AccountId: 011433970860
ContactId: 877c9fa3-6dfe-4086-abdc-935c7ea3266b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 548030 ms
Total Talk Time (AGENT): 141551 ms
Total Talk Time (CUSTOMER): 208993 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/877c9fa3-6dfe-4086-abdc-935c7ea3266b_20250416T20:22_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], how are you?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][POSITIVE] I'm doing well, thank you. Um, I'm calling to check on the status of a claim.
[AGENT][NEUTRAL] OK, I can help you with claim status. Is it for yourself?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number, uh, give me a second, it's uh
[CUSTOMER][NEUTRAL] Here's the claim number.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, or I can look it up by your name or social.
[CUSTOMER][NEUTRAL] OK. I do have the policy number. It is 01220189.
[AGENT][NEUTRAL] OK, thank you. And can I get your name and your date of birth?
[CUSTOMER][NEUTRAL] Yes, it is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And do you have a good callback number, Mr. [PII], just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Just need a few more pieces of information. What's your address?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] House address? It is uh [PII].
[AGENT][NEUTRAL] And then an email address.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Uh, it looks like it might be an old um work address.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] It is, it might be uh my work email, so it would be [PII].
[AGENT][NEUTRAL] OK, yes, that's what we have. Do you want to change your email address to your personal?
[CUSTOMER][NEUTRAL] It's fine.
[AGENT][NEUTRAL] OK, and what um data service are we looking at? Is this for yourself?
[CUSTOMER][NEUTRAL] Yes, uh, so the, let me see.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The date of service is from [PII].
[CUSTOMER][NEUTRAL] To [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, you're looking at that claim 3588062. Is that the one you were checking on?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, it looks like we had requested your primary explanation of benefits.
[CUSTOMER][NEUTRAL] Uh, I already submitted all those documents, um, so the examiner was supposed to be looking at it, uh, today, and you guys were going to just call the CDS Caremark, uh, provider just to verify the information.
[AGENT][NEUTRAL] OK, um, let me see if I've got notes.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Yeah, it looks like uh I spoke with someone, and this was yesterday, um they were gonna call CVS.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure
[AGENT][NEUTRAL] Um, I don't have an update on it. Um, I could get you back over to our claims department to see if there's anything, but I don't have anything updated yet.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You wanna go um want me to transfer you to the claims department?
[CUSTOMER][NEUTRAL] Yeah, to see if they have an update uh from today and just.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, hold on one moment, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Deferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Hi [PII], it's [PII] in the care team. I've got a member on the line that wanted to get an update on, I guess you spoke with somebody yesterday and they were gonna check with an auditor about the claim. Um, I was gonna see if you could look at it and see.
[CUSTOMER][NEUTRAL] Um, sure.
[CUSTOMER][NEUTRAL] What's the policy number, [PII]?
[AGENT][NEUTRAL] 01220189.
[CUSTOMER][NEUTRAL] And it's for uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] Uh, verify the info.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And which claim is that?
[CUSTOMER][NEUTRAL] They're inquiring about?
[AGENT][NEUTRAL] Uh, it's the most recent.
[CUSTOMER][NEUTRAL] Or all of them.
[AGENT][NEUTRAL] Uh, most recent 1, 3588062.
[AGENT][NEUTRAL] I guess there's a note in the system that somebody was gonna get with the auditor and then call CVS.
[AGENT][NEUTRAL] Um, it looks like, cause these are like chemo charges, but they're like chemo drugs.
[AGENT][NEUTRAL] So I don't know um what to tell him if that's transpired. I assume it hasn't because there's not a new note, but um.
[AGENT][NEUTRAL] He wanted to check with the, make sure the claims department see if y'all had any information maybe I don't.
[CUSTOMER][NEUTRAL] No, I don't see any additional information um.
[CUSTOMER][NEUTRAL] I do see the insured was waiting for a call back and that's the number that 832-257.
[CUSTOMER][NEUTRAL] 7753.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEUTRAL] Should I just tell him to
[CUSTOMER][NEUTRAL] And I'm not sure she doesn't say.
[AGENT][NEUTRAL] Um, just wait for a call back, or is there an estimated time or?
[CUSTOMER][NEUTRAL] Well, what I can do, I was just gonna suggest that I mean.
[CUSTOMER][NEUTRAL] I'm not sure who.
[CUSTOMER][NEUTRAL] I'm a little bit confused by this because she said.
[CUSTOMER][NEUTRAL] There's no EOB spoke with auditor to see what else he could send in. She is the auditor. I thought maybe not.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] I guess let me um.
[CUSTOMER][NEUTRAL] You can either transfer them to me or um.
[CUSTOMER][NEUTRAL] Or I can like uh what I'm gonna do at this point I think I'm gonna reach out and see if I can get some information from [PII] as to what exactly um if there's an update at all.
[CUSTOMER][NEUTRAL] I believe she's here so I can reach out and so if you want to um like I said you can either transfer him over to me and I can tell him or um you can just tell him that we're gonna review that uh information and that someone will call him back and either I will have I will call him back either way um and let him know at least what I find out so it's up to you if you wanna transfer him to me.
[AGENT][NEUTRAL] OK, do you think
[AGENT][NEUTRAL] Uh, yeah, do you mind if I just transfer him over that way he knows he's talked to the claims department or whatever.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] OK, here you go. Thank you so much.
[CUSTOMER][NEUTRAL] And you said everything was verified correct [PII]?
[AGENT][NEUTRAL] Yes, it was. Uh-huh, yeah.
[CUSTOMER][POSITIVE] OK alright thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Hello, good afternoon, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes.