AccountId: 011433970860
ContactId: b55308da-d53b-4838-9de1-9ee7cb25a79f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 650619 ms
Total Talk Time (AGENT): 183047 ms
Total Talk Time (CUSTOMER): 204389 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/b55308da-d53b-4838-9de1-9ee7cb25a79f_20250106T21:24_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh yes, ma'am. I'm trying to figure out what I gotta do. I filed two claims and they've been rejected and I need to find out what I have to do to get that right because evidently I'll need some documentation.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right, sure. I can assist you with that information. And may I have your name and a callback number?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII] My phone number [PII].
[AGENT][NEUTRAL] OK. And may I have the policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Uh yeah, let me look for that. Hang on, let me put you on speaker.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Oh, I just had it.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm pulling it up. I had it and I had to get off of it too.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I was trying to log in online and I can't. I was able to log in on my phone.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Are you logged in on your phone?
[CUSTOMER][NEUTRAL] I am logged in on my phone but here I got um let's see my policy number.
[CUSTOMER][NEUTRAL] Yes, I have a policy number it's 2551818.
[AGENT][NEUTRAL] OK. And may I have your date of birth, mailing address and email address on file for verification?
[CUSTOMER][NEUTRAL] Yeah, [PII] [PII]. And I think my email, I'm not really sure if you got [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, that's what we have. Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, let's see.
[CUSTOMER][NEUTRAL] I also had another policy of critical illness. I don't know. I, I, I, I have skin cancer, so I had some removed. So I'm trying to figure out what I have to do to be able to um
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Playing that.
[AGENT][NEUTRAL] OK. All right. Let me go ahead and go over your claim and see exactly what are they needing. Do you mind holding for me, Ms. [PII]?
[CUSTOMER][POSITIVE] Oh, I don't mind at all, thank you.
[AGENT][POSITIVE] OK, 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][NEUTRAL] Thank you for holding and being patient for me, Ms. [PII]. OK, so I went ahead and review all the claims and on your cancer and your critical illness, um, and it looks like what we're needing right now because it looks like the first time we requested for some information was for the fully itemized bill with the diagnosis codes.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And then we send another request and this request is uh for your authorization for us to request the medical records. Have you received that one?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have not, so can you email that to me?
[AGENT][NEGATIVE] You have not OK.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] OK, let me see where I can get the form because it was mailed to you and I, I just have the EOB but I don't have the form, um.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK, so it was actually mailed like to my mailbox at home?
[AGENT][NEUTRAL] Yes, it was sent to your home. Um, it was sent on the [PII]. Um, so more than likely it's gonna be there. Uh, we'll stay either the end of this week or the beginning of next because of the holidays, um.
[AGENT][NEUTRAL] That's when you're gonna be receiving that form for you to send it, uh, sign it and send it back to us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So once I have that form, do I have to resubmit everything?
[AGENT][NEUTRAL] No, no, you don't have to resubmit everything. You just need to send us the form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And so, uh, since, since that, I had surgery. So um I had some skin cancer removed. So do I need to provide that doctor's information or does those forms ask me about doctors?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, no, uh, that's gonna be different. Um, the one that we send you is just an authorization to request medical records for the findings, for the first findings. So right now, um, what we're gonna need for you to send in if they did a, a different surgery is um to go ahead and send us an itemized bill.
[AGENT][NEUTRAL] So you will go ahead and request an itemized bill to your doctor.
[CUSTOMER][NEUTRAL] And, and
[CUSTOMER][NEGATIVE] OK, and so to get the itemized bill I had requested it. I don't have it yet. So why would y'all, if I'm doing itemized, why do y'all need um.
[CUSTOMER][NEUTRAL] I guess the authorization forms.
[AGENT][NEUTRAL] The authorization forms is to get medical records. Uh, the medical records is, um, to determine any preexisting, to get the information of the doctor, uh, relating the, the cancer, the skin cancer. So, um, it's just, we just need medical records and that's why we're asking you to sign it because we cannot get medical records without your authorization. So that's your authorization.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. So, so, so far, I've submitted for my biopsies. One of those would be considered diagnostic. One would be considered, I guess, surgery because it was positive. So I have submitted my doctor's information from my dermatologist. So now, I need to get, I guess the itemized bill from the surgery.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes, from the surgeon. Yes, from the surgeon. Mhm.
[CUSTOMER][POSITIVE] Dot correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right. I'll see about getting that done. Thank you.
[AGENT][NEUTRAL] Mhm. You're welcome. Is there anything else I'm gonna help you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Uh, no, ma'am, that's it. I appreciate it. Thank you. OK, all right.
[AGENT][POSITIVE] OK. You're welcome and you're welcome. Have a good day. Thank you for calling APL.
[CUSTOMER][NEUTRAL] You too.