AccountId: 011433970860
ContactId: 640a1b80-c9b4-451d-b96c-bd67d8521888
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 606400 ms
Total Talk Time (AGENT): 268033 ms
Total Talk Time (CUSTOMER): 220339 ms
Interruptions: 9
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/640a1b80-c9b4-451d-b96c-bd67d8521888_20250107T21:06_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. With whom am I speaking? How may I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], this is [PII] in uh group billing. I have an insured on the phone. She is calling about a claim.
[AGENT][NEUTRAL] Hi
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh. What's the policy number?
[CUSTOMER][NEUTRAL] She said that the the, well, she's got 3, but one of them is 635-883.
[AGENT][NEUTRAL] You can just
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] What she's calling about is, I mean, it's the insured's daughter because her mom passed away on December. She said she'd sent the information to [PII] that she'd spoke to someone earlier and said that [PII] was working on it and she just wanted to know if there is any updates or anything but she had sent the information that was requested.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I have to find out what policy we're talking about first, so if you don't have that information.
[CUSTOMER][NEUTRAL] Well, she's got intensive care. Well, it's the cancer and intensive care.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Uh-huh. OK. All right, cause I'm trying to see how, uh, OK, just send her to me cause I'm not seeing on cancer where anybody has been assigned any of these claims, so I don't know where the sha came in at.
[CUSTOMER][NEUTRAL] OK, she's got another one. She's got another cancer policy which is the 635-884.
[CUSTOMER][NEUTRAL] And her intensive care is the 635-885.
[AGENT][NEUTRAL] I see it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see, OK, go ahead and send her over. Did you verify her information?
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] I did not. Oh my goodness, I did not. I did not. I do have a good callback number.
[AGENT][NEUTRAL] That's OK. I'll verify. I'll, I'll do it.
[AGENT][NEUTRAL] That's all about it.
[AGENT][NEUTRAL] OK, what's that?
[CUSTOMER][NEGATIVE] It is [PII] and I just totally lost it.
[AGENT][NEUTRAL] That's OK. And what's her daughter's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, alright, you can go ahead and send her over.
[CUSTOMER][NEUTRAL] Alright, oh, when I did get the social I mean the social is the.
[AGENT][NEUTRAL] Well, that verifies, yeah, that's, that's verified. And the mother's name, and you got the mother's name, right?
[CUSTOMER][NEUTRAL] [PII] and, and the mother's name, I did.
[AGENT][NEUTRAL] So you verify, you verify. OK. Thank you.
[CUSTOMER][POSITIVE] Uh, maybe not all the way, but I did, so, OK. All right, my dear. Thank you. Uh, you too, [PII]. Thank you. Mm bye-bye.
[AGENT][POSITIVE] Oh, that was good. Yeah. OK.
[AGENT][POSITIVE] Thank you. Have a good one.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. Is this [PII]?
[CUSTOMER][NEUTRAL] Mhm, it is.
[AGENT][NEUTRAL] OK, I understand that you have verified your mother's name and her social security number. Do you know her address?
[CUSTOMER][NEUTRAL] Yes ma'am, [PII].
[AGENT][POSITIVE] Thank you for verifying that and I'm sorry for your loss and I understand that you're calling to check the status, uh-huh, you check the status of a claim.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Let's see here. Check one thing. I will check that for you to see what's going on.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you for your patience.
[CUSTOMER][POSITIVE] Yes ma'am, thank you for checking.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, so it looks like the claim is under review, so they're still working on it, OK? So you can just check back. Um, unfortunately, when it goes for review, there's really no time limit as to when it's gonna come back, but hopefully, it should be back within about 2 weeks, OK? But you can continue to check each day if you would like, all right?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, what's the uh review mean?
[AGENT][NEUTRAL] Um, there's something that had to be reviewed that something had to be reviewed for some reason, and she did not put any notes in here. I'm not sure what, but sometimes you have to make sure that, uh, something meets the definition of the policy to be payable, so that could be several reasons, mhm, but it has to be reviewed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] And that's on the cancer policy.
[AGENT][NEUTRAL] Yes, ma'am. Mhm.
[CUSTOMER][NEUTRAL] What about the intensive care? What does it say?
[AGENT][NEUTRAL] Let's take a look. Let me take a look at that.
[CUSTOMER][NEUTRAL] We had 2 intensive care.
[AGENT][NEUTRAL] So she only had one intensive care policy and possibly up under the cancer policy, there's an intensive care writer. That's probably what is going on. But the other, uh, let me see, the one intensive care, let's take a look.
[CUSTOMER][NEUTRAL] OK, probably so.
[AGENT][NEUTRAL] It's probably still being worked on because it's still gonna be all tied together.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Now, was she in intensive care?
[CUSTOMER][NEUTRAL] Uh yes, ma'am.
[AGENT][NEUTRAL] OK. Hm. Give me one second.
[CUSTOMER][NEUTRAL] stayed in intensive care and she also went to a nursing home.
[AGENT][NEUTRAL] Take a look.
[CUSTOMER][NEUTRAL] After that,
[AGENT][NEUTRAL] OK, give me 1 2nd.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Let me place you on a b[PII] hold while I review some information, OK? One moment.
[CUSTOMER][NEUTRAL] OK. Uh-huh. Thank. You are on hold.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Did she do that?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for patiently waiting. So the claim is still, it's all apart. Everything is together. So once it comes back from a review, they will process everything accordingly, OK? So everything is just still, uh, taking a little time to because of the review, right?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, baby, cause that what I was just trying to see, um.
[CUSTOMER][NEUTRAL] You know, uh,
[CUSTOMER][NEUTRAL] Like how long it was gonna take cause I know I've done it to her everything she asked me to see it and I was just trying to see if they done anything? Has she got anything done that's time.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, you know, like, like I said, the, the, the, the, the problem right now is, is at the medical review level. We, that's not us, that's not the processor, so you spoke to the processor. Once it goes to that next level, we have to wait for the medical review board to look at what they need to look at and return it to us. So that's why, you know, that's where it is now. We're just waiting to get a response back, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. Oh, it ain't no problem. I just was following up.
[AGENT][NEUTRAL] OK. All right. And like I said, you know, we don't know when it'll come back, you know, if you wanna check, you know, uh, tomorrow or the day after, you know, you can just check. All you can do is just continue to check. Mhm.
[CUSTOMER][NEUTRAL] To see what the status was. I didn't know that.
[CUSTOMER][NEUTRAL] Uh-huh, cause they won't email me. They won't email me and let me know when you.
[AGENT][NEUTRAL] No.
[AGENT][NEGATIVE] No, she won't, unfortunately. No. Yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh, OK, but what is, uh.
[CUSTOMER][NEGATIVE] Do, do they have enough information cause I know my mom did have cancer.
[AGENT][NEUTRAL] Apparently, uh, uh, apparently she does. Uh, if she needed something additional, I don't think she would have sent it to the medical review board. Now, with that being said, if they request something, now if they request something then she wouldn't know that until they tell her, hey, we need this right here, OK? So, as far as she's concerned, she had everything she needed, OK?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh, OK, so I just wanna make sure you had what she for me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you. That's fine. Well, I appreciate you let me know, and you have a very happy [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome and you take care of yourself. You too, Ms [PII], and you, you call us back, OK?
[CUSTOMER][NEUTRAL] I am.
[CUSTOMER][POSITIVE] OK, I will. Thank you so much Miss [PII]. You, you have a happy New Year. Bye-bye.
[AGENT][POSITIVE] Thank you. You're welcome. Thank you.
[AGENT][POSITIVE] You too. OK. Take care. Thanks for calling APO. Bye-bye. Uh-huh. Bye-bye.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes ma'am. Bye bye