AccountId: 011433970860
ContactId: 4a334908-3989-4c1e-a156-e598dc2336a0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 481399 ms
Total Talk Time (AGENT): 169096 ms
Total Talk Time (CUSTOMER): 108974 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/4a334908-3989-4c1e-a156-e598dc2336a0_20250520T17:13_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Oh yes, I'm just, I've had a uh claim maybe I think it's been like 2 years ago, and I'm just trying to see why hasn't it processed through because I have seen what they needed.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Oh, OK. I can definitely check on the claim. You said it's about 2 years old?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Um, may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] And my number is [PII].
[AGENT][NEUTRAL] Thank you, Missy, do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, it is 237.
[CUSTOMER][NEUTRAL] 9853
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And I have you here. Can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] My date of birth is um [PII].
[CUSTOMER][NEUTRAL] And then you wanted my email address that's on file? Oh [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Thank you for that. And the the mailing address on file?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So, um, is it for you or your spouse?
[CUSTOMER][NEUTRAL] It's for my spouse.
[AGENT][NEUTRAL] OK, hold on one second.
[AGENT][NEUTRAL] OK, so let me check your previous um policies because there's no claims on here for him or you. Hold on one second.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Let me check. I'm gonna look at the first one and the last one.
[AGENT][NEUTRAL] You said about 2 years ago. I'm just gonna look at both. Do you mind if I place you on just a brief hold while I look through the policies?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] No, go ahead.
[AGENT][NEUTRAL] OK, hold on one moment.
[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] Uh-huh.
[AGENT][POSITIVE] Alright, thank you so much for holding. I apologize for that wait. So, um, I believe I figured out what happened. Um, is this from or around
[AGENT][NEUTRAL] [PII], [PII], it's from Texas Oncology, Crockett Medical, Mother Francis Hospital. Does that sound?
[AGENT][NEUTRAL] Like what you're looking for?
[CUSTOMER][NEUTRAL] Yeah, that sounds right, but that, that ain't, yeah, but that ain't.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The one that was set, I didn't mean to fit that in there that was just kind of put in there and I didn't mean to set it in there when I sent it off.
[AGENT][NEUTRAL] What?
[CUSTOMER][NEUTRAL] That one from Crockett Medical Center because at that time.
[CUSTOMER][NEUTRAL] We wasn't even diagnosed with anything yet.
[AGENT][NEUTRAL] Oh, well, that's OK. Let me see what that one was um, well, just overall the for the claim, it, it was denied for a few reasons. Um, the main one is the pre-existing condition and in the now this was a few years ago, but in the explanation of benefits, there was a form to sign so that we can, it was a release of information so we could request records from your doctor. Do you remember sending that back or anything?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, I did.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So then let me look at the documents. Do you?
[CUSTOMER][POSITIVE] Matter of fact, I think I did it. I think I did it. I think I did it through the phone.
[AGENT][NEUTRAL] What do you mean?
[CUSTOMER][NEUTRAL] I sent the documents through the tele through the telephone like um.
[AGENT][NEUTRAL] Like a fax?
[CUSTOMER][NEUTRAL] I took no, it was like um.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Like a download and it was on y'all's website or whatever I had to do.
[AGENT][NEUTRAL] OK, OK, like you took a picture and like uploaded it.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] There's a few things that I'll need to do then. Um, do you, are you OK with holding?
[CUSTOMER][NEUTRAL] Uh, well, I've got to get back to work.
[AGENT][NEUTRAL] So let
[AGENT][NEUTRAL] What time do you get off of work?
[AGENT][NEUTRAL] Or when is the best time for me to call you?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Um, it will be after, um, [PII].
[AGENT][NEUTRAL] OK, because I leave, what are, what um time zone are you in?
[CUSTOMER][NEUTRAL] Um, [PII], uh, is that Central Standard Time?
[AGENT][NEUTRAL] Central. OK, yeah, so we're on the same time. OK, so I don't leave here until [PII], but it doesn't matter. I'll call you before I leave today and that will be after you get off.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] OK, so I'll get this all together and get an update for you and then I'll call you before I leave today.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] You're very welcome. And again, my name is [PII]. I'm the only [PII] here, OK?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] All right.
[AGENT][POSITIVE] All right, thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Mhm you too.
[AGENT][POSITIVE] Thank you.