AccountId: 011433970860
ContactId: 5771ca02-19ab-4b9f-b4b8-05cd585db6f4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 289329 ms
Total Talk Time (AGENT): 97474 ms
Total Talk Time (CUSTOMER): 148177 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/5771ca02-19ab-4b9f-b4b8-05cd585db6f4_20250618T17:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] here.
[CUSTOMER][NEUTRAL] I have a claim, um.
[CUSTOMER][NEUTRAL] I guess we could start off by giving you the number and it had to go to an appeal, so do you need to transfer me to a different department maybe?
[AGENT][NEUTRAL] Uh, no, I shouldn't need to. Um, do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, 207, no, it looks like 227 2271291.
[AGENT][NEUTRAL] OK, and Miss [PII], do you have your date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I mean, can you verify your address and email address?
[CUSTOMER][NEUTRAL] [PII]. [PII].
[AGENT][NEUTRAL] OK, and then lastly, Ms. [PII], can I get a good callback number in case we are disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. OK, and you said you submitted an appeal on a claim, is that right?
[CUSTOMER][NEUTRAL] Well, I submitted the the claim in wrong and so then she said uh she understood all that and she said OK well we have to redo it but we have to call it um.
[CUSTOMER][NEUTRAL] What did I just say?
[AGENT][NEUTRAL] Uh nope.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Appeal I guess she said it had to be called an appeal, but anyway, and so I've sent a lot of information in to them to um.
[CUSTOMER][NEUTRAL] Further explain everything and so I haven't heard from them so I'm curious to see where we are and if we still need more information.
[AGENT][NEUTRAL] OK, um, what our latest information received. OK, and then did you submit that back in, uh, [PII], is that right?
[CUSTOMER][NEUTRAL] Oh Lord, [PII] probably I mean I'd have to look it up, uh.
[CUSTOMER][NEUTRAL] Let's see you want me to look it up?
[AGENT][NEGATIVE] Uh, no.
[CUSTOMER][NEUTRAL] I sent him a bunch of different documents.
[AGENT][NEUTRAL] Yeah, it looks like
[CUSTOMER][NEUTRAL] I must have sent them 10 or 12 documents.
[CUSTOMER][NEUTRAL] Oh my. Do you see that?
[AGENT][NEUTRAL] Yes, I see it.
[AGENT][NEUTRAL] OK, looks like we've got it currently under review with that additional documentation that you sent.
[AGENT][NEUTRAL] Um, so it's, it's being reviewed by our medical director, so.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, I'd probably allow, uh, let's see.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] That was it
[AGENT][POSITIVE] Uh, probably allowed probably about 5 more working days, um, and we should hopefully have determination by then.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK. All right. Well, um.
[CUSTOMER][NEUTRAL] Let's see, OK, I'll check back I guess so.
[AGENT][NEUTRAL] OK. Is there anything else I can help with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] Uh, yeah, well, you know, I'm thinking I should go ahead and send a new form to the physician to fill out properly.
[AGENT][NEUTRAL] Um, I, I don't, it doesn't look like we need a new form, but, um,
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEGATIVE] Well, because it was filled out incorrectly, you see, that's what the whole problem comes from.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Actually,
[CUSTOMER][NEUTRAL] So I'm a nurse, so I was trying to be nice, so I checked off the boxes that his nurse just took it, he signed here and then went to disability.
[CUSTOMER][NEUTRAL] But he didn't really look at it and fill it out, which is he had to have checked invasive.
[CUSTOMER][NEGATIVE] So that's where we got into all this trouble.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEGATIVE] So we could send him a a brand new one and let him fill it out correctly um she said it still had to go to appeal, so I'm not sure what to do, but I hate for him to.
[CUSTOMER][NEUTRAL] To review it and then not have the correct doctor's information, you know, so I don't know.
[AGENT][NEUTRAL] Um, yeah, I mean, it looks like we're, we've got it currently under review, um, so if you did submit additional documentation that showed that it was invasive, then that should be.
[CUSTOMER][NEUTRAL] Yeah, I sent the op notes and everything.
[AGENT][NEUTRAL] OK, yeah. If it's, if it shows invasive, that should be sufficient. Um, I don't, I don't think that we would need a new form.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, so because it is under review right now, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, so if we do, we can always go at it again.
[AGENT][POSITIVE] Absolutely, yeah.
[CUSTOMER][POSITIVE] OK, alright, well, we'll just wait then, that's good.
[AGENT][NEUTRAL] OK, um, yeah, just give it about 5 working days and then, um, hopefully by then it'll be, uh, completed, so.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] And then um
[CUSTOMER][POSITIVE] OK. All right. Good. Thank you.
[AGENT][POSITIVE] OK, thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.