AccountId: 011433970860
ContactId: fb76b07d-a1c1-41c5-8ec6-9cc3a6df11c4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1501839 ms
Total Talk Time (AGENT): 489492 ms
Total Talk Time (CUSTOMER): 519665 ms
Interruptions: 8
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/fb76b07d-a1c1-41c5-8ec6-9cc3a6df11c4_20250428T18:51_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] Broker Resources. I have a [PII] with [PII]'s office on the phone wanting to verify status of a disability claim on this participant. Do you have, you're ready for the policy number?
[AGENT][NEUTRAL] OK, um, let me go ahead.
[CUSTOMER][NEUTRAL] It's 258-2977 on [PII]. I didn't fully ID ID his information and she's got the claim number and I forgot to ask her what the claim number was because I was trying to look at this policy number, um, and her callback number is [PII].
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 332-2098
[AGENT][NEUTRAL] And you said that Ms. [PII] is, is the, is the contact person for the group or who is she?
[CUSTOMER][NEUTRAL] She's with, she's with [PII]'s office.
[AGENT][NEUTRAL] The agent, the broker.
[CUSTOMER][NEUTRAL] Yeah, the broker's office. sorry, [PII]'s broker.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] OK. OK, and you say you fully verified the member, correct?
[CUSTOMER][NEUTRAL] I did not get his date of birth or any of that stuff, so I did not get all that information. I verified her, yeah, OK, sorry, you ready?
[AGENT][NEUTRAL] Oh, you do not. OK, OK.
[AGENT][POSITIVE] Got it. OK, I got it. It's, it's OK. I'm ready. Thank you.
[CUSTOMER][NEUTRAL] OK, OK, let me pull her in just one second. Hey, [PII].
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] Yeah, I'm sorry, can you hear her? Hi, I've got Soul on the phone and she's gonna help you with the status of that claim, OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Thank you you have a great day. Thanks for calling APL thank you bye bye.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Good afternoon, Ms. [PII]. This is [PII] in the claims on the care team. Um, and you're calling about a disability claim for Mr. [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, can you verify his date of birth?
[CUSTOMER][NEUTRAL] Yeah, give me one second.
[CUSTOMER][NEUTRAL] It's gonna be [PII] [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] All right. And um
[AGENT][NEUTRAL] You are calling from the broker's office, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] All right. Uh let me see where we are with this claim. It looks like it's under review. Um, bear with me, let me go through the notes.
[AGENT][NEUTRAL] Waiting on the documents. I'm sorry, it's taking a little bit to fill up.
[CUSTOMER][NEUTRAL] I'm sorry, what did you say?
[AGENT][NEUTRAL] I'm waiting on the documents to pull up. It's taking a lot of that.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK. Um.
[AGENT][NEUTRAL] OK, so the last time that we processed the claim was [PII], and it looks like they sent in the explanation of benefits together with the form that he needed to complete for preexisting.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Uh, I don't see any other submission after this one.
[AGENT][NEUTRAL] Do you know if he received that form?
[CUSTOMER][NEGATIVE] Wait, what form? he was missing a form? I'm sorry, you're cutting out.
[AGENT][NEUTRAL] OK, this is what is stating on the EOB, OK. I'm just gonna read it out.
[AGENT][NEUTRAL] Um, it says based in our effective date of the coverage.
[AGENT][NEUTRAL] It is necessary for we to obtain past medical record history.
[AGENT][NEUTRAL] Please complete the enclosed form and return to our office.
[AGENT][NEUTRAL] So it looks like we sent a form.
[CUSTOMER][NEUTRAL] OK. And what was the form? Was the form sent to him directly?
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][NEGATIVE] And y'all never received it back is what you're saying?
[AGENT][NEGATIVE] Correct, we have not received that form back.
[CUSTOMER][NEUTRAL] Uh, would you be able to email me the form by chance?
[AGENT][NEUTRAL] Um, I will have to check and see exactly what form was that since it came from claims. Um, let me check with claims and see what form was sent out. Um, also, let me check and see because it looks like it needed additional information. So let me look into this really quick, OK?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] The.
[AGENT][NEUTRAL] OK, so we need the employer's portion of the claim.
[CUSTOMER][NEUTRAL] Employers portion.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it looks like those are the only two documents that we're needing to complete the claim. Um, let me check with, uh, claims department and see if they have a copy of that form and see if I can email it to you. Do you mind holding for me a little bit longer?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's fine.
[AGENT][POSITIVE] OK, thank you.
[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][NEUTRAL] Transferring.
[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, I'm good. How are you?
[AGENT][POSITIVE] I'm waiting for 6, but I'm good.
[AGENT][NEUTRAL] Um, I have a member on the line that, um, she is, well, she's not a member. Oh, OK, come on. So, OK, this is a broker. I got the broker on the line. She's calling about the disability claim, but it looks like we sent a form that the member said he never received and she needs a copy to be sent out to her email, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, I don't know if I can get that copy. I, I pulled the documents to see if it was image, but I, I didn't see an image. So, um, I don't know if you can send it to me so I can email it to her so I don't have to transfer her again because she was transferred for broker resources.
[CUSTOMER][NEUTRAL] Yeah just um shoot me a message or an email on what form it is that you need and I'll get it to you.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, OK, um, it's gonna be the, let me do it right now because I, I wanna send that before I let her go. um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] [PII], you're [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure, I wanna send it to somebody else.
[AGENT][NEUTRAL] Um, but it's, uh, yeah.
[CUSTOMER][NEUTRAL] Yeah, [PII]
[AGENT][NEUTRAL] OK, yeah, is that the medical record request one, let me see.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEGATIVE] I hope this is not.
[CUSTOMER][NEUTRAL] What's the uh policy and I'll go ahead and make sure that like I'm giving you the, the correct thing too.
[AGENT][NEUTRAL] Oh, Sure, yes, yes, I'm sorry. It's uh 258-2977.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] OK, it looks like we're missing the employees portion of the claim form.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And the employer portion.
[CUSTOMER][NEUTRAL] And then we, we were also missing the physician's form, but that may have been what we received.
[AGENT][NEGATIVE] Yeah, it looks like we received the um the physician and the employers. It looks like we're missing the employees. Oh yeah, I already asked her for that.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK and then.
[CUSTOMER][NEUTRAL] Let's see, we obtain your past medical history if your claim is due to a preexisting condition, please complete the enclosed form and return to our office if you have questions.
[AGENT][NEUTRAL] Mm mhm.
[CUSTOMER][NEUTRAL] OK, so it's for preexisting, OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Yeah, I should have said instead of my records.
[CUSTOMER][NEUTRAL] It's OK. It, it can just be so many different things when it's cancer or whatever, so I was like, uh, let me check.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Let me just double check.
[AGENT][NEGATIVE] Mm yeah, I just don't wanna transfer her. I mean, yeah, she was only like if she called me and I needed to transfer, I'll go ahead and transfer, but whenever she's transferred from another department I'm like, oh, let me try to get this resolved, especially if it's a broker. I don't wanna be transferring her so many times.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right, right, OK, so let's see which one is that.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] That's not it.
[AGENT][NEUTRAL] If you don't mind, I'm gonna put you on a brief hold so I can let her know and maybe I can get that email at the same time. OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEGATIVE] You are on hold
[AGENT][POSITIVE] Thank you for holding, Ms. [PII].
[CUSTOMER][NEUTRAL] Yeah, I'm here.
[AGENT][NEUTRAL] OK, um, so she's sending me that form so I can send it to you. You said you wanted to have it emailed to you?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, what's your email?
[CUSTOMER][NEUTRAL] Uh, let me know and I'll read you out my email.
[AGENT][POSITIVE] Yeah, I'm ready.
[CUSTOMER][NEUTRAL] Alright, it's gonna be [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEGATIVE] Can you uh still answer her one more time just to make sure I think I messed that one up.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] [PII] [PII] [PII] [PII]
[AGENT][NEUTRAL] Uh, yeah, I totally had it wrong. OK.
[AGENT][NEUTRAL] OK, so it's gonna be um your name at the letters [PII].
[AGENT][NEUTRAL] [PII]. agency.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] OK, perfect. OK, so let me go ahead and um send this out to you right now, OK? It's gonna be one more minute.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see if she sent it. One moment.
[CUSTOMER][NEUTRAL] You are on
[AGENT][NEUTRAL] OK, hello Miss [PII].
[CUSTOMER][NEUTRAL] Hey.
[AGENT][NEUTRAL] Did you find it?
[CUSTOMER][NEUTRAL] I'm trying to make sure. I think so. I think it's the list of attending physicians um form.
[AGENT][NEUTRAL] Yeah, I believe so too. Mhm.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] So I'm going to download the.
[AGENT][NEUTRAL] Yeah, I wish we had a copy of that. I don't remember having a copy and I checked Guru and I don't see it unless I look in the wrong place.
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It is on SharePoint so.
[AGENT][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Yeah, so it's the HIPAA form and yeah I'm gonna send you a link um.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEGATIVE] Let's see, so here's that is not what I wanted.
[CUSTOMER][NEUTRAL] Why, why.
[AGENT][NEUTRAL] Oh, you know what, yeah, I think it's see here. Let me see.
[CUSTOMER][NEUTRAL] OK, so there's the list of attendance physicians for preexisting investigation.
[CUSTOMER][NEUTRAL] And then um and then we'll just need the hiPA release.
[AGENT][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] So I don't know if we've gotten that already if we've gotten that one then we shouldn't need that one, but if we.
[CUSTOMER][NEUTRAL] Don't then I'm assuming we need to get that as well.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, what I see here, and I'm just going by the notes, I see that we got the doctor claim form and the authorization claim. Those are the last two things that was received.
[AGENT][NEUTRAL] Doctor claims.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] An authorization claim.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Let
[AGENT][NEUTRAL] And for this one.
[CUSTOMER][NEUTRAL] Let me pull this up.
[CUSTOMER][NEUTRAL] Because I don't want to, I don't want you to send over uh HIPAA release if we already have it because then they're gonna be like why are we having to fill this out again.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so we have on file.
[CUSTOMER][NEUTRAL] OK, so this is statement of the insured.
[CUSTOMER][NEUTRAL] And then.
[CUSTOMER][NEUTRAL] The employer statement which I think they said wasn't like completed in full last time.
[CUSTOMER][NEUTRAL] I think that's what we previously I'm gonna double check that denial we'll see.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] DL 39 incomplete um in order for additional consideration be given oh please have your physician just kidding. OK, so that we have the insured and then we have the employer previously and then this one was.
[CUSTOMER][NEUTRAL] That was most recently submitted.
[CUSTOMER][NEUTRAL] Which I don't know why.
[CUSTOMER][NEUTRAL] Maybe because we didn't have the physicians form we didn't request information maybe I don't know I feel like we should have requested that already, but that's just me.
[AGENT][NEUTRAL] Mm not sure.
[AGENT][NEUTRAL] OK. So do we need something else so I can add it here to the email?
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] I am double checking now. Let's see, policy holder statement.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] HIPA authorization.
[CUSTOMER][NEUTRAL] OK, so we have.
[CUSTOMER][NEUTRAL] AIPA authorization on file it looks like.
[CUSTOMER][NEUTRAL] And then we got direct deposit, so it looks like we are needing the doctor's claim form which I sent you.
[CUSTOMER][NEUTRAL] It looks like we need the physician's statement.
[AGENT][NEUTRAL] OK, physician's statement.
[CUSTOMER][NEUTRAL] Yeah, because like.
[CUSTOMER][NEUTRAL] What we have on file is the insured portion which is basically just, you know.
[CUSTOMER][NEUTRAL] Their information.
[CUSTOMER][NEUTRAL] What their sources of income are and stuff like that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] After that we have.
[CUSTOMER][NEUTRAL] The HIPAA authorization.
[CUSTOMER][NEUTRAL] And their direct deposit.
[CUSTOMER][NEUTRAL] And then we have a.
[CUSTOMER][NEUTRAL] Please upload the supporting documents for your client physicians form detailed billing other uh tests that the documents uploaded are true to the best of my knowledge. I don't know what that is.
[AGENT][NEUTRAL] OK, so it's gonna be the 5.
[CUSTOMER][NEUTRAL] Maybe that's from the broker to them.
[AGENT][NEUTRAL] Yeah, probably the physician's statement and the employer's statement. Those are the ones that are missing.
[CUSTOMER][NEUTRAL] Mm, it looks like we have that, um, because they resubmitted it.
[AGENT][NEUTRAL] But what about the employee?
[CUSTOMER][NEUTRAL] Yeah, it looks like we have all of that we just need the physician statement and then um.
[CUSTOMER][NEUTRAL] And then that other denial is stating that we need to check for preexisting so it's gonna be that list of physicians which is that link that I sent you.
[AGENT][NEUTRAL] OK. I'm, I'm just going by the last claim that says, uh, that, uh, OK, it says in order to consider your claim, we need the employers to complete the employer's portion.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Entirely.
[CUSTOMER][NEUTRAL] Yeah, I don't know why that remark code was used because we have that we got that back in March.
[AGENT][NEUTRAL] OK, so we do not, OK, we don't need that. OK. Just making sure.
[CUSTOMER][NEUTRAL] We don't need the employer or the employee. We just need the physicians. I think they accidentally did 6 instead of 9. I'm pretty sure it should have been DL 39, which states that we are missing the physician's form, so I think that was a key stroke error, um, because it looks like we have the third party release we have direct deposit, we have the um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I'm gonna add that.
[AGENT][NEUTRAL] Oh, got you, OK.
[CUSTOMER][NEUTRAL] The policy holder or the employer's statement saying.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] You know all of that information and then we have the insured statement so it looks like we have all of that um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We just don't have the physician's portion of the disability claim form and then that.
[CUSTOMER][NEUTRAL] Preexisting list of physicians that I sent you the link for as well, so those are the two ones that we would need.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so, all right, here we go.
[AGENT][POSITIVE] Um, OK, it's fine. Alright, so I send it alright. OK, thank you so much.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][POSITIVE] OK, have a good day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Huh. Mhm.
[AGENT][NEUTRAL] Thank you for holding. OK, uh, did you receive the email that I sent you with all the information that is needed in the form?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] No, I haven't received anything.
[AGENT][NEUTRAL] Not yet.
[AGENT][NEUTRAL] I'm just gonna refresh just to make sure.
[CUSTOMER][NEUTRAL] OK, I think I just did.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, I got it.
[AGENT][NEUTRAL] OK, so that will be the form that he needs to fill out and it looks like I went ahead and spoke to the claims department and we were going through all the paperwork and she was letting me know that um we don't really need the employers or the employees. We already got that one. So she said that the one that we're needing is the uh physician's form and I did add that to the email.
[CUSTOMER][NEUTRAL] Physician, the list of the attending physicians, that's the one that you sent me?
[AGENT][NEUTRAL] Uh-huh. Yeah, that's for pre-existing. The list of the attending physician is for preexisting, so that's to get medical records. Um, but we also need um the portion of the form that is for the physician to be filled out and sent back to us. It doesn't look like we haven't.
[CUSTOMER][NEUTRAL] OK, so the physician's portion of the claim form, y'all did receive the employer and the employees though.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, yes, she went over all the claim. That's why it took a little bit longer to get back with you, but yeah, she went through all of it. I said just make sure we have everything before I ask her for anything else.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Yeah, thank you so much.
[AGENT][NEUTRAL] I
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today, Miss [PII]?
[CUSTOMER][NEUTRAL] That's it.
[AGENT][POSITIVE] OK, well, you have a good afternoon and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.