AccountId: 011433970860
ContactId: df09fa4d-2a97-48b0-b98a-0b588eac2aa7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 631659 ms
Total Talk Time (AGENT): 206940 ms
Total Talk Time (CUSTOMER): 375947 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/df09fa4d-2a97-48b0-b98a-0b588eac2aa7_20250121T18:50_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling Ali [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi. Um, I was just talking to somebody, but I guess it went dead and I just, nobody came back to me. Um, I have some claims already, um, for my husband, and, uh, they wanted me to fill out a paper so they can uh get more information to see if my husband had a preexisting condition. Um, I have filled out all the papers with the
[CUSTOMER][NEUTRAL] The specialist, the uh hospital, and his primary care physician. Um, but there is a part where it says date or dates of consult and reason for consult. I cannot answer to that because he went to the doctor by himself. I wasn't, I didn't go to the doctor with him. So, what do you want me to put on there so you can, you are able to get whatever you need.
[AGENT][NEUTRAL] OK, let me go and um pull up the policy and I can help you. Can I get a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] The policy number is 02548800.
[AGENT][NEUTRAL] Can I get your name and date of birth?
[CUSTOMER][NEUTRAL] My name is [PII], [PII].
[AGENT][NEUTRAL] Can you verify your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And lastly your email address.
[CUSTOMER][NEUTRAL] Excuse me?
[AGENT][NEUTRAL] Can you verify your email address as well?
[CUSTOMER][NEUTRAL] OK, um, I don't know whether you have the school or the, my personal one, my school is [PII], and my personal is, OK.
[AGENT][NEUTRAL] That's the one.
[AGENT][NEUTRAL] OK, give me one second.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and do you have the claim number um that you were referring to?
[CUSTOMER][NEUTRAL] No, I don't have the claim num um. The only thing I have on the paper that I brought with me to work, it just says the policy number, the insured name, and the effective date. That's all.
[AGENT][NEUTRAL] OK, you don't know a date of service, um.
[AGENT][NEUTRAL] Uh, let me see.
[CUSTOMER][NEUTRAL] OK, my husband is deceased.
[CUSTOMER][NEUTRAL] He died from from a stroke.
[CUSTOMER][NEUTRAL] He was um diagnosed diagnosed with cancer, lung cancer in September.
[CUSTOMER][NEGATIVE] He only lasted for a whole month in the hospital and then he died from a, a um a stroke.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I, I filled out all the papers, I gave them all the information that they needed for the stroke and the, and the cancer. Now they're asking for more information to see if my husband had pre-existing conditions or conditions, I guess. Uh, so they need me to give them all this information about all the doctors that he saw for the last year.
[CUSTOMER][NEUTRAL] But I did not go to the doctor with my husband. He had regular regular checkups with his primary doctor. He, he went to see the cardiologist on a, he had a regular basis. He went to the neurologist, he went to, um, he was getting some depression medication from a um
[CUSTOMER][NEUTRAL] Whatever, psychiatrist, and he also went to the uh gastroenterologist. So, um, but I don't know the dates. I don't know, I mean,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like in here um it looks like we sent out a form for you to fill out with his physician information on there, um, that was treating him. And, uh, hold on one second. Cause I'm looking at, I'm looking at a note that's on here. Let me make sure that's the last one that we sent out.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes, so we processed the claim on [PII] and we put, we denied it as preexisting, but um if his condition was not pre-existing, we need to um like I said, we need that um physician's form fill out.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, but, but the physician, when you say physician, you, you only need the primary care physician, or you need all the ones that they he saw the last year, because that's what I understood from the girl that.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] So you can uh you can put the primary and then you can put his other doctors on that form. I mean, if you run out of room, you can just put them on the, like on the bottom or the back. And what we're gonna do, we're gonna request some medical records from the doctor to see if it's um a pre-existing condition. Since the policy started, um, let me see when it started. Since the policy started in September, we have to verify um
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We have to go back as far as like a year just to see um if it's preexisting to determine if we can pay any benefits or not.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, now, um, that's what I said. I mean, I don't have a problem. I already filled out the whole um page with all the doctors that I believe he saw the last year, um.
[CUSTOMER][NEUTRAL] The dates on the part that it says date of consult. What do you want me to put? From um the day before he died, and, uh, and a year prior to that, so you can, you can have that date so they can, they can give you that information.
[AGENT][NEUTRAL] I mean, that's fine. I mean, if you don't have the dates, I mean, you can just guesstimate that's what I'm saying that's fine. I mean, if you don't have them, like I said, we're gonna, based on the, the list that you sent in, um, we're gonna, we sometimes we probably call to confirm that the member um was there for that time frame and we also would look at as other documentation that we have to see if we see that doctor on there. And then we're gonna request the records from there. So like, if you don't have the dates, that's fine.
[CUSTOMER][NEUTRAL] No, I don't have the date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] As long as you send us a list of the, the physicians.
[CUSTOMER][NEUTRAL] OK, now.
[CUSTOMER][NEUTRAL] Now, I have another question. For another uh insurance that I have for the hospitalization, they ask for all this also. I have all the information. I have all the
[CUSTOMER][NEUTRAL] The, the medical records from his primary doctor for the last 2 years. I have the Hand Regional Medical Center, uh, medical records for the last 2 years. I have pretty much all of this myself. Do I need to send that to you so you don't have to wait until they, they, um, they send it to you?
[AGENT][NEUTRAL] Well, we have to request from the doctor. I mean, regardless, I mean, you can send it in, but we still have to request from the doctor um to verify the information.
[CUSTOMER][NEUTRAL] OK. So, on the, on the date of counsel, I just put a range from before he died and a year prior to that on each one of these, so they, you can get the information that you need, right?
[AGENT][NEUTRAL] Yes, ma'am, that's fine.
[CUSTOMER][NEUTRAL] Oh, from [PII].
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Well, you're saying yes for both of them. My, my husband died in [PII], on [PII]. So do I need it from September?
[AGENT][NEUTRAL] So like I say, when we send out the request for medical records from the doctor, um, we actually request from [PII] through, um, hold on one second. No, [PII].
[CUSTOMER][NEUTRAL] Because he was diagnosed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] [PII] or [PII].
[CUSTOMER][NEUTRAL] OK, so that's the range that I have to put on each one of these doctors, um, so you can get the information.
[AGENT][NEUTRAL] Well, I mean, that's just, I'm just saying that's what, that's the date that we put on the form when we were sent to the doctor. But like I said, as far as on the paperwork, you can put
[AGENT][NEUTRAL] The dates that you're thinking that he saw those doctors, so that way we'll know who to send the records request to.
[CUSTOMER][NEUTRAL] Well, and that's what I was saying. I mean, my husband was an independent person. I didn't take off my days, uh, from, from work to go with him because he went to the doctor when he needed to go to the doctors. So I don't have any idea when he went. I mean, I can just put a.
[AGENT][NEUTRAL] Yes, that's what I'm saying, that's fine. Um, like I said, that's what I was saying, that's fine. I mean, if you don't have the information, we'll, we'll know who to request records from just based on what you sent to us, and we'll go from there.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK, so don't put anything on data of console.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so the little blank and you're gonna ask from [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, what's your name? So I can, I can note here who I talked to and gave me that information.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] [PII], OK. OK, [PII], so I'm, I'm going to put this over here that you told me to just leave it blank.
[CUSTOMER][NEUTRAL] If it's blank and you all are going to request from uh [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Thank you, ma'am.
[AGENT][POSITIVE] Alright, no problem. Was there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] All right, thanks for calling A. You have a wonderful day.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Uh.