AccountId: 011433970860
ContactId: f8c08e91-a9a9-4d51-8727-972681ceefa7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1031260 ms
Total Talk Time (AGENT): 664059 ms
Total Talk Time (CUSTOMER): 352890 ms
Interruptions: 7
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/f8c08e91-a9a9-4d51-8727-972681ceefa7_20250121T18:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], it's [PII]. I've got um Ms. [PII] on the phone and she's been talking back and forth with claims about information on her claim. Her policy number is 1702608, and she is filing a claim for part three.
[CUSTOMER][NEUTRAL] Somebody told her to send in the UB04 form herself.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then now she's asking for more information that needs to be sent in. I was just wondering if you could assist her further.
[AGENT][NEGATIVE] Yeah, she yelled at me the other day.
[CUSTOMER][NEUTRAL] The claim, yeah, the claim number is 355-0719.
[AGENT][NEGATIVE] Yeah, that's for part three. Yeah, I, I went a couple rounds with her the other day, so, and she yelled at me.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, and I read the remarks.
[CUSTOMER][NEUTRAL] Yeah, I read the remarks, yeah.
[CUSTOMER][NEUTRAL] I read the remarks to her and I told her that it specifically says to send in the itemized statement with procedure and diagnosis codes and she said well they told me I need to send this UBO4 form in and I'm like, well if they told you to send it in then you need to send it in and she said.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Now she's confused. I confused her by reading the remarks, I guess.
[AGENT][NEUTRAL] No, she, she was confused anyway. She, she said we were holding up her claim. We had this, she's had this, um, policy for 19 years. I said no, you had it since [PII].
[CUSTOMER][NEUTRAL] Oh my.
[AGENT][NEUTRAL] And then, and then she um she filled out the claim form and put the kid's date of birth as the date of accident on both her claim and her son's claim, so she's really confused. So I told her she sent in only X-rays or surgical whatever and I told her we needed the uh billing from the hospital or she can request the UBO4. I didn't say she had to send the UBO4 but.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] That's her phone number listed?
[CUSTOMER][NEUTRAL] Well, she told me she went.
[CUSTOMER][NEUTRAL] Yeah, her phone number is [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh,
[AGENT][NEGATIVE] Yeah she's gonna start yelling at me again. I just know it.
[CUSTOMER][NEUTRAL] Yeah, she got a little spicy. She got a little spicy meat me when I told her about the UB what it asked for and she said, well, I went to the hospital and got this and that's what I'm sending in, and I'm like, OK.
[AGENT][NEUTRAL] OK, so send it in and don't call us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And she never corrected the claim form either for [PII]. So, OK, go ahead and put her through and um I'll do my best to help her out.
[CUSTOMER][NEUTRAL] Oh my.
[CUSTOMER][POSITIVE] OK. All right. Thanks, [PII].
[AGENT][NEUTRAL] You've been verified, right?
[CUSTOMER][NEUTRAL] Yeah, she's been verified.
[AGENT][POSITIVE] She's been verified? All right, great. Thank you so much, [PII].
[CUSTOMER][NEUTRAL] Yes, OK.
[CUSTOMER][POSITIVE] You're welcome bye bye.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello, is this Ms. [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hi, this is [PII] in the claims department. How are you?
[CUSTOMER][POSITIVE] It is. I'm good.
[AGENT][NEUTRAL] OK, so I understand you were speaking with [PII] and she indicated to you that what we were needing for uh [PII]'s claim, um.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] Oh I remember that thing.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And she said that you did obtain the UBO4 form from that initial visit, OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes ma'am.
[AGENT][NEUTRAL] OK, and I think there was a little bit of confusion. She said that um she said that she told you that we you could send in the billing. I had talked to you though and requested that you beO4 form like I said that's the easiest way to get the claim information that's needed, OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] And that that.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I thought you sound like her, the one that told me that.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] So I did that and I just submitted it through the app.
[AGENT][NEUTRAL] Through the portal, OK, so what I'll do is um kind of take a look and and uh just review it real quick now um I also let me see.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I also, when I spoke with you last week, we
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] I think we talked about your claim form as well. Let me just take a look at that.
[CUSTOMER][NEGATIVE] Yes, and I went down there, I went down there to try to get mine and they told me that they couldn't give me that, that the insurance people had to call them to get that.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Was this a different facility?
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, and I wasn't gonna argue at the time because their office was slap full of people was sick with flu, COVID, and all kind of stuff, so.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So this was the, the hospital visit that you, you know, you went to the doctor and they sent you to the hospital for an X-ray, is that right?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, well, the X-ray was, the doctor is in with the hospital.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's like an urgent care, but they on the the back side of the hospital.
[AGENT][POSITIVE] Yeah, that's right. OK.
[AGENT][NEUTRAL] OK. And also, um.
[CUSTOMER][NEUTRAL] The only, only thing I can get through the hospital is my X-rays, but when it comes to my um actual visit, I have to go through the urgent care there.
[AGENT][NEUTRAL] Yeah, I
[AGENT][NEUTRAL] Got you OK and so the urgent care is telling you that we have to request it, is that right?
[CUSTOMER][NEUTRAL] To get the paperwork.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so what um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have a phone number for them by any chance?
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I can look it up um.
[CUSTOMER][NEUTRAL] Let me.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Let's see, it is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and this is to the urgent care?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so what I'm gonna do is I'll try to contact them. They may um request that I send over authorization which I can do. I'll just have to get a fax number for them and then what I'm gonna do is just um let's see, let me just check on a couple things here.
[AGENT][NEUTRAL] OK, yeah, because I'll need the billing from them along with that accidental bodily injury diagnosis because this is the one where we talked about it and they said they sent you for the X-ray of the ribs that you did um injure yourself, how are they used.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It as a pain diagnosis and that's not unfortunately payable under the accident policy. So what we need to do is have them provide us the um notes from the visit that indicate that you did fall and you had a um you said you fractured them, is that right?
[CUSTOMER][NEUTRAL] Well, the doctor had said I fractured them, but then he called me when I got home that evening, about 15 minutes before they closed, and said, I need you to come back up here because we lost your X-rays.
[AGENT][NEUTRAL] That's right. And they wanted you to come and pay it, and you said no, right. OK. Because it, you have to pay for it, yeah.
[CUSTOMER][NEUTRAL] And I didn't go back.
[CUSTOMER][NEUTRAL] Yes, but I didn't think nothing about, yeah.
[AGENT][NEUTRAL] Well, if they lost your X-rays.
[CUSTOMER][NEUTRAL] And you know they they charged me for those X-rays too.
[AGENT][NEUTRAL] And I was gonna say if they lost the x-rays, then they should be able to provide that service for you at no charge because um
[AGENT][NEUTRAL] If they lost them, that's on them. So that's kind of strange.
[CUSTOMER][NEGATIVE] But I was in so much pain. I didn't.
[AGENT][NEUTRAL] Yeah, I understand. I know.
[CUSTOMER][NEGATIVE] It was hard for me to even go back.
[AGENT][NEUTRAL] Well, let me see what I can um get from them as far as uh what's needed for the.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, the billing portion of it because like I said, your policy is actual charges so we do have to have those actual charges. However, I do have the X-ray so if I can just be able to put the two together and make that, uh, determination that the claim is eligible, then we can just go ahead and process. So if I'm, I'm gonna just see if they'll send me um notes from the visit so just so you're aware that's what I'm gonna call them and request, um.
[CUSTOMER][NEUTRAL] OK, just let me know if you need anything from me.
[AGENT][NEUTRAL] I will.
[CUSTOMER][NEUTRAL] And um do I have everything for my son?
[AGENT][NEUTRAL] I do have the authorization. I do have the authorization. I'm checking on that now. I do have the authorization from um your claim form, so we'll be able to um use that. However, I did notice when you updated this claim form, the other one didn't have an accident date. This one you actually put [PII] as the accident date, um, and it was in fact [PII], correct?
[CUSTOMER][NEUTRAL] Yes, it was [PII], I think, or the [PII].
[AGENT][NEUTRAL] OK, so what will happen, yeah, so what will happen is I can make a note that the accident date should be the [PII] or somewhere in that area. As long as I'm able to obtain those documents from the um from the uh urgent care facility that should be able to uh verify that when you injured yourself. If, if need be, I'll um have you upload that claim form just correct that date again.
[CUSTOMER][NEUTRAL] Right in there.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, but if I can get the documents, um, that should be able to, um, be enough verification.
[CUSTOMER][NEUTRAL] Right, OK.
[AGENT][NEUTRAL] Um, so now let me just, I'm looking at the UV.
[CUSTOMER][NEUTRAL] Let's say it was [PII], I believe when I failed.
[AGENT][NEUTRAL] OK, well, it's [PII] for the date of accident.
[CUSTOMER][NEUTRAL] And I went to the doctor the [PII] or the [PII].
[AGENT][NEUTRAL] Yeah I believe it was [PII]. OK, so for, let me just check.
[AGENT][NEUTRAL] I'm looking at [PII]'s claim now.
[AGENT][NEUTRAL] And that was the one we also needed the uh data accident corrected and I'm gonna look at that claim form.
[AGENT][NEUTRAL] So, um, yeah.
[CUSTOMER][NEUTRAL] It was 1014 or 24.
[AGENT][NEUTRAL] Yeah, but on that one I don't have let me look at the other one before it, that one has his date of birth as the date of accident.
[AGENT][NEUTRAL] Let me look at this other one.
[CUSTOMER][NEUTRAL] Yeah, his date of birth is [PII]. He had that accident two days before his birthday.
[AGENT][NEUTRAL] OK, um.
[CUSTOMER][POSITIVE] But I think I just uploaded a new thing and got all the dates right and everything.
[AGENT][NEUTRAL] Yeah, unfortunately that one doesn't show. So on the first submission you put [PII] was the date of accident. On the second submission there's no date. There's no um there's no correction to the date of accident and then it was left blank on section C of where, you know what happened. So if you can, um, I do see the UBO4 in here and [PII] was the day he was seen in the emergency room, right?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh yes, [PII].
[AGENT][NEUTRAL] OK, so if you could go ahead and complete that for just the one page is all I need of that claimant statement and correct that date of accident to the correct date of accident and put those accident details on his claim form if you could do that for me like I said um I'd appreciate that and like I said that way um everything's kind of um I could put everything together now I am looking at the billing this should be all that's needed for for his claim.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] I'm looking at his last, the last one I submitted. It says data accident 10-14 [PII].
[AGENT][NEUTRAL] Right, and it should be 10-14, 2024, yeah.
[CUSTOMER][NEUTRAL] 0, 24, can't, I can't, I can't create that, can I, yeah. Well, let me re
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] If you can correct that and it does have the and um just.
[AGENT][NEUTRAL] I believe it the accident details that I'm that first claim you submitted so it just has the wrong accident date but it does state, um, let me read that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Let's see, I'm trying to add to it now.
[AGENT][NEUTRAL] Two days after the hurricane, um, so the, yeah, OK, so that's what I thought. So you have to give us some detail about what happened to [PII].
[AGENT][NEUTRAL] Um, because this looks like the accident detail for you under, under the first claim that we processed for [PII], it gave us the accident date. Like I said, it says [PII], and then it says you're, you were walking down the back steps and your feet came from under you. That was what happened to you on the fractured ribs. So we need to have the detail about what happened to [PII] for his eye.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Because it was his uh correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm, um, I am.
[AGENT][NEUTRAL] So all you need to fill out that page 1 and that section C. Yeah.
[CUSTOMER][NEUTRAL] I opened my claim.
[CUSTOMER][NEUTRAL] Well, I opened my claim and I'm sitting here filling it out now. Would it, when I close it, will update it?
[AGENT][NEUTRAL] Um, it should, it's so if it allows you to resubmit it because basically what you're doing is resubmitting, but we only need that first page of the accident claim form where it says at the top the statement of insured, then it has your name and then section D for [PII], and then section C we need that data accident and then tell us what happened.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, that's all that's needed so it should allow you to go ahead and update and you just resubmit it and like I said we just need that first page now it might send all the documents and that's fine too.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that makes sense. Um,
[CUSTOMER][NEUTRAL] Yeah, let me see if I get it. um.
[CUSTOMER][NEUTRAL] 101 1014.
[CUSTOMER][NEUTRAL] 17
[CUSTOMER][NEUTRAL] People.
[CUSTOMER][NEUTRAL] OK, I guess I'll have to.
[CUSTOMER][NEUTRAL] Yeah, I'll have to download it and then reinsert it. OK, let me try that.
[AGENT][NEUTRAL] OK, and yeah, like I said, all that's needed again is that first page section C that shows us rattles the patient, the data accident, and then what happened, how he injured himself, and that should be all that's needed and then like I said, um, the billing does look um like that's what we we were asking for so that's all um that's good.
[AGENT][NEUTRAL] Um, so we just get that, um, claim, uh, form corrected. [PII]'s claim is fine and it will be, uh, in line for processing and like I said, I'm gonna contact the urgent care. I'll probably end up calling you back and just give you an update as to what they told me.
[AGENT][NEUTRAL] Because it might take a little bit of time if I request that information I'll have to fax over authorization um and then have them uh send that information to me so but I'll call you back and give you an update just so that you know um what what I was able to find out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what is your name?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][POSITIVE] Excellent. And do you have a direct number or?
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] Yeah, I can give you my direct line.
[CUSTOMER][NEUTRAL] OK. What is it?
[AGENT][NEUTRAL] Now if I don't um if I don't answer, I do have secure voicemail, so if I'm not able to answer because I am on the, on the phone um and so if I'm not able to answer, it goes to voicemail just leave me a voicemail and I'll call you back as soon as I can. So my direct number is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] OK. And the same thing with me if for some reason I don't answer, call me back cause I have, I mean, leave me a voicemail because I have so many spam calls.
[AGENT][NEUTRAL] I understand. So yeah, if I could um call you back and you don't answer, I'll leave a voicemail and let you know um you can either call me back or I'll, like I said I'll give you an update either way if you're not able to answer, I'll leave it on your voicemail um like I said, I do anticipate that they're, they're gonna request this um document for the um.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You know, the, uh, HIPAA information so what I'll do is um get a fax number from them and I'll send over this uh authorization request and then hopefully they can provide me uh the uh chart notes because it's basically what I need just from the visit to verify that it was an accident.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, OK, um, and so I just need to redo his claim form, right?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, that's correct. And then as far as I, like I said, as far as I can tell, the billing is sufficient, that's what we needed that's what we asked for was those itemizations so, um, it will, you know, um, that should be sufficient once I get that corrected claim form and then that should be all that's needed for [PII]'s claim. So hopefully we can get your claim squared away as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. Thank you for your patience.
[CUSTOMER][NEUTRAL] All right. You too. Bye-bye.
[AGENT][POSITIVE] Have a great day thank you for calling APL.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Bye bye.