AccountId: 011433970860
ContactId: d2367bb6-4663-4520-ae78-a3e10c8542e2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 965119 ms
Total Talk Time (AGENT): 405450 ms
Total Talk Time (CUSTOMER): 276491 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/d2367bb6-4663-4520-ae78-a3e10c8542e2_20250113T18:40_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. I was just on the phone with [PII] and my call got dropped, um, and she was in the middle of, uh, reaching out to a claims rep to figure out uh why my claim wasn't processed if I had the proper documentation.
[AGENT][NEUTRAL] OK, I can take a look at that. Can I have your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. What's a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And what's the policy number?
[CUSTOMER][NEUTRAL] 2329682.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright [PII] and verify your address and date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that information and you're calling in regards to uh claim denial?
[CUSTOMER][NEGATIVE] Yes, and it's, it's, I've, I've submitted 3 different ones for the same thing and the very last time I've, because each time I submit something I was told to submit something else and I did and then I had to submit everything all together and I was still denied.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, let me take a look at that.
[AGENT][NEUTRAL] And also verify your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Alright thank you.
[AGENT][NEUTRAL] OK, so I showed the most recent submission received on the [PII]. That has not been processed just yet.
[AGENT][NEUTRAL] Um, it's in line for review.
[AGENT][NEUTRAL] Let me just, OK.
[CUSTOMER][NEUTRAL] Oh no, not that one. That's not the one I'm calling about.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] All right, so the claim before then we are requesting additional information uh it shows that we need the.
[AGENT][NEUTRAL] Admit and discharge summary for the hospital stay.
[CUSTOMER][NEUTRAL] That was, that was submitted with the itemized bill.
[AGENT][NEUTRAL] OK, let me take a look here.
[AGENT][NEUTRAL] Bear with me a moment, I'm gonna pull the actual documents to see what we have.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's just a quick look at the.
[AGENT][NEUTRAL] Claims history, it looks like we are needing to determine the reason for the hospital stay.
[AGENT][NEUTRAL] And that's why we're requesting that so let me bear with me just a moment if you don't mind holding while I take a deeper look at this.
[CUSTOMER][NEUTRAL] Yes, that's fine.
[AGENT][POSITIVE] Alright thank you one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Alright, 16.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi, [PII].
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] Hi, thank you for holding. OK, so from what I can see based on the information received, the last 3 submissions we have, um, the after visit summary so that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's basically portion and directions um after the hospitalization. But the admin and discharge summary is um the doctor's notes and uh test results and things of that nature throughout the hospital stay. Uh, it gives a breakdown of, go ahead.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I think
[CUSTOMER][NEUTRAL] OK, I, I can get you guys that. it's, it's not like in like where I can view it. It just says doctor's notes, so it's not necessarily the admin discharge. OK, OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm. That's how it is on, like if you go online to the chart or um the records there, that's how it shows, yes, it does. So when requesting it from the hospital, it would be the admin discharge summary.
[CUSTOMER][NEUTRAL] Yeah, yes. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, cause I know the one I sent, that's what they, that's because I called them and I was like, well, they're asking for this, what's that? No, I think that's exactly what we gave you already. So like, that's what they refer to it as like the hospital. So I guess you guys just want the additional notes of the doctors that I, I can also get from the, like you said, the chart online.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yeah, that's what we need to um move forward.
[CUSTOMER][NEUTRAL] OK, and now.
[CUSTOMER][NEUTRAL] OK, now when I resubmit, do I have to resubmit everything again because I, I, I could just submit that and they know to where to apply it.
[AGENT][NEGATIVE] Not at all.
[AGENT][POSITIVE] Absolutely. It'll go in line to be reviewed. Um, once myself or one of the other adjusters receive that information, we'll be able to refer back to the documents that were submitted prior, so no worries there.
[CUSTOMER][NEUTRAL] OK, now do I have to resubmit another cancer form like APL form with it, or can I just submit the document? OK, perfect.
[AGENT][NEUTRAL] No, you, no, you don't. You can submit the documents, just be sure, um, your identifying information is there, your name, um, if you can refer to the policy number or claim number, but just something to help us locate um your policy.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Got it. OK, I'll probably just put like a cover sheet. Um, what's my other question? My other question is, um, which, uh, I got cut off and I get, didn't get that answer last time. Um, I just wanted to verify that my cancer insurance is still showing active because I know it was, um.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, the, the premiums were being waived because I was on disability and I, I just wanted to make sure that's still the case because I know on my end it's showing laps online.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] It is showing labs as of [PII]. Let me look into this. Give me one moment. I just wanna check the notes to see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Cause I, cause the last time I got something, it said my premium was, was waived till January of this year. It's the last time I got documents and I was told it would take care of 3 months, because I know they have me submitting um cancer disability and they're like submit it and then I'll take care of you for 3 months and then you have to start submitting it again.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, let's see.
[AGENT][NEUTRAL] Now per the notes, the last thing I show it says to submit a new claim form with all parts completed.
[AGENT][NEUTRAL] If the disability is continued due to cancer treatment after [PII]. So have we received the claim form from you since then?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let me check what I asked that question, but I'm gonna look as well to see.
[CUSTOMER][NEUTRAL] So hold on, let me look.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So where.
[CUSTOMER][NEUTRAL] One more second.
[CUSTOMER][NEUTRAL] Hold on, I guess I go with my friends.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] I'm looking on my end as well.
[CUSTOMER][NEUTRAL] I know the last time I had submitted the cancer disability paperwork, it
[CUSTOMER][NEUTRAL] Told me that I had my premium covered till January and so when I called in I had Alpha rep. Does that mean I don't have to keep submitting one monthly they said I didn't because I was good till January.
[CUSTOMER][NEUTRAL] Find it.
[CUSTOMER][NEUTRAL] Oh, here it is. I found it. So I'm looking at.
[CUSTOMER][NEUTRAL] Claim number 352-067-9.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it has me waived till January.
[AGENT][NEUTRAL] OK, let me take a look at that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I do show that. I'm just looking to see where the disconnect was because I show that claim and the waiver um [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] Yeah, I'm gonna have to
[AGENT][NEUTRAL] Look a bit deeper into this because I do show here the waiver of premium and it has the date [PII], but I don't see it applied to uh the policy. So what I will do is research this, um, take any necessary steps that need to be taken to apply that waiver.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And I can give you a call back to let you know that it has been completed or if there was anything I located or uh during my research as to why it hasn't.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so, uh, give me a moment. I will say let's see.
[AGENT][NEUTRAL] It'll definitely be before the end of business day today, um, but I wanna say about an hour or so just give me time to look into that and um have clear answers for you and um assure you that it's been taken care of. Is that OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, that's perfectly fine, thank you so much.
[AGENT][NEUTRAL] Alright, good deal. So, um, that callback number is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, [PII], I will give you a call back once I have this cleared up, OK?
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][POSITIVE] All right, no problem. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Oh yes. Quick question. Um, I submitted my claim for disability in February. Does that mean that's when it would end?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] For your disability policy.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Let me move over to that just one moment.
[AGENT][NEUTRAL] I show that we have one pending um.
[AGENT][NEUTRAL] To be released on the [PII], it does not state that it's ending. Let's see.
[CUSTOMER][NEUTRAL] Cause I know my policy states I only get a year for disability and I just don't know if the year ends when I applied for it or when I got it in March because I know there's an elimination period.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] Gonna check to see if I can.
[AGENT][NEUTRAL] Locate the actual start date because right now because that claim is pending once it's completed, it's gonna have uh the specific information if it's um completed if the benefits have been maxed and things of that nature but right now because it's pending, there's no final um remarks to give a clear answer on that so give me a moment.
[CUSTOMER][NEGATIVE] Uh, no.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like the first.
[AGENT][NEUTRAL] Pay period was [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So yeah, I, I don't want to misinform simply because that claim, uh, once I, today is the [PII] on the [PII] when those benefits are released, then, um.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] The specifics will be there, yeah, they'll have the remark codes that'll tell you the benefit max or if it's the last payment but right now I don't have that information.
[CUSTOMER][NEUTRAL] I would be able to
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. That's fine. I can wait 2 more days.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yeah, once it's cleared um once the benefits are released, it'll have that information there, but as of now it's in a pending state without those specifics, so I don't wanna give you the wrong information there.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty.
[AGENT][POSITIVE] All right, so I am going to get to work on that waiver of premium for your cancer policy and I'll give you a call back with that information.
[CUSTOMER][POSITIVE] Perfect. Thank you so much.
[AGENT][POSITIVE] No problem [PII], thank you. I'll speak to you soon.
[CUSTOMER][NEUTRAL] OK. Bye-bye.
[AGENT][NEUTRAL] Alright bye bye.