AccountId: 011433970860
ContactId: 636e58e7-e336-4e94-ae9b-8286ed7daecb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 598799 ms
Total Talk Time (AGENT): 188086 ms
Total Talk Time (CUSTOMER): 142227 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/636e58e7-e336-4e94-ae9b-8286ed7daecb_20250528T15:59_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] in Broker Resources. How are you doing?
[AGENT][POSITIVE] I'm good [PII] how are you?
[CUSTOMER][NEUTRAL] I'm good, thank you. Um, I am calling because I have a um broker's assistant on the line and she is following up on a claim for a cancer and an accident policy, um, and she was curious where we were at with um getting that result.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, not a problem, [PII]. Do you have their policy number?
[CUSTOMER][NEUTRAL] Yes, so it is going to be.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] There a few of them.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it's gonna be 231-512-6.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] And then who are we talking to on the phone?
[CUSTOMER][NEUTRAL] Her name is [PII].
[AGENT][NEUTRAL] And then did we get a call back from [PII]?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 2098.
[AGENT][NEUTRAL] All right. And then um she verified everything for the insured.
[CUSTOMER][NEUTRAL] Um,
[AGENT][POSITIVE] I can verify it. OK. Yeah, no worries.
[CUSTOMER][POSITIVE] I don't know. OK, OK, perfect. I'm gonna, I'm gonna add her on, OK?
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Hey [PII], are you still there?
[AGENT][NEUTRAL] Hi, [PII].
[CUSTOMER][POSITIVE] Yeah I'm here. OK perfect I have [PII] on our claims line for you OK?
[CUSTOMER][POSITIVE] OK, thank you. Of course bye bye.
[AGENT][NEUTRAL] Hey, [PII], this is [PII]. How are you doing today?
[CUSTOMER][POSITIVE] I'm doing good.
[AGENT][NEUTRAL] Good. Um, so I just need to verify the patient's in the insured's information, excuse me, with the name and date of birth, please.
[CUSTOMER][NEUTRAL] OK, his name is [PII]. His date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And I understand from [PII] that you had a couple of claims, uh, was one on the cancer and then another policy?
[CUSTOMER][NEUTRAL] We had one on the critical illness, accident, and cancer.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Actually.
[AGENT][NEUTRAL] OK, let me just have a look.
[CUSTOMER][NEUTRAL] I wanted to check on the status of them. He said he received something in the mail from y'all, um, about papers to fill out that he had already sent, so we were just confused.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] Um, so yeah, they're each different policies. Let's see here.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like on the critical illness,
[AGENT][NEUTRAL] That claim was processed on the [PII] of this month. Um, it looks like it's requesting an itemized bill.
[AGENT][NEUTRAL] Um, it looks for this, uh, claim. It says we need an itemized bill for treatment received and medical records for the state of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think I remember submitting uh.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What's it called where they give you permission for y'all to search his medical records.
[AGENT][NEUTRAL] Oh, like an authorization.
[CUSTOMER][NEUTRAL] Is that something
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Yeah, I don't see that there was any sort of correspondence sent out cause
[AGENT][NEUTRAL] Usually, if it's a medical records thing, you know, we'll just um mail something to the provider.
[AGENT][NEUTRAL] Let me see what was.
[AGENT][NEUTRAL] I don't see any authorizations on former or authorizations on file for this policy. I just see.
[AGENT][NEUTRAL] On what was submitted on [PII], um, it was the claim information as far as the form and all of that, but I don't see any authorizations on the member's policy for this one.
[CUSTOMER][NEUTRAL] Oh, do you see like girl scroll all the way to the bottom. There should be a HIPAA authorization.
[AGENT][NEUTRAL] Let me
[AGENT][NEUTRAL] I just see the claim form.
[CUSTOMER][NEUTRAL] I'm looking at it all the way at the end it's.
[CUSTOMER][NEUTRAL] The last page.
[AGENT][NEUTRAL] Oh, page 6, I see it.
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] Page 6 of 7.
[CUSTOMER][NEUTRAL] Well, from my screen it says it's the 9th page.
[AGENT][NEGATIVE] What do you have a claim number with the one that you're looking at because it may not be the same one. This one only shows 7 pages total.
[CUSTOMER][NEUTRAL] Yeah, it's, you want, you ready for it?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's 359.
[CUSTOMER][NEUTRAL] 862 9.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, that's the claim number I'm looking at.
[AGENT][NEGATIVE] It's weird. It doesn't show me that many pages.
[CUSTOMER][NEUTRAL] That is weird.
[AGENT][NEGATIVE] That's missing the last two.
[CUSTOMER][NEUTRAL] It's showing me 9, like, it lets me look at it on the OSC.
[AGENT][NEGATIVE] Yeah. No, it shows me 7 pages total.
[AGENT][NEUTRAL] So it looks like we're missing, missing that. Um, that can just be faxed or scanned or to us, not everything else has to be re-uploaded.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what about that accident claim?
[AGENT][NEUTRAL] And let me go to that policy. Give me just a second.
[AGENT][NEUTRAL] So on his accident policy, the last thing I see reported was in January of this year.
[AGENT][NEUTRAL] Do you have a
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is that the one you're looking for?
[CUSTOMER][NEUTRAL] Yeah, I, I just wanna make sure everything's processed and y'all didn't need any further information.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] It looks like that paid out and it exhausted the amount, so it wasn't requesting anything additional. There was a benefit payment made to the insured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it was just the critical illness claim then?
[AGENT][NEUTRAL] Mhm. Yeah, it looks like.
[CUSTOMER][NEUTRAL] I just needed clarification on that.
[AGENT][NEUTRAL] Yeah, no, not a problem. Did you need me to check anything else?
[CUSTOMER][NEUTRAL] No, I think that's it.
[AGENT][POSITIVE] Alright, thanks for calling APL. I hope you have a good rest of your day.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.