AccountId: 011433970860
ContactId: 2da0963f-9bf5-41c3-aeda-0cb48153e491
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1223839 ms
Total Talk Time (AGENT): 284642 ms
Total Talk Time (CUSTOMER): 148111 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=-2.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/2da0963f-9bf5-41c3-aeda-0cb48153e491_20250422T15:33_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], uh, this is [PII]. I'm just calling to um inquire about my claim and, uh, y'all had requested some information and I had that faxed over, so I was just making sure you received everything you needed.
[AGENT][NEUTRAL] OK, well, I can definitely check your policy and see if the additional information um it has been received and everything is OK. Um, Ms. [PII], may I have a good contact number in case we're disconnected and then your policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, it's uh [PII].
[CUSTOMER][NEUTRAL] And the claim number is 358-5605 and it's under a [PII], he's my late husband.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] OK for me to be. Alright, I'm just reading the notes and getting up to date. Sorry, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][POSITIVE] No, you are just fine.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] The claim form will be used as proof. OK, so you were asking for the claim form. OK, so let me see what I do see something came in on [PII], so I'm getting ready to pull that now.
[CUSTOMER][NEUTRAL] OK, yeah, that's when she said she had faxed everything that was needed. I just wanna make sure.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][POSITIVE] It's coming up now. Sorry, he's taking his time.
[CUSTOMER][POSITIVE] No, you are just fine. You take your time.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And Mrs. [PII], do you mind if I place you on just a brief hold? I'm just looking through the documents.
[CUSTOMER][NEUTRAL] Yeah, go ahead. That's fine.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] All right. I just need the claim form cause that's all we asked for. So is this, I just need to make sure it's her portion and the doctor's portion, right?
[AGENT][POSITIVE] Yeah, completed by you and your physician returned to our office, da da da da. So really all they needed to do is fill that out and they wouldn't have had to send the records, but they did, so it's OK.
[AGENT][NEUTRAL] Alright, so this is in this benefit. Alright, so she's on that. Where's the doctor's part?
[AGENT][NEUTRAL] No, no, that's not it. OK.
[AGENT][NEUTRAL] So is it like physician's portion in lieu of the records or records instead of the physician portion? Cause I don't see.
[AGENT][NEUTRAL] I don't see a physician's portion.
[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][NEUTRAL] Hello, Mrs. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for that wait. So, I'm speaking with the um examiner who's processing your claim. So I see the documents, I see your part of the claim form, and I see the records. I don't see the physician's statement signed by the doctor and dated. So I asked her if the records, like, can we use the records in lieu of the doctor or how does that work? So I'm just waiting for an answer to see if
[CUSTOMER][NEUTRAL] Uh huh
[CUSTOMER][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, the, the explanation of benefits that I received stated that y'all received the attending physician portion, but you needed the, the actual claim form to go along with it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Wait a minute.
[AGENT][NEUTRAL] What does it, so it doesn't say the, wait, what does yours say?
[CUSTOMER][NEUTRAL] It says the enclosed claim form must be completed by you or your physician, which, of course, I didn't get the claim form. Um, the claim form will be used to as proof of loss for your critical illness diagnosis. If you should have any questions, please contact. We are very sorry for your loss. We will need the statement of insured portion of insured portion of the claim form. We received the attending physician portion. We need the death certificate.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me tell her that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It shows we have it states.
[AGENT][NEUTRAL] We have received the physician.
[AGENT][NEUTRAL] Statement.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm just gonna place you on another brief hold, OK? I just didn't want you to think I forgot about you or anything. I'm working.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Oh, no, no. OK, that's fine. Now, if you need another copy of that physician statement, I have copies of everything, um, except the actual claim form. I couldn't send that. They, uh, they had to do it, the employer and, and whoever else they were working with, um, so, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am. OK.
[AGENT][NEUTRAL] Well, it looks like she's typing now. OK, hold on one moment for me, OK?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] See the remark code didn't say all that now.
[AGENT][POSITIVE] Um, and it's nice that we apologize for her loss of this week.
[AGENT][NEUTRAL] Information requested for claim.
[AGENT][NEUTRAL] Come on, baby, cause uh.
[AGENT][POSITIVE] That is so sweet. We are sorry for your loss. We will need the statement of insured portion of the case, so we have a, we have received the attendant physician portion. We need the death certificate also. Oh, OK, OK, OK, OK, now that makes sense.
[AGENT][NEUTRAL] The GPS completed by.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] How is she going to get an ER physician to complete a claim form? What?
[AGENT][NEUTRAL] OK, wait a minute.
[AGENT][NEUTRAL] We received the attendant physician portion. We need the death certificate and autopsy if one was performed. If insured was at the hospital, we need the medical records on the.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] What
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] If he is insured
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] So the statement should just there.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] I'm gonna have them call her. I'm about to make a hug.
[AGENT][NEGATIVE] And have them research and call because I'm just playing middleman. That's how I got in trouble. Mm mm, I'm not doing it. I'm about to make a hug.
[AGENT][NEUTRAL] We all gonna handle that.
[AGENT][NEUTRAL] Cause it clearly says we, we received the attendant physician portion. So now I'm gonna have to tell her we have it.
[AGENT][NEUTRAL] Uh oh.
[AGENT][NEUTRAL] Girl, don't worry about it. I'll snip it and send it to you, [PII], cause I don't have time for this. She's on the phone.
[AGENT][NEUTRAL] Oh no, I don't want to send all that. That's PHI. Hold on.
[AGENT][NEGATIVE] Oh, get out of the way.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thankfully she's a sweetheart because she could be like.
[AGENT][NEUTRAL] I'm gonna send the hub.
[AGENT][NEUTRAL] This is crazy. This would have been a phone call.
[AGENT][NEGATIVE] It could have been done.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, hello, Mrs. [PII]. Thank you so much for your patience. I um had the exam. I reached out to the examiner that's processing everything so that I could get a clear answer for you. So she looked at all the documents, she said everything, she has everything that she needs and she's is in processing now. Um, so you should be receiving um your update shortly. We just got it on the [PII].
[CUSTOMER][NEUTRAL] Uh-huh, yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am. I just was reaching out just to make sure that y'all received everything that y'all needed to, uh, in order to process the claim.
[AGENT][NEUTRAL] Yes, ma'am. So you got it all in and you're good to go. um and then depending on if you use the online service, well, no, the policy is not active. So you'll receive the explanation of benefits in the mail.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right. Thank you.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that's it. Now, your name is [PII], you say?
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK. All right. I just wanted to notate. OK, I appreciate it. Thank you so much. You have a great day, [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you also and thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Uh-huh, thank you. Bye-bye.