AccountId: 011433970860
ContactId: 699338d5-b99a-4229-85a8-d2119c87f0d5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 785400 ms
Total Talk Time (AGENT): 315765 ms
Total Talk Time (CUSTOMER): 188729 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=-1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/699338d5-b99a-4229-85a8-d2119c87f0d5_20250314T13:11_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hi, I received the text message today that um said that my claim was ready to be reviewed and it had been denied, so I just, I need to know what we did wrong.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Sure, I can assist you with your claim. And may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh [PII] and my phone number is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the policy number?
[CUSTOMER][NEUTRAL] Uh, the policy number is 02548904.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And Miss [PII], for security, may I have your date of birth, mailing address and email address on file?
[CUSTOMER][NEUTRAL] [PII] is my birthday. Um, mailing address is [PII].
[CUSTOMER][NEUTRAL] What was the other one you asked for?
[AGENT][NEUTRAL] The email address.
[CUSTOMER][NEGATIVE] You know, uh sorry, I'm on my cancer treatment right now, so my brain is foggy. Um, it is [PII].
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, thank you. Let me go ahead and pull the, the information and see what happened. Do you mind holding for me a minute?
[CUSTOMER][NEUTRAL] No, that's fine.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Ms. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so I went ahead and um went over the notes of the examiner and it looks like um was this for radiation therapy, Ms. [PII]?
[CUSTOMER][NEUTRAL] No. I said, so what I understood was to start the claim. I had to send my pathology report reporting that I have cancer.
[CUSTOMER][NEUTRAL] And so that was my pathology report that we sent.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Got you. OK, um.
[CUSTOMER][NEUTRAL] I, I have cancer. I am doing the treatments right now.
[CUSTOMER][NEUTRAL] So that's what we were confused on like what did we do wrong?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, not, you haven't done anything really wrong, um, because what we're doing is, we went over the pathology pathology report, but it looks like we're gonna need additional information, um, and that's why I had to put you in.
[AGENT][NEUTRAL] And hold because I had to go through all the notes she puts in the, she put in the system, which it's just indicated that um we're sending you a treating physician form that you're gonna need to complete and send it back to us.
[CUSTOMER][NEUTRAL] We sent that in.
[CUSTOMER][NEUTRAL] We had Doctor [PII] fill it out and sign it. We sent that in.
[CUSTOMER][NEUTRAL] Doctor [PII], the forms they filled, she filled it out. That's my oncologist, not a
[CUSTOMER][NEUTRAL] Um, GI doctor.
[AGENT][NEUTRAL] OK. When you say you send it in, is it a form that you filled out with all the doctors you have seen, or is that just the one that it was included on the claim form?
[CUSTOMER][NEUTRAL] Just the one that was included on the claim form.
[AGENT][NEUTRAL] Yeah, it's a different form. It's a different form that they're sending, OK? Um, so they're sending, sending you that form with this paperwork right now that they're sending, um, they sent today, this morning.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What when you say by sending, is it gonna come in the mail or by email?
[AGENT][NEUTRAL] It's gonna be by mail.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, so they said that they need more additional information. All this information is gonna be on the paperwork that they send you, um, but yeah, the form is, is included on that paperwork, um.
[AGENT][NEUTRAL] And it looks like we're gonna be requesting medical records from [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oil, oil. So, um that's, uh, OK, so that's part of what we're doing as well. So basically, um we need the medical records. We're gonna send request for that. You don't have to do anything, um, but we're gonna need that form to be filled out, sent back to us, and then there's another part that indicates that if you're trying to get benefits for radiology, uh, to send in the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] Coil, that's my apologist.
[AGENT][NEUTRAL] Um, and that's just extra. That's why I was asking if that's what you were trying to get um benefits for. No, OK.
[CUSTOMER][NEUTRAL] No, we haven't started anything with that part yet.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that's fine. That was just an extra that's in the, that's in the notes. Um, so basically that, that right now that is where it's at, is, is basically in process. It's gonna be waiting for that information in order to be reviewed and reprocessed again. So once we receive the medical records and once we receive that uh treating physicians form that we're gonna send to you or it should be on the way.
[AGENT][NEUTRAL] And get the additional information that we need and we'll go ahead and reprocess the claim. So right now it's more like in a pending status until we receive what we have requested, OK?
[CUSTOMER][NEUTRAL] Uh, I guess so, um, I'm trying to think if there is.
[CUSTOMER][NEGATIVE] And then it said in there it said one thing, this is not like phone friendly at all, the website, it said that um
[CUSTOMER][NEUTRAL] We would need
[CUSTOMER][NEUTRAL] What that it looks like it could be preexisting. I've had this policy for the past 3 years.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] So I don't understand that.
[AGENT][NEUTRAL] And that will be, uh, explained, um, the pre-existing cost is, is basically, that's why we need the medical records. That's why we're asking for the medical records, and that's why we need the physician treatment payment. So those two are gonna determine that preexisting condition.
[CUSTOMER][NEUTRAL] So do you only need
[CUSTOMER][NEUTRAL] Do you only need Doctor [PII]'s or do you, do you also need the um GI doctor stuff? But Doctor [PII] has all my GI doctor stuff already transferred to her.
[AGENT][NEUTRAL] OK. Um, we probably we're gonna need uh from another doctors and that's probably why we're asking for the treating physician form to be filled out. Um, so any
[CUSTOMER][NEUTRAL] Well, the treating physician.
[CUSTOMER][NEUTRAL] Is the oncologist now.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And she has the like the pathology report that we sent in like that came from.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The oncologist, even though it was the GI doctor that did it, because the GI doctor, once they found out I had cancer, they just send it all to her.
[AGENT][NEUTRAL] OK, so you probably just need to send the information of the GI doctor. Is anybody that went through the process of seeing you, determining that you have um that you was positive for cancer or um before any other treatments, who's who have seen you, um, and then after that you started receiving regular treatment which I'm pretty sure that will be through [PII].
[AGENT][NEUTRAL] Um, but yeah, that, that's basically why we need that form filled out to see who else we need to get um medical records if we need to.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] So I just fill it all out. It's not for the doctors to fill out? OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, it's not for the doctors to fill out. That's something that you're gonna fill out. It's just a list of doctors you have seen before, uh, [PII], and just, yeah. OK, and just send that over to us and then the medical records again, you don't have to do anything. That's something we're working here, um, and this you're gonna be requested um by us to the doctor, OK? Um, you don't have to do anything about it.
[CUSTOMER][POSITIVE] OK, I can do that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And when will they send that by mail or is it already started the process?
[AGENT][NEUTRAL] Um, it was processed yesterday, so, uh, more than likely it will be out of our office, either, either it went this morning or by [PII] because it's always in the morning when it goes out by mail.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. Thank you.
[AGENT][NEUTRAL] Right. You're welcome, Ms. [PII]. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] Not today, but I'll probably call back.
[AGENT][POSITIVE] Mhm. OK. Well, I hope you feel better today and have a good day, OK? You're welcome. Bye-bye, Ms. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] All right bye.