AccountId: 011433970860
ContactId: 73704ed5-2189-4430-93ab-d6fb5ea4d4d3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 557179 ms
Total Talk Time (AGENT): 232807 ms
Total Talk Time (CUSTOMER): 251914 ms
Interruptions: 4
Overall Sentiment: AGENT=0, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/73704ed5-2189-4430-93ab-d6fb5ea4d4d3_20250421T18:38_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi [PII], I was just on the phone talking and I don't know my I guess my call got disconnected or whatever, but um I was calling because, alright, so I initially sent in a claim for my husband for cancer um policy back on in [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then they requested, I sent what the claim required, which was a pathology report and the actual claim. So then they sent something saying they needed a physician statement. OK, so I sent that in on [PII]. So, and I understand that it takes a little longer sometimes for these claims, I guess for certain insurance companies cause they all my other companies, I didn't have this long of a wait. But
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I still.
[CUSTOMER][NEGATIVE] I've got nothing and I, I got no kind of response back on it and I, I just think it's ridiculous that it's taken this long. This is over 1 month now and it's already 15 days maybe since that 15 business days since I sent in a physician statement or 12 business days, whatever it is. But um I'm just trying to find out.
[AGENT][NEUTRAL] Mm
[AGENT][NEGATIVE] It's still long enough. You should have received something.
[CUSTOMER][NEUTRAL] I'm just trying to find out what.
[CUSTOMER][NEUTRAL] What's the hold up?
[AGENT][NEUTRAL] OK. Well, I'm definitely sorry for the delay, but I'll be more than happy to look into the claim for you and get you an update or let you know what's going on. Um, may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's [PII] and it's [PII].
[AGENT][NEUTRAL] Thank you. May I have your policy number?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] It's 1415882.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, and I have the policy up here, Ms. [PII]. Can you verify your date of birth and the mailing address on file?
[CUSTOMER][NEUTRAL] It's [PII] and the address is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. OK, so,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] This is [PII]. Hold on one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so, as of [PII], I do see that it's on hold as it's in medical review with Dr. [PII] Now, once it gets to Doctor [PII], there's like
[AGENT][NEGATIVE] That's kind of out of our hands. It's no turnaround for him to do his review and send it back to us. So typically, like if it doesn't go to him or any, it's just processing, yes, we have 7 to 15 day turnaround, but since it's in review and like we don't have a phone number, email, like there's no way for me to reach.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, once it's in that review status, we just have to wait until Dr. [PII] finished and then he gets the decision for claims to, you know, continue processing, um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] So I kinda don't have like a, a date or, you know, I wanted to give you something more concrete, but
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right. Mm.
[AGENT][NEUTRAL] Waiting for Dr. [PII]
[CUSTOMER][NEUTRAL] Right, I mean, like.
[AGENT][NEUTRAL] I can, um,
[CUSTOMER][NEUTRAL] I mean, it's just
[AGENT][POSITIVE] If you like I can, I'm sorry.
[CUSTOMER][NEGATIVE] I mean, the man has cancer. What else does he need? like.
[AGENT][NEUTRAL] I can, I don't think it will make a difference, but I can try for you if you'd like me to reach out to um a claims examiner to see like if they have like maybe
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEGATIVE] A turnaround or more of an update. I just know once he gets to Doctor Bar, it literally freezes until he's done.
[AGENT][NEUTRAL] Um, cause he's reaching out to doctors and all of that, trying to, you know, confirm and verify. So,
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] I mean, and that's, that's my point. What's the purpose of me getting, I mean, the, the, you get a physician statement. I got a pathology report. I got a physician statement where they filled it out saying that he has cancer, what kind of cancer, what his treatment is. I, I don't, you know, I, it ain't like I filled it out myself.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right. Um, I mean, I definitely, if you want me to, I, I'll be more than happy to reach out the claims to see if we can get you more of a, like a concrete update. I just
[CUSTOMER][NEUTRAL] It, it's crazy.
[AGENT][NEUTRAL] I don't want to leave you in the wind, but I don't, we, I don't have an update right now.
[CUSTOMER][NEGATIVE] Right, I mean, I, I, yeah, right, and I understand what you're saying. It's just, it's just a little bit frustrating when you got all these bills coming in and, you know, it's frustrating for him and he already dealing with the fact of him having cancer.
[AGENT][NEGATIVE] It's frustrating.
[AGENT][NEUTRAL] And that's the stress that he doesn't need. I mean, you either, but I'm just saying.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Right, right, right, uh, and
[AGENT][NEUTRAL] If you want me to, I'll be more than happy to reach out the claims just to see, you know, I just want to
[AGENT][NEUTRAL] Try anything, um, cause I don't have a way to like reach Doctor [PII], but I can, I can see if maybe they have another way or anything.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Mhm. Yeah, well, I appreciate it. It's just, yes, mhm.
[AGENT][NEUTRAL] You want me to do that? OK.
[AGENT][NEUTRAL] OK. Do you mind if I place you on just a brief hold? I'm just gonna call on the other line and then click back over with you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's fine.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Deferring
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Hey, [PII], this is [PII] on the care team. How are you?
[CUSTOMER][POSITIVE] Doing well [PII] thank you how are you?
[AGENT][NEUTRAL] I'm OK. I have an insured on the other line who's kind of upset because their claim has been pending with Dr. [PII] for a while. There's no turnaround time for that, right? I
[AGENT][NEUTRAL] Like when he's done, OK.
[CUSTOMER][NEUTRAL] There's not I mean I don't know who the claim is pending with you may check with whoever has it pended to see if there's an update, but as far as I know there is no turnaround. It's just a matter of when it gets reviewed and the determination is made correct.
[AGENT][NEUTRAL] When he's done.
[AGENT][NEUTRAL] OK, that's what I thought. She, uh, I mean, it's been a while, but I just told her, um, she asked me if there was anybody else that I can check with her that could give an update, and I'm like, well, let me see, I don't think it'll change anything, but let me see.
[CUSTOMER][NEUTRAL] Who
[CUSTOMER][NEUTRAL] Who's the claim pending with do you know? What's the policy number?
[AGENT][NEUTRAL] Um, hold on, let me get out the notes. Um, policy number is 1415882.
[CUSTOMER][NEUTRAL] For [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Man.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It looks like it might be the J.
[CUSTOMER][NEUTRAL] Um, let's see one.
[CUSTOMER][NEUTRAL] DB, yeah, it's the hay.
[CUSTOMER][NEUTRAL] You can maybe send a message to her and ask her if there is any update or unknown uh ETA a one no decision um I mean other than that there's really nothing we can tell them.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] I think so.
[CUSTOMER][NEGATIVE] Because it it yeah unfortunately.
[AGENT][NEUTRAL] It's OK. I think she just wanted to know that I tried more than just telling her.
[CUSTOMER][NEUTRAL] Right, right, um, and I, I mean I would just tell her you can send a message to the um.
[AGENT][NEUTRAL] We'd also I
[CUSTOMER][NEUTRAL] To the adjuster to ask, you know, to inquire, but at this point we just have to wait for that determination to come back.
[AGENT][POSITIVE] OK. Well, thank you very much.
[CUSTOMER][POSITIVE] You're welcome. I hope I was some help.
[AGENT][NEUTRAL] You were, I, I mean, you were confirming for me. She, she might not want to hear it, but I'm gonna have to smooth it off.
[CUSTOMER][NEUTRAL] Right. OK.
[AGENT][POSITIVE] Thank you. Have a good day.
[CUSTOMER][NEUTRAL] If you need anything else let me know [PII] you too.
[AGENT][NEUTRAL] OK. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.