AccountId: 011433970860
ContactId: 36ae2e75-8793-48a2-9d1f-4aa5bd925c8b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 696359 ms
Total Talk Time (AGENT): 175896 ms
Total Talk Time (CUSTOMER): 91489 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/36ae2e75-8793-48a2-9d1f-4aa5bd925c8b_20250410T20:08_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] on the care team. I've got an insured on the line that is checking on a claim status, um, and it looks like we got the physician's statement, but the claim is still, still denied for needing additional information, which I assume is the diagnosis, but the physician's statement has that, so she's wanting to ask questions on that.
[AGENT][NEUTRAL] OK, and what was the policy number?
[CUSTOMER][NEUTRAL] Policy number is 254.
[CUSTOMER][NEUTRAL] 592 7
[AGENT][NEUTRAL] And the name of the person who's calling?
[CUSTOMER][NEUTRAL] It's the insured [PII].
[CUSTOMER][NEUTRAL] Um, but it's for a claim on her spouse.
[AGENT][NEUTRAL] And what was the policy number? I'm sorry, the claim number.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] The claim number is 3587552.
[CUSTOMER][NEUTRAL] And it looks like right underneath it, there's a document, but it's all zeros and that's the physician's statement.
[CUSTOMER][NEUTRAL] Not sure.
[AGENT][NEUTRAL] OK, give me just a second.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, sorry, give me just a second just pulling up the information here.
[AGENT][NEUTRAL] I can know what to tell her.
[AGENT][NEUTRAL] OK, you can go ahead and transfer over.
[AGENT][NEUTRAL] And did you verify all her information?
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] I did, yes, I did.
[AGENT][NEUTRAL] OK, and what was the callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] OK great thank you.
[CUSTOMER][POSITIVE] OK, thank you. Here you go.
[AGENT][POSITIVE] Thank you for holding this is [PII].
[CUSTOMER][NEUTRAL] Hi, [PII]. How are you?
[AGENT][POSITIVE] I'm doing very well, thank you. How are you doing, [PII]?
[CUSTOMER][NEUTRAL] OK, I'm calling in reference to my claim.
[AGENT][NEUTRAL] Yes ma'am, you had a question regarding your spouse's claim?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Uh, sure, yes, how can I help you today?
[CUSTOMER][NEUTRAL] What else do you guys need?
[AGENT][NEUTRAL] OK, I can take a look at that for you. You're just paying to check on the claim status.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And she said we didn't turn anything. The lady answered the phone and I said, well, we turned in a physician statement. He had surgery on [PII]. We turned all that in from an accident, like, what more do you guys need?
[AGENT][NEUTRAL] Uh sure.
[AGENT][NEUTRAL] Well let's take a look at that for you. Um, bear with me just a moment. Let me just pull up that claim for you.
[CUSTOMER][POSITIVE] Thank you. Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] OK, Ms. [PII], I'll take a quick look at your claim. Do you mind if I put you on hold for just a moment?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Alright, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi there. Do you mind looking at a claim with me real quick?
[AGENT][NEUTRAL] Uh oh.
[AGENT][NEUTRAL] Oh let me see, I can share my screen with you. uh, let me know if you can see it.
[AGENT][NEGATIVE] Oh, I know I hate when that happens.
[AGENT][NEGATIVE] Oh no. That bad.
[AGENT][NEUTRAL] Um, so it looks like on this one we asked for, we're needing the diagnosis code, is that correct?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Because she's on the other line and she's wanting to see what else is needed for her claim.
[AGENT][NEUTRAL] Um, but then I see it looks like we did receive a physician's form and it does have the diagnosis code on here. So I just wanted to be sure what to tell her that that she needs to provide.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I can tell her that looks like we do have what we need and that we that we'll review the form.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah, I saw that, so that should be fine. But yeah, I did see where we're asking for the diagnosis code, so, um, I
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh, let me reshare. um, it's the open mail. There's an open mail, um, that was received.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Do, do you see my screen?
[AGENT][NEUTRAL] Right here.
[AGENT][NEUTRAL] The attending position statement?
[AGENT][NEUTRAL] Yeah, accident.
[AGENT][NEUTRAL] This, this one right here. Can you see my screen?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Um, um.
[AGENT][NEUTRAL] So we're not able to use this for the HI?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] All right, so I'm not sure how to do that. Do you know what I'm supposed to do?
[AGENT][NEUTRAL] I mean, is it in the
[AGENT][NEUTRAL] Is it in the main queue?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Looks like a T
[AGENT][NEUTRAL] G
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me, I'm gonna go ahead, she's on the.
[AGENT][POSITIVE] OK. All right, I'll let her know. Thank you.
[AGENT][NEUTRAL] Mm bye.
[AGENT][NEUTRAL] I'm sorry about that, Miss [PII], are you still there?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Yes. So I did review the, the um documents that we received, um, the physician's statement. And so, yes, I'm gonna have um request that that adjuster go ahead and re-review this claim for you. Um, and so it will be re-reviewed and processed, um, and that will be, um,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Uh she'll review it today, but it may, it may be either today or tomorrow that it is released since it's kind of towards the end of the day, but at the very latest it should be processed by tomorrow.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Uh, sure, Ms. [PII]. So was there anything else I could do to help you today?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] No, you have a good day.
[AGENT][POSITIVE] Yeah sure, thanks for calling APL. You have a good day as well.
[CUSTOMER][POSITIVE] Thank you. You too. Bye bye.