AccountId: 011433970860
ContactId: e1f3ed4e-aeed-4d0e-962e-5dc9a12a3614
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 432230 ms
Total Talk Time (AGENT): 216028 ms
Total Talk Time (CUSTOMER): 176875 ms
Interruptions: 4
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/e1f3ed4e-aeed-4d0e-962e-5dc9a12a3614_20250228T16:22_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I was calling to get a status on the claim.
[AGENT][POSITIVE] OK, sure, I can assist you.
[CUSTOMER][NEUTRAL] I have the claim number.
[AGENT][NEUTRAL] OK, and you're calling from a provider's office, but is this your personal policy?
[CUSTOMER][NEUTRAL] No, it's a personal policy or it's a claim off of a Midland ISD policy.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For a teacher, a teacher who.
[AGENT][NEUTRAL] OK. Um
[AGENT][NEUTRAL] Uh, a teacher who's employed or um it's your account?
[CUSTOMER][NEUTRAL] No, it was a, it's for a teacher who was employed by Midland ISD and paid premiums for this insurance.
[AGENT][NEUTRAL] Let me have your name.
[CUSTOMER][NEUTRAL] It's for [PII]. Last name is [PII].
[AGENT][NEUTRAL] May I have a callback number just in case we get disconnected, Ms. [PII].
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] OK, do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, policy number 2382136.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK, so [PII] is the are you Ms. [PII]?
[CUSTOMER][NEUTRAL] I'm her twin sister. I have POA.
[AGENT][NEUTRAL] OK, so what is your name?
[CUSTOMER][NEUTRAL] My name's [PII].
[AGENT][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] [PII] and then [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Alright, thank you, Miss [PII]. And what is the date of service for the claim?
[CUSTOMER][NEUTRAL] Uh, date of service for the claim, um.
[CUSTOMER][NEUTRAL] Uh, you mean when she got diagnosed?
[AGENT][NEUTRAL] Uh no, it's gonna be the claim on date of service like um if she has some, I don't know, service rendered on [PII] or um like what is the date of the claim?
[AGENT][NEUTRAL] Or let me have the claim number. Let me, I think that will be easier. Go ahead with the claim number.
[CUSTOMER][NEUTRAL] Um, it would
[CUSTOMER][NEUTRAL] It's 34.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah it's 348-461-7.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me pull the details on that claim. OK, one moment.
[CUSTOMER][NEUTRAL] I just, yeah, I sent a fax. I just wanna make sure y'all got it, the information y'all were requesting.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and um,
[AGENT][NEUTRAL] In [PII], uh.
[AGENT][NEUTRAL] Let me have her date of birth one more time. I'm not sure if you gave it to me or not, but let me have that one more time and let me have the mailing address on file for verification.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I don't know if you have the [PII] address which is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you, yes, that's what we have. Do you know her email address? Yeah.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] That's not the one we have. You don't know the one we have.
[AGENT][NEUTRAL] It's also through work, but it's not that one.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's also what?
[AGENT][NEUTRAL] It's also from the employers, um, it's an email from the employer.
[CUSTOMER][NEUTRAL] Oh, she doesn't have access to that anymore.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] She, um, she, um, got diagnosed with pancreatic cancer.
[AGENT][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] And then she developed.
[CUSTOMER][NEUTRAL] Um, Guillain-Barre.
[CUSTOMER][NEGATIVE] And she was unable, unable to feed herself or walk. So she had to take a disability retirement.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] She's in an assisted living place now in [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] She has no access to her work email.
[AGENT][NEUTRAL] Got you. OK.
[AGENT][NEUTRAL] Um, let me check and see um.
[AGENT][NEUTRAL] What's going on? It looks like they may be requesting medical records, but now I'm not sure. Let me check and see what it is. OK, one moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so it's under review. Um, so right now it looks like it's under review, um, with our doctor. So once he completes that, um, we'll go ahead and uh make a determination on the claim, OK? So right now it's, it's on the review.
[CUSTOMER][NEUTRAL] OK, I just because y'all had requested a pathology report and a bill from [PII] and I want I had think I actually I looks like I said.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 3 things and only meant to send 2. So, um I just wanna make sure y'all got those.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, it looks like we did because yeah, it's fine. Uh yeah, whenever we it's fine, we get that a lot, so it's just fine whenever it's a duplicate, we just go ahead and just continue.
[CUSTOMER][POSITIVE] Sorry about that middle one.
[CUSTOMER][NEGATIVE] That wasn't intentional. I didn't.
[AGENT][NEUTRAL] Um, but yeah, right now is, uh, when is, uh, sent to the next step, which it looks like this one is sent to the next step, that means that all the information we needed is there. So right now it's just uh waiting for Doctor [PII], uh, which is our doctor, uh, to go ahead and review the claim and just go ahead and uh give us an OK to continue, OK?
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's cool. I just wanna make sure y'all had what y'all needed and that you weren't waiting on anything else because I, you know, we hadn't received any letters, so, but that makes sense if you're emailing it to the wrong app. Can we fix her email?
[AGENT][NEUTRAL] All right, yeah.
[AGENT][NEUTRAL] It looks like we do. Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, we
[AGENT][NEUTRAL] Uh, we can, but we don't really send anything by email unless it's requested. Um, yeah, that's, that's something that we use it, yeah, yeah, so no, all the information that we send out is gonna be by mail, and right now we have not sent anything, uh, recently by mail, um.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] OK, OK, in that case we're good.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Until it's completely processed then we'll go ahead and send you something either indicating that we did approve and pay or either indicating if we're missing anything else but right now uh since it's under review we're not able to see exactly where is it at it's just saying that it's under review, OK.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][POSITIVE] Yeah, yeah, I get it. I just wanna make sure y'all got the that y'all got what y'all needed to send it to the next step, so I appreciate you letting me know.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You're welcome. Is there anything else I can help you with today, Miss [PII]?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK, well, thank you for calling APL. You have a good day, OK?
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] You're welcome. Bye bye.