AccountId: 011433970860
ContactId: 5f75f967-47aa-4b46-8577-c47645c3fcba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 771239 ms
Total Talk Time (AGENT): 262612 ms
Total Talk Time (CUSTOMER): 88974 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=-2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/5f75f967-47aa-4b46-8577-c47645c3fcba_20250602T12:44_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] Um, hi, [PII]. This is [PII] in the Midland claims department. Um, I have a member on the, hello. Um, I have a member on the line. She's calling in regards to the status of her disability claim. Would you be able to further assist her?
[AGENT][NEUTRAL] Hey.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Sure. Um, may I have the policy number?
[CUSTOMER][NEUTRAL] Um, yes. Her policy number is 02586652.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can, oh, is she already verified?
[CUSTOMER][NEUTRAL] Um, yes, I already verified everything and I'll let her know that she has a claim on file. One is pending and um she wanna know the status of the one that denied, so that's why I'm transferring her so someone could further explain that to her.
[AGENT][NEUTRAL] OK, um, you can send her through.
[CUSTOMER][NEUTRAL] OK, here she is and her callback number is the one that's in the system.
[AGENT][POSITIVE] Alrighty, well, thank you, Evie.
[CUSTOMER][NEUTRAL] OK, thank you, [PII]. Here she is. Bye.
[AGENT][POSITIVE] You're welcome. OK, bye bye.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hey, this is [PII] with the care team. How are you doing?
[CUSTOMER][POSITIVE] I'm doing pretty good how are you?
[AGENT][NEUTRAL] I'm doing good. Um, so you let me know that you're wanting to go over the claim status of the denied claim.
[CUSTOMER][NEGATIVE] It's denied.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, are you, wait, are you asking?
[CUSTOMER][NEUTRAL] Yes, I'm asking.
[AGENT][NEUTRAL] There is a claim that came in on [PII] that was denied. I'm getting ready to see why. And then there's looks like some documents that came in on the [PII], that's in process and so maybe it was asking for more information and that's what's here on the [PII]. But I'm getting ready to, um, she just gave me your policy number, so I'm about to look at everything now, OK?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so it'll be just a few moments, OK?
[CUSTOMER][POSITIVE] No problem.
[AGENT][POSITIVE] Alright, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Why is claims?
[AGENT][NEUTRAL] You know what,
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] 258.
[AGENT][NEUTRAL] 6652.
[AGENT][NEUTRAL] Is that
[AGENT][NEUTRAL] No, I'm trying to see what came in on the [PII].
[AGENT][NEUTRAL] Alright, and then over here I need to do.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] G
[AGENT][NEUTRAL] Physicians portions, miss.
[AGENT][NEUTRAL] What is this? I hope it's the physician's question.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I'm his registered.
[CUSTOMER][NEUTRAL] Yes I am.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for that wait. So it looks like, OK, so we received all your documents, we received your payroll journal, but there's, so the physician's part of this claim form is not filled out. That's what it's denied for. Um, so it's a
[CUSTOMER][NEUTRAL] No, I sent that in.
[AGENT][NEUTRAL] So you do have a part that the physician signed, not yours, the physician, the doctor?
[CUSTOMER][NEUTRAL] Yes, I sent it in with my paperwork.
[AGENT][NEUTRAL] OK, let me check again because all I see is a policyholder statement filled out.
[AGENT][NEUTRAL] Everything else was blank. Um, hold on one moment, OK?
[AGENT][NEUTRAL] Let me look at what you originally said. OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Now, why does claims have me doing this? Why couldn't the claims rep help her with the claim? I'm confused. See this is why.
[AGENT][NEUTRAL] Whatever.
[AGENT][NEGATIVE] I don't even want to address it because it's make everybody else easier.
[AGENT][NEGATIVE] So whatever.
[AGENT][NEUTRAL] There's nothing here. Let me see what her original we don't research, but.
[AGENT][NEUTRAL] They're passing it to us, so what are we supposed to do?
[AGENT][NEUTRAL] 5:19 let's see.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Statement of insured.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Unless the doctor's office filled this out too. That's the same handwriting.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] No, it sounds it.
[AGENT][POSITIVE] Oh, I can stand it on the right foot.
[AGENT][NEUTRAL] Oh, is that why they're saying it's not? Because the actual form wasn't signed and dated, maybe.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Is that what's happening?
[AGENT][NEUTRAL] I don't know, and I'm not figuring it out.
[AGENT][NEGATIVE] I don't know why claims brought her to us.
[AGENT][NEUTRAL] Oh my
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Let me see if it's what the notes say.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] No a physician see missing.
[AGENT][NEUTRAL] Form is submitted and signed but not.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Let me see, Miss [PII]. You know what? I'm not doing this.
[AGENT][POSITIVE] I, I know exactly what I'm gonna do.
[AGENT][NEUTRAL] Hello Miss [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. This is what I'm gonna do. I'm gonna send a message over to the claims examiner um that processed your claim. I'm gonna have them look at these documents, the original documents that you sent over and the second batch that came on the [PII]. I do see where the on the on the [PII], um, like when you first sent it in, I do see the phys[PII]'s statement.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] It's not I see it and it's filled out, but like there's two pages of the physician's statement.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] But you only have one, it looks like the doctor or someone signed at the bottom. There's like another page to this that they have to sign um like with your.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Like the day for treatment? Is that the one you're missing?
[AGENT][NEUTRAL] Yes, J4 because this one ends on J3.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I
[CUSTOMER][NEUTRAL] Uh, I'll get that filled out.
[AGENT][NEUTRAL] Oh, go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] I, I was just saying I can go ahead and get that filled out and sent in.
[AGENT][NEUTRAL] OK, because I don't know if that that may be why I'm that's why I'm gonna send it over to see if that's why they are denying it because it's, it's complete, but not fully comp, it's kind of incomplete because of the other page, even though there's a signature here. So um did you want me to send it over to them to give you a call or you want to have that filled out and then send it in and then see.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Go ahead and give them to call me and uh I'll talk with them and see if I need to go get this filled out.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. Well, I'm sending this over now and I did make it urgent, um, so they'll be giving you a call within 24 hours, OK?
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, ma'am, that's all.
[AGENT][POSITIVE] Alright, well, thank you so much for calling APO Ms. [PII]. I hope you have a good day.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][POSITIVE] Thank you, you're welcome. Bye bye.