AccountId: 011433970860
ContactId: f80844a3-16ba-4b80-afc2-56ecfb6eea46
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 670700 ms
Total Talk Time (AGENT): 211753 ms
Total Talk Time (CUSTOMER): 414936 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/f80844a3-16ba-4b80-afc2-56ecfb6eea46_20250410T20:05_UTC.wav
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[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Hey [PII], what are you doing answering the phone? It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Honey, this is what they have us doing, child.
[CUSTOMER][NEUTRAL] Are you for real?
[AGENT][NEUTRAL] In addition to everything else.
[CUSTOMER][NEUTRAL] OK. OK. Well, I got an insured on the phone. It's, it's a disability claim, so I told her what's going on with her claim. So now she's wanting to explain and at this point I'm like, I don't, I thought she needs to speak with somebody in disability, but the policy is 258.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 3002.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so I told her the claim that was, we requested the medical records from Doctor [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so she's saying, she's starting to explain. I, I guess it has something to do with her policy and at the time, something about the time limit from when she sees a doctor to the actual surgery. So I, I'm guessing she's thinking her claims about to be denied. So now she's trying to explain.
[CUSTOMER][NEUTRAL] Like her whole doctor, like when she went to the doctor, why it was only for a consultation.
[CUSTOMER][NEUTRAL] Uh, so yeah, when she got into that, I wasn't really sure. I thought she needs to speak with the clients examiner.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, you can send her on over.
[CUSTOMER][POSITIVE] Alright, thank you, [PII] here she comes.
[AGENT][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Good afternoon. Thanks for calling ATO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, I'm calling concerning the claim that I have.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, are you, are you, is it the claim that you just recently recently submitted or the one that was previously processed?
[CUSTOMER][NEUTRAL] OK, I don't know of one being processed.
[AGENT][NEUTRAL] OK, so we have a claim that was processed on [PII], but we were requesting medical records on that claim.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so that's the one I'm calling about. So I just talked to the provider they don't have.
[CUSTOMER][NEUTRAL] Whatever you sent they don't have it um and I'm trying to find out how did you send it and.
[CUSTOMER][NEUTRAL] Um, and get a and try to get it up.
[CUSTOMER][NEUTRAL] An explanation to find out exactly what's going on because I, I, nobody told me anything about, you know, that there's a clause in there and all that. So I'm just trying to get it, trying to find out what's going on cause I'm sitting here waiting so I can pay my rent and I'm like, OK, and I'm finding all the rest of this stuff out like at the last minute. So I'm trying to find out, can you explain to me exactly what's going on?
[AGENT][NEUTRAL] OK. And so it looks like they are requesting the medical records.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Probably to determine preexisting uh because your policy just became effective on [PII], uh, so we just have to determine whether or not, I'm sorry.
[CUSTOMER][NEUTRAL] That was
[CUSTOMER][NEUTRAL] I'm, I'm, I'm sorry. I didn't mean to cut you off. That was only because
[CUSTOMER][NEGATIVE] The when I tried to get it a couple of months before, they kept, the guy kept, we kept missing the.
[CUSTOMER][NEGATIVE] For him to get the information that he needed, we kept missing the deadline, so it made it pushed it back. In other words, I was trying to get it before then, but that it didn't happen. Not that I was trying, not that I wasn't trying to get it. It's just, he kept missing the deadline and then pushed it to the next month, in other words.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So go ahead, I'm sorry. I didn't mean to cut you off.
[AGENT][NEUTRAL] Mm, that's OK.
[AGENT][NEUTRAL] Yeah, but um but that's more than likely that's the reason that they are checking just to be sure that um it's not so this it's not a denial or anything like that but we're just checking to make sure that it's not.
[CUSTOMER][NEUTRAL] OK, so when did I get that, when did the er when did my insurance take effect?
[AGENT][NEUTRAL] Uh, the policy was effective on [PII].
[CUSTOMER][NEUTRAL] OK. I didn't get.
[CUSTOMER][NEUTRAL] What, um, let me, uh, let me do a little short explanation. OK. I went for a regular eye checkup because my eyes was starting to bother me. I, I, um, so when I went, the regular eye doctor told me that I had cataracts in my right eye, cause I, I noticed that my eyes was starting to bother me and I drive trucks, big rigs over the road. So I um
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, what she told me was, I don't do, she didn't do the eye surgery. I was gonna have to have it removed because it was to that point. So, she referred me to the doctor that did the surgery, OK? So I think on [PII], I guess that's when I went to see him. It was for a consultation and he didn't do any treatment. He just, he just did a consultation to tell me.
[CUSTOMER][NEGATIVE] If I, if, you know, what I needed to have done, if I needed to have it done. That's what she thought and she sent me to him. Then when I saw him, he told me, yeah, definitely I had to have surgery, OK? The reason why I didn't have surgery until March is because I couldn't find anybody, I've run team. I didn't have anybody to replace me, so I couldn't just take off. So I had to wait to get a replacement to take over for me for this month that I was out and
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] order for me to have the surgery. And so that's where we at now. So I'm, I'm waiting, trying to, trying to um wait for a check that's never came and I didn't know why. So that's why when I called my representative, that's what he told me, you know, all this was going on. So, basically I called the, the dent the doctor's office today to find out have they got the forms that you guys had sent them or whatever, they said they haven't received anything. How did you guys send them to them?
[AGENT][NEUTRAL] Uh, that information was mailed over to them.
[AGENT][NEUTRAL] And it was
[CUSTOMER][NEUTRAL] That's probably why they haven't received. Is it, is there a way you can fax that to them?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, I see. Do you
[CUSTOMER][NEUTRAL] So we can uh uh I.
[AGENT][NEUTRAL] Yes ma'am. Do you have a fax number?
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, because I just talked to them today, so hold on one minute.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because if I would have knew all this, I would have got off you like right away. I didn't know. OK, the, the fax number is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]. And the lady uh who handles that is named [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, let me read that back just to make sure I got everything correct. Uh, the fax number is [PII] and the contact person is [PII], is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, alright, um, so I would give this.
[CUSTOMER][NEUTRAL] Can this be faxed to the to her today?
[AGENT][NEUTRAL] I can check and see. I can try to uh get with the representative that's working on your uh claim and have her to see if she can fax this information over to the doctors.
[CUSTOMER][POSITIVE] OK, cause I'm, I'm not, I'm [PII] old. I'm not trying to get evicted from my apartment and I was waiting on a check that never showed up, so I'm really hoping and praying that this is cleared up.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright, I will get with her and um.
[AGENT][NEUTRAL] See if she can get it faxed over to you. I mean faxed over to the doctor. I'm sorry.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, alright, I guess that's all I can do is just, well, how, how long will I, will I, before I know what's, what's gonna happen?
[AGENT][NEUTRAL] Well, actually, it's gonna depend on once we'll try to get it faxed over, um, then we'll have to wait until the doctor send the information back to us and after he sends it back to us, then we'll have our medical examiner to review it.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh, to help us determine whether it's a pre-X or not.
[AGENT][NEUTRAL] So it's basically just gonna depend on when we get those records back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK, so what exactly is it? I guess that's the part that I'm not really understanding, is it?
[CUSTOMER][NEUTRAL] OK, I took a, is it that they did something before I got insurance or is that what it is?
[AGENT][NEUTRAL] Um, usually when they check pre-X, they, I guess just wanna make sure that this is not something that you were treated for before.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, before you
[CUSTOMER][NEUTRAL] Oh no, I know that.
[AGENT][NEUTRAL] I'm sorry, yeah.
[CUSTOMER][NEUTRAL] Yeah, that, that, I just, I'm, uh, um, I didn't, I.
[CUSTOMER][NEUTRAL] I'm sorry, I, I'm just like kinda nervous because I didn't know none of this until today. Uh, yes, well, yeah, he sent me an email yesterday so I'm just finding out all this and it's kind of like I, I've been sitting here waiting, waiting, waiting, and I didn't know all of this was going on because I would have tried to you know, try to aspiate it before now. But um, no, this is, this, like I uh with him.
[CUSTOMER][NEUTRAL] I hadn't seen any doctors here before I went to the eye doctor and she told me and then I went to him. I, they haven't treated me for anything other than that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, OK, but, uh, let me try to get this information over to her so she can try to get it uh faxed over, uh, and if you wanna check back with us maybe toward the end of the week, well, I'm sorry, tomorrow is the end of the week, um, give us to the beginning, right.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Tomorrow is in the week.
[AGENT][POSITIVE] Uh, can you give us some maybe call back on Monday? I'm so sorry. That's how ready I am for this week to be ready, so, uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I hear you. I trust me, I'm getting ready to go back to work, but I, but my rent is not paying and my bills are not paid because I've been off since the last month.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, OK. Look, I
[CUSTOMER][NEUTRAL] So that's why I'm trying to and then I find out, um, OK, there's a problem so I'm rea[PII] kinda like.
[AGENT][NEGATIVE] Uh no.
[CUSTOMER][NEGATIVE] And it'll be like a couple more weeks before I even get paid. I'm like, oh Lord, what am I gonna do? So I'm hoping this thing get cleared up.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, yeah, but let me try to get this to her to see if she can and check back with us maybe on Monday and hopefully we'll we be able to tell you whether if we got it faxed over and if we have received anything from them.
[CUSTOMER][POSITIVE] Alright, well thank you.
[CUSTOMER][NEUTRAL] OK, alright.
[AGENT][NEUTRAL] OK. Was there anything else I can help you with, Ms. [PII]?
[CUSTOMER][NEUTRAL] All right, all right, thank you. Oh, is there a direct number to?
[CUSTOMER][NEUTRAL] Is there a direct number to call you because they had to patch me through to your department.
[AGENT][NEUTRAL] Uh, there's, there's not. You can just call the number and then they can, uh, somebody if, if they can't help you then they'll send a, send you back to one of us because I'm on like the claim support team, yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right, thanks a lot.
[AGENT][POSITIVE] All right and you have a great rest of your day, Ms. [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] All right, you too.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye bye.