AccountId: 011433970860
ContactId: cf2c6f4c-261b-42e5-a491-a3cb5adb0b83
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 198000 ms
Total Talk Time (AGENT): 75951 ms
Total Talk Time (CUSTOMER): 118353 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/cf2c6f4c-261b-42e5-a491-a3cb5adb0b83_20250422T14:33_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good Morning, thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey Ms. [PII], this is [PII] on the care team. How you doing?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][NEUTRAL] I'm good. Um, I don't think I need to transfer, but I do need, can you look at this with me?
[AGENT][NEUTRAL] Mhm, it's the policy number.
[CUSTOMER][NEUTRAL] Um, it's 250-6754.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I was confused at first because I didn't know why the disability was asking for a pathology report, but then he also said that he had a critical illness claim, which was denied requesting the pathology report. So, critical illness has what they need, but this disability claim, you see what came in on the [PII]? That's the pathology report. But it was denied because of preexisting. So is that pathology report and everything? Is that
[CUSTOMER][NEUTRAL] What, I'm trying to make sure what that [PII], the pathology report is satisfying what we requested because it
[CUSTOMER][NEUTRAL] Looks like he uploaded it to both policies, the critical illness and disability, but disability never asked for a pathology report.
[CUSTOMER][NEUTRAL] It just said medical records.
[AGENT][NEUTRAL] Whenever they upload it through the online service center, it puts the uh information on any active policies that they have.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] So it's not necessarily that we need it um if she doesn't need it, she'll deny it for whatever reason but whenever it doesn't matter if they have active policies lap policies or whatever because it doesn't know which policy the charges would be processed under so that's why so it's not necessarily that we need anything under this disability, uh, if she can use it, she will.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Uh, but this remark code states let me see.
[CUSTOMER][NEUTRAL] Cause he's asking because the, the denial reason is saying that we need the medical records for pre-existing, I guess cause it's less than a year. Yes, ma'am.
[AGENT][NEUTRAL] And this
[AGENT][NEUTRAL] Based on your.
[CUSTOMER][NEUTRAL] So he was asking me, is the pathology report, the medical records, and I'm like, um, I don't think so, but let me have somebody look at this with me.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] No, that's not, that's gonna be something different. So did he sign and date the the forms and turn and and send them back to our office?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Cause he should have.
[CUSTOMER][NEUTRAL] No, he just sent, he just uploaded this. Oop, sorry.
[AGENT][NEUTRAL] Yeah, um, that's OK, um, this claim, um.
[AGENT][NEUTRAL] Basically probably send him the authorization form to sign and send it back to us so that they can obtain the medical records and uh and review them for PX.
[CUSTOMER][NEUTRAL] OK, so let me start there then and I'm gonna see if he um signed it and sent it back. Well, I know he didn't cause it's not here, but I'm gonna ask him anyway. And then if he hasn't, I'll tell her to go ahead and tell him to go ahead and send it in and then cause I was looking on on base and I'm like, I don't even see the medical record request. I don't think this is it. So, OK, I got it. I'm clear.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm she hasn't, she hasn't sent it out yet, yeah.
[CUSTOMER][NEUTRAL] Because he didn't send in the authorization for us to be able to, right?
[AGENT][POSITIVE] Mhm. That's correct, yes.
[CUSTOMER][POSITIVE] OK, I got it thank you.
[AGENT][POSITIVE] OK, no problem.
[CUSTOMER][POSITIVE] All right, have a good day.
[AGENT][NEUTRAL] You too bye bye.
[CUSTOMER][NEUTRAL] Bye.