AccountId: 011433970860
ContactId: 8d50fb16-7cc3-4889-9801-268e5351335d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 910080 ms
Total Talk Time (AGENT): 349324 ms
Total Talk Time (CUSTOMER): 157743 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/8d50fb16-7cc3-4889-9801-268e5351335d_20250416T20:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][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 he 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.
[AGENT][NEUTRAL] Um, sure.
[AGENT][NEUTRAL] What's the policy number, [PII]?
[CUSTOMER][NEUTRAL] 01220189.
[AGENT][NEUTRAL] And it's for uh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, verify the info.
[AGENT][NEUTRAL] And which claim is it?
[AGENT][NEUTRAL] They're inquiring about?
[AGENT][NEUTRAL] Or all of them.
[CUSTOMER][NEUTRAL] Uh, it's the most recent.
[CUSTOMER][NEUTRAL] Uh, most recent 1 358-8062.
[CUSTOMER][NEUTRAL] I guess there's a note in the system that somebody was gonna get with the auditor and then call CVS.
[CUSTOMER][NEUTRAL] Um, it looks like, cause these are like chemo charges, but they're like chemo drugs.
[CUSTOMER][NEUTRAL] So I don't know um what to tell him if that's transpired. I assume it hasn't because there's on a new note but um.
[CUSTOMER][NEUTRAL] He wanted to check with the make sure the claims department see if y'all had any information maybe I don't.
[AGENT][NEUTRAL] No, I don't see any additional information um.
[AGENT][NEUTRAL] I do see the insured was waiting for a call back that's the number that [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, um.
[AGENT][NEUTRAL] And I'm not sure she doesn't say.
[CUSTOMER][NEUTRAL] Should I just tell him to.
[CUSTOMER][NEUTRAL] Um, just wait for a call back or is there an estimated time or?
[AGENT][NEUTRAL] Well, what I can do, I was just gonna suggest it I mean.
[AGENT][NEUTRAL] I'm not sure who.
[AGENT][NEUTRAL] I'm a little bit confused by this because she said.
[AGENT][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] So, um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I guess let me um
[AGENT][NEUTRAL] You can either transfer them to me or um.
[AGENT][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. 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.
[AGENT][NEUTRAL] 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 want to transfer him to me.
[CUSTOMER][NEUTRAL] OK, do you think
[CUSTOMER][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.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said everything was verified correct [PII]?
[CUSTOMER][POSITIVE] OK, here you go, thank you so much.
[CUSTOMER][POSITIVE] Yes it was uh huh, yep.
[AGENT][POSITIVE] OK alright thank you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Ah.
[AGENT][NEUTRAL] Hello, good afternoon, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hi, my name is [PII]. I'm on the claim support team and [PII] transferred you over to me um, it, it looks like we're um we're.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If we had a question about whether a claim could be reprocessed and we're waiting for an answer, um, what I'm gonna do at this point is I'm gonna reach out to, uh, I believe it was [PII] you spoke to yesterday and see if I can get an update. Would it, would it be OK with you?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] If I call you back or would you, would you wanna hold? I think um if you give me a little bit of time I'll definitely, oh OK, OK, because I was gonna say I'll definitely give you a call back once I get an answer um but I'm just gonna try to follow up with her and see if we have any update because I don't see an update as of yet, OK?
[CUSTOMER][NEUTRAL] I'll hold. It's fine.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, no worries. I'll, I'll hold. I'm not, not in a rut.
[AGENT][NEUTRAL] OK, so I'm gonna place you on a brief hold and I'm gonna reach out and see if I can get an update for you, OK? So just uh bear with me for one moment please. You're welcome.
[CUSTOMER][POSITIVE] Alright, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] The only one in the queue.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] So going back here just a little.
[AGENT][NEUTRAL] This is [PII].
[AGENT][NEUTRAL] I, I sent, I sent a message. I'm just waiting for a response. I just wanted to let you know I didn't forget you were on hold.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And um just so I understand it looks like you sent in some um information for a claim and um there is uh a request for some explanation of benefits and those are not available, is that correct?
[CUSTOMER][POSITIVE] No worries, no worries.
[CUSTOMER][NEUTRAL] And um, on your side.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yeah you guys were just uh verifying the information on on y'all's uh end of things.
[AGENT][NEUTRAL] Yeah, we needed an explanation of benefits for the the chemo drugs, um.
[CUSTOMER][NEUTRAL] You're going to the hospital.
[AGENT][NEUTRAL] And it there in the note indicates that that you don't have any explanation of benefits from Caremark.
[CUSTOMER][NEUTRAL] No, it's, uh, it's called a patient, uh, cost explanation. So, uh, I submitted those documents along with, uh, the payments, uh, that were made, uh, through CVS Caremark.
[AGENT][NEUTRAL] OK, and you don't have the explanation of benefits from Caremark?
[CUSTOMER][NEUTRAL] Uh, well, the explanation of benefits, all that information is in the second document, which is the patient cost.
[CUSTOMER][NEUTRAL] Document um there you can find all of that information.
[AGENT][NEUTRAL] OK, so in other words we're asking for information that you already submitted and you don't have any further information, is that right?
[CUSTOMER][NEUTRAL] Yeah, you guys just need to confirm the information.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so I've, I've reached out, um, so just bear with me until I get a response, OK? Um, hopefully, um.
[CUSTOMER][POSITIVE] Yeah, no worries.
[AGENT][NEUTRAL] Yeah, because like I said, I don't know um exactly who.
[AGENT][NEUTRAL] Who this uh was sent to so I'm just trying to verify that information and then um see what is exactly uh the update is, you know, were they able to reach out because it looks like they were going to reach out to CVS directly.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Yeah, correct.
[AGENT][NEUTRAL] OK, OK, alright, so just bear with me for a few more minutes. OK, thank you.
[CUSTOMER][POSITIVE] Alright, no worries.
[CUSTOMER][NEGATIVE] Yeah, of course. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, Mr. [PII]?
[AGENT][NEUTRAL] Um, OK, so the adjuster that's working on your claim, um, she is not available at this moment, um, so she, she was the one that was gonna, her name is [PII], she was the one that was gonna reach out to the pharmacy, um, and then call you back with what she was able to find out. So, um, I do have a callback number for you of [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is that a good number, is that a good number to reach you at?
[CUSTOMER][NEUTRAL] All right. Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so what I'm gonna do now is I'm gonna send another inquiry to Miss [PII] and just have her um follow up with her and see if she was able to reach anyone with CVS or with um what information she was able to find out if any and then um either she'll call you back or I will either way I'll get I'll get some kind of a response and um one of us will call you back if that's acceptable to you.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, today?
[AGENT][NEUTRAL] Um, yes, hopefully today. I don't think she's left for the day. I think she's just away from her desk at the moment. Um, let me see if I can check that, but I believe she, um, she is not gone for the day. So, um, and if I find out something different, um, I'll, but like I said, either way, I'll call you back. My name is [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm on the claims support team um so I will like I said if if for some reason I she is not able to call you back I will definitely call you back either way and give you some sort of an update.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, sounds good.
[AGENT][NEUTRAL] OK, did you have any other questions at this time?
[CUSTOMER][NEUTRAL] Uh, no, we'll just wait for, uh, [PII] to get back to us.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, well thank you for your patience I appreciate that and thank you for calling APL and uh we'll speak to you soon.
[CUSTOMER][POSITIVE] Yeah, no worries.
[CUSTOMER][POSITIVE] All right, thank you, [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Alright bye bye.