AccountId: 011433970860
ContactId: a89f719a-a9b9-4163-9b48-c1b186dbc4e6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 323630 ms
Total Talk Time (AGENT): 251449 ms
Total Talk Time (CUSTOMER): 33881 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/a89f719a-a9b9-4163-9b48-c1b186dbc4e6_20250415T14:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] on the care team. I was gonna see if you could help me look at a claim. I don't understand what the comment is on it.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] The policy number is 1415882.
[AGENT][NEUTRAL] OK, give me a second, let me get over there.
[AGENT][NEUTRAL] OK, and what's our claim number?
[CUSTOMER][NEUTRAL] The number is 358-913-7.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, uh let's see here.
[AGENT][NEUTRAL] So you're not familiar with that remark code? Is that what it is?
[CUSTOMER][NEUTRAL] Oh, yeah, he's Doctor [PII]? Is that us? Is that a medical reviewer or?
[AGENT][NEUTRAL] Yeah, it's a medical director that does our reviews so what uh we don't give his name we just say it's under like it's with our medical review team or whatever um typically what they're looking for.
[AGENT][NEUTRAL] Um, they've had this policy for a while, so it's probably not being looked at for, um, preexisting, but it's probably just to verify that whatever benefit they're trying to claim took place.
[AGENT][NEUTRAL] So, um, it looks like cancer in situ, which is
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know, like the lowest level almost it it really hasn't metastasized is what it is and so they've put it with the medical director to just confirm it's an outside party that will look at it for us to confirm before we pay or deny that way we we know for sure ultimately it's up to us like if we look at it and.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] You know, the supervisor and the examiner just like I don't know how I feel about this, but we get his professional medical opinion so that's that's what's going on with it.
[CUSTOMER][NEUTRAL] OK, and do you know how long that typically takes?
[AGENT][NEUTRAL] Um, I think he responds to emails once or twice a week. Um, I don't know if anybody else has started reviewing emails as well because like I said, we, we've stopped saying Doctor [PII] we started just saying medical review, um, but I think either midweek or end of the week is when he or they, um, depending on who it is, we'll review anything and send us a response, so.
[AGENT][NEUTRAL] I would say to allow 7 to 10 business days because once they get it back they'll immediately process they don't wait an additional time um and let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Wonder when this was done.
[AGENT][NEUTRAL] Hang on, I can figure that out real quick.
[AGENT][NEUTRAL] So we just received it on [PII].
[AGENT][NEUTRAL] And it looks like they sent it to review on.
[AGENT][NEUTRAL] Come on.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] It looks like they probably just sent it um so like yesterday or today so it was just being pulled for review.
[AGENT][NEUTRAL] And sent over based off of what I'm saying I don't get those emails. I'm not copied on those emails so I can't say that for 100%, but the note from [PII] which is the product supervisor, um, she put a note.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This morning that the path report is under a different mail number so I don't know if it just wasn't if it didn't need to go to medical review and it's now gonna be processed today or if it was sent and we're just waiting either way that is where it's at right now so it is in process but it's under medical review and that's just standard it's not anything that they've done wrong there's not anything that they can send us that's.
[AGENT][NEUTRAL] Going to sway us one way or the other, that's just standard procedure, especially for this type of policy um under cancer and critical illness. It's common for us to seek just a professional opinion to make sure that we are.
[AGENT][NEUTRAL] Understanding what we're reading because we get a lot of path reports and stuff and sometimes we, it's clear cut and dry and sometimes it's just not so it's standard it's not anything that they've done we just.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Are seeking another opinion but like I said, based off of what Delicious put on here, it maybe it doesn't actually need to go to review and it'll get processed today so I would just let them know that it's that it's in processing it's with.
[AGENT][NEUTRAL] Um, our medical review just for verification purposes, it's not, it's not a bad thing. They haven't done anything, yeah, and then once that's completed.
[CUSTOMER][POSITIVE] OK, OK, perfect.
[CUSTOMER][POSITIVE] OK, I will let her know. OK, thank you so much.
[AGENT][POSITIVE] Yeah, OK, yeah, welcome.
[CUSTOMER][NEUTRAL] All right, bye.
[AGENT][NEUTRAL] Bye.