AccountId: 011433970860
ContactId: d4da37f1-b413-42b3-a5d2-491829d76958
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 746690 ms
Total Talk Time (AGENT): 224972 ms
Total Talk Time (CUSTOMER): 443285 ms
Interruptions: 5
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/d4da37f1-b413-42b3-a5d2-491829d76958_20250228T19:44_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon, for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Hi, Ms. [PII]. My name is [PII], and I'm calling about a claim that I have filed.
[AGENT][NEUTRAL] OK, I can verify claim status for you, Ms. [PII]. What's that policy number, please?
[CUSTOMER][NEUTRAL] OK, there's 2 numbers and uh because there were 2 different dates.
[CUSTOMER][NEUTRAL] So I'm gonna give you the first one. It was [PII] and it's 3560114.
[AGENT][NEUTRAL] That sounds like a claim number. Hold on one moment.
[CUSTOMER][NEUTRAL] Yes ma'am, did you need something different?
[AGENT][NEUTRAL] Uh, policy number?
[CUSTOMER][NEUTRAL] Oh OK 252-508-3.
[AGENT][NEUTRAL] OK, thank you. And verify your date of birth, mailing address and email address for me, please.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh, mailing address [PII].
[AGENT][NEUTRAL] OK. And the email address, please?
[CUSTOMER][NEUTRAL] I think it's gonna be under my school email FM at [PII].
[AGENT][NEUTRAL] OK, thank you. And excuse me, Ms. [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you, give me one moment.
[AGENT][NEUTRAL] OK, give me a moment. It looks like on that claim number you gave me, they were needing itemized bills as well as the pathology report for initial diagnosis.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Did they not get it?
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] Uh, it looks like we received some other additional claim information on the [PII] and it's in review.
[CUSTOMER][NEUTRAL] OK, because they did need just what you said they needed, which was the pathology and the billing and I had called for APL like they asked to talk and and request those records but they needed the company to request those records so I'm assuming that means that they did and now they're reviewing the records, right?
[AGENT][NEUTRAL] Uh, let me see one moment.
[AGENT][NEUTRAL] Uh, it really kind of does state. Let me, uh, see if I can get with an examiner and they can verify if, uh, we received that information. Do you mind holding for one moment?
[CUSTOMER][NEUTRAL] No, ma'am, and like I wanna say this, the first policy number, I, I mean not policy, the first claim number I gave you, or does that matter? Just looking at the policy.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, no, just the policy number.
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] Yes, ma'am. Hold on one moment, please.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[AGENT][NEUTRAL] his process system.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Thank you for calling APL. You're speaking with [PII]. How may I help you today?
[AGENT][NEUTRAL] Hey, [PII], um, I have an insured on the phone. She's calling about a claim and it looks like it's under review, but she wants to make sure that we received her medical records and is wondering if that's a review. Ms. [PII]?
[CUSTOMER][NEUTRAL] Who, who is the um?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK. Do you want a mask?
[AGENT][NEUTRAL] No, it's cancer policy.
[CUSTOMER][NEUTRAL] Oh, OK. I, I can just tell her, let me see, give me the policy number.
[AGENT][NEUTRAL] 252-508-3.
[CUSTOMER][NEUTRAL] OK, give it to me again. I put the wrong number.
[AGENT][NEUTRAL] 252-508-3.
[CUSTOMER][NEUTRAL] 831. OK. It looks like it's in review with Doctor B and it looked like uh who this belongs to. This belongs to [PII]. So like when you see that 99, that means they got the medical records and go to the medical director for review. That's all you got to tell it. They was received and they'll put at our medical director desk for review.
[AGENT][NEUTRAL] So, that does mean that medical records have been received, because that's what she's going to verify.
[CUSTOMER][NEUTRAL] Yes, uh-huh, yeah, that was when you see that 99, that means we got them and they are with the medical director if you see 24, that means we don't have them.
[CUSTOMER][NEUTRAL] So she switched it over on Monday to 2:24 and and put 99 and I always put notes in my screen letting you know receive medical records. uh-huh, yeah, that see that ain't my uh-huh, yeah, yeah, I always read that's right, you'll know what's going on. I don't know.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah, that's why I always love when you do it.
[AGENT][POSITIVE] It makes it easier to read.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Why people don't do that. I would put receive medical records on blank blank day. They sent to doctor for review. That's what I always put, but anyway, that's what that means that she got the medical records and she sent them over to our medical director on the [PII], and they, they, she haven't got the information back yet.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I guess I get so used to what you do because you usually put all that information in there.
[CUSTOMER][POSITIVE] Yeah, cause, see, I, I like to do it because when I ain't here, ain't nobody gotta be trying to figure out what's going on, you know, you can, uh-huh, you ain't got to try to, yeah, what, what she needs, why she did, you know, so that's why I went, even when I pay a claim, I put on there the latest claim, pay benefit of the blank amount because I want the person calling and speaking to whoever, they'll know what I'm needing or what's going on. Yeah.
[AGENT][POSITIVE] Exactly.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that's the first thing I did when she asked that. I looked at notes, I didn't see anything. I was like, uh, let me check. Thank you, [PII], see.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah. Well that's what that means. OK.
[AGENT][POSITIVE] I appreciate you.
[CUSTOMER][POSITIVE] You're welcome. All right, bye bye.
[AGENT][NEUTRAL] Bye.
[AGENT][POSITIVE] Uh, Ms. [PII], thank you so much for holding. Um, I spoke with the examiner and she said it looks like we have received that information, so it is in review.
[CUSTOMER][NEUTRAL] OK, um, that was the main thing cause I knew that they'd asked me to. I couldn't get it. I knew they were supposed to request it, so I just was seeing what the situation was on it. Um.
[AGENT][NEUTRAL] No, I understand. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so y'all don't need you think anything else from me right now?
[AGENT][NEUTRAL] Not that I'm showing, no, ma'am.
[CUSTOMER][NEUTRAL] OK. I have a maybe a question you can answer and maybe, maybe not. So I know on one part of the policy, it reads that like first time cancer you receive like $5000.
[AGENT][NEUTRAL] For the first occurrence? Mhm.
[CUSTOMER][NEUTRAL] And then it also
[CUSTOMER][NEUTRAL] Yes ma'am, yes ma'am. OK, and then underneath it it also mentioned that.
[CUSTOMER][NEUTRAL] And I, I spoke to several people over a period of two months, I guess is the way to put it. And um there's one about a heart that if you've had a heart thing, you would receive $2500.
[AGENT][NEUTRAL] Uh, for a heart attack or stroke.
[CUSTOMER][NEUTRAL] And I think
[CUSTOMER][NEUTRAL] Yes, and I don't
[CUSTOMER][NEUTRAL] I've never done all of this. This is all my first go around. And so I'm just trying to figure it out. Uh, on that part of this information, my, the one they're dealing with is my oncologist, but the other one was discovered that I had some form of a heart attack.
[CUSTOMER][NEUTRAL] At an undetermined date and um they had me do an EKG getting ready for this cancer surgery. And then while they did that, they discovered that there had been something. So they asked me to go get an echo. So I had an echo. And then at that point in time, I did have to set up an appointment with a cardiologist. And he, I think thought it could just be treated with medicine at this time and
[CUSTOMER][NEUTRAL] I would see him in a year. So my question is, is that a separate claim or is that all tied together? Because the information they're getting is from my oncologist as opposed to my primary doctor.
[AGENT][NEUTRAL] Uh, that would be a separate claim for the heart attack or stroke.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, and like I said, um, it was one to where they didn't give me a determined date as to when that had happened, but it was trying to get me prepped and ready to say I could have my cancer surgery. So I had numerous tests and that's when the EKG and the echo showed that at some point in time it had happened. So I would just need to file a new claim on that.
[AGENT][NEUTRAL] Uh, yes, ma'am, and send in those results and any uh cardiologist notes, um.
[AGENT][NEUTRAL] Trying to think of anything else I would need, um.
[AGENT][NEUTRAL] Any lab results, uh, EKG, echo, any kind of results, as well as, uh, notes from your doctor showing that it was, uh, that there was a positive diagnosis of a heart attack.
[CUSTOMER][NEUTRAL] OK, um, I have one of those APL claim forms.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Is that
[CUSTOMER][NEUTRAL] Yeah, they have like the attending statement of the position.
[CUSTOMER][NEUTRAL] And then the authorization to use the health information part, so it's like 3 pages.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So if I were to take that to my primary doctor, that's where I would start.
[AGENT][NEUTRAL] Uh, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][POSITIVE] It's it's been a lot, but I'm learning. I'm learning.
[AGENT][POSITIVE] Yeah, bless your heart, it's a lot.
[CUSTOMER][NEUTRAL] Well, you know, I, I also have to say,
[CUSTOMER][POSITIVE] It's, it's where I've been checked over and they've been able to treat things and so I, I feel pretty blessed to be perfectly honest. So it's a while, it's taking a little while, but at the same time, they got the cancer and this other thing, the cardio, yes, yes, it was like maybe even less than 1% recurrence, so I feel blessed.
[AGENT][POSITIVE] Absolutely.
[AGENT][POSITIVE] Good.
[AGENT][POSITIVE] Oh, blessing. Yes, ma'am.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] And then the uh other thing with this heart attack that surprised the mess out of me and uh probably would have never known if they hadn't been trying to find what to do about the cancer, you know, so all things have kind of been.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Helpful and I think maybe God opens some doors for me to get better so that's what I have to believe so.
[AGENT][POSITIVE] Absolutely, absolutely. The father always makes sure we get taken care of for sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, alright, Miss [PII], on this, other than they'll call me if they need something, but I have everything in and not holding them back.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh, not that I'm showing, no, ma'am. Once they placed it in review, then apparently we have what we need and they'll give out their decision and they'll, um, probably be mailed or um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't think they normally call it unless maybe unless if they need additional information, but they don't call to kind of confirm claim status.
[CUSTOMER][POSITIVE] OK, alright, well I certainly appreciate it. I will ask this and you may not know. Do you kind of know how long it takes for them to review and I'm not rushing. I'm just kind of asking.
[AGENT][NEUTRAL] Oh, no. Um, no, ma'am. I'm not sure. Sometimes it can take a week, um.
[AGENT][NEUTRAL] Hopefully no longer than a week, but it can take some time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK alright I appreciate it thank you so much.
[AGENT][POSITIVE] Yes, ma'am, and thank you for calling APL. You have a great rest of your day, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye.