We got
[CUSTOMER][NEUTRAL] We figured it out.
[AGENT][POSITIVE] Oh thank you, yeah, we did, yeah, less than an hour.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] I know, go us.
[AGENT][POSITIVE] Yeah, well, thank you so much. I'll go ahead and let her know that it's fine. Thank you. You have a good afternoon. Bye-bye. You're welcome.
[CUSTOMER][POSITIVE] Oh, you're welcome. OK. Thank you so.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you for holding and being patient for me Mr. [PII].
[CUSTOMER][NEUTRAL] What baby?
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Uh, yes, it looks like we only received one page of the 15 pages you send in.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh my gosh, OK, well, here's what I'll do. I will put them in the mail with a certified letter tomorrow.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Because I don't know what happened. I, I took them to our library to fax because we don't have a fax machine. So if you will give me, do I need to mail it to [PII].
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] Yes, that's where that's where the claims goes to, yes.
[CUSTOMER][NEUTRAL] OK, well, that, see, I had no explanation. I just got this one page that said your claim cannot be processed. So now I know. So I, I, I will put it in the mail. I
[AGENT][NEUTRAL] Yeah, and yeah, we were just trying.
[CUSTOMER][NEUTRAL] I, I'm gonna just leave the fact sheet on top of it to show you that I did have it faxed, so I do not know what happened, but I will mail it and and I'll mail it certified.
[AGENT][NEUTRAL] Yeah, it's OK, and we see one page. Yeah, so we know you did. It's just that we only receive one page.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, well thank you so much for your time.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. Have a good afternoon.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] All right. OK. Bye-bye. [PII].
[AGENT][NEUTRAL] Bye bye.