AccountId: 011433970860
ContactId: d3369da6-c396-4ed5-95b7-ae5d5df506c2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 756900 ms
Total Talk Time (AGENT): 194474 ms
Total Talk Time (CUSTOMER): 349357 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/d3369da6-c396-4ed5-95b7-ae5d5df506c2_20250219T22:06_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh yes, ma'am. My name is [PII], and I was called concerning the status of a claim that I've got filed.
[AGENT][NEUTRAL] OK, Mr. [PII], I can help you with the claim. Can you please give me your policy number?
[CUSTOMER][NEUTRAL] OK, uh, uh, policy number is 0041263. I have a claim number and a reference number too if you need that.
[AGENT][NEUTRAL] OK, and that policy number, let me repeat it, is 0041263.
[CUSTOMER][NEUTRAL] No, it's 00431263.
[AGENT][NEUTRAL] OK. Let me look that up real quick, sir.
[AGENT][NEUTRAL] OK, Mr. [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then also for security reasons, can you verify your address, phone number, and email address?
[CUSTOMER][NEUTRAL] OK, uh, my address is [PII].
[CUSTOMER][NEUTRAL] My phone number is [PII], which is a cell number, uh, meaning that we don't have a landline, you know, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then uh we don't do the email we don't have an email address, you know.
[AGENT][NEUTRAL] OK, sir. And if our call gets disconnected, is this cell phone number a good number to call you back on, sir?
[CUSTOMER][NEUTRAL] Yes ma'am it is.
[AGENT][NEUTRAL] OK, thank you, and you're calling because you have a claim in.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Now I have a claim like I say I have a claim number if you would like that.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] OK, 355-2072.
[CUSTOMER][NEUTRAL] And then I also have a reference number 00431263 which that is the policy number, you know, so.
[AGENT][NEUTRAL] OK, yes sir, alright, let me look up the claim real quick.
[AGENT][NEUTRAL] OK, were you just wanting the status of the claim?
[CUSTOMER][NEGATIVE] I want to know what the status is on it. I mean, uh, um, I had trouble.
[CUSTOMER][NEUTRAL] I sent the stuff, my first stuff to [PII]. I didn't know [PII] and all that. And anyway, then, um, I talked to somebody and they sent me the forms and this form that I got right here, it says explanation of benefits and some of the stuff that they needed, and I, I, I've sent, um, I've sent a mailed it on [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, you know, the explanation of benefits and the claim form and that sort of thing, you know, and, uh, I would, and I mailed that like say on [PII], all right then and heard nothing from it and on [PII].
[AGENT][NEUTRAL] OK. All right.
[CUSTOMER][NEGATIVE] I talked to a lady named [PII], and she told me that it looked like they had everything they needed and I should be hearing from it and I think she said 7 to 10 days or something to that effect and said if I hadn't heard from it to call back. So like I say, I called on February and I hadn't heard anything and so um.
[CUSTOMER][NEUTRAL] You know, I was just calling and checking on the status of it.
[AGENT][NEUTRAL] Oh, all right. Well, I've got some remarks on the claim for you. I can give you information on. Uh, the first one is this policy does not provide benefits for office visits. So the office visit is not covered.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] We've got another one that says the laboratory tests are not a covered benefit under the policy.
[AGENT][NEUTRAL] And then the third thing that it's giving is in order for processing of the claim to continue, we will need the pathology report, a first diagnosis of cancer.
[AGENT][NEUTRAL] That that information still has not been received, uh, and then upon receipt.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am. I sent that.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I said, I've mailed it to you. That's I mailed on uh [PII], you know, I mailed, um, I got that from uh what do you call them oncologist, my uh prostate doctor. I got that information from them and then uh they were saying.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Here in my hand this explanation of benefits that that y'all had sent me saying what they needed and I understand all it's gonna pay on is radiation treatments and um and uh in my travel expense it had all benefit travel expense and that's the two things that I that I knew it was gonna pay on, OK? And um, and sent.
[CUSTOMER][NEUTRAL] The information on how many miles it was from my house to the clinic, you know, where they was giving my treatments. I sent the explanation of benefits from, uh, Medicare and then also the I mean the uh um the uh diagnosis and the pathology and that sort of thing, you know.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK. All right, so.
[CUSTOMER][NEUTRAL] So they should have that.
[AGENT][NEUTRAL] OK, so what I'm gonna do, sir, since you've said that you've already sent that information in and that's something they're requesting, I'm going to put in a request for somebody from the cancer claims department and examiner to give you a call back so that way they can talk to you over the phone and give you any other assistance that you may need with the policy and to make sure that we've got all the information that we need to continue to process your claim.
[CUSTOMER][NEUTRAL] You know, well, according to see the form that I received, uh oh, in this on this form, it says at the top, it's got, it says check date [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And then it gives the policy number and it gives a reference number which is a policy number, the insured, which is meiny [PII], then the claimant num I mean the claim number and the claimant, which is me and uh and and it's got remark uh description in the list of the stuff that you was telling me that they needed and telling me what it wouldn't pay and wouldn't pay.
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And uh like I say, I've, I've supposedly what they needed, you know.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes sir, I understand exactly what you're saying so I want to make sure that you talk to somebody that's an examiner in the claims department that looks over the claims and examines them that way you can get um all your questions answered we can make sure that we've got all the information that we need, OK?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK, no.
[AGENT][NEUTRAL] Alright, so it's gonna be a brief hold while I get that um request in for them to give you a call back. I'm gonna put you on a brief hold.
[CUSTOMER][NEUTRAL] OK, well, OK.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Hi, Mr. [PII]. This is [PII]. I've got that request in for somebody to call you back and you should be receiving a phone call within 24 hours.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, all right, OK.
[AGENT][NEUTRAL] No, OK.
[CUSTOMER][NEUTRAL] So, uh, they probably, they'll probably be calling me tomorrow then see at some point.
[AGENT][NEUTRAL] Yes sir, they'll either call by [PII] tonight or they'll give you a call after [PII] tomorrow.
[CUSTOMER][POSITIVE] OK, all right, that sounds good, OK.
[AGENT][POSITIVE] OK. Thank you, Mr. [PII] for calling APL. I hope you have a good rest of your night.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Mm bye-bye, sir.