AccountId: 011433970860
ContactId: ebc3c3b5-2810-4b87-b145-1b14b638402f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 413839 ms
Total Talk Time (AGENT): 290160 ms
Total Talk Time (CUSTOMER): 115623 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/ebc3c3b5-2810-4b87-b145-1b14b638402f_20250227T15:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. You're speaking with [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hey, [PII], it's [PII]. How are you doing?
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Good, I've got policy number 257.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] And he is upset that we are requesting medical records, doesn't understand why when he sent in all information that we've ever requested and more.
[AGENT][NEUTRAL] OK, well, let me let you explain it to him but he'll know. Tell him that let's go ahead.
[CUSTOMER][NEUTRAL] OK. Now,
[CUSTOMER][NEUTRAL] And, and he does, he's called on the Spanish line, but he does speak English. His wife is there as well.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, I can tell him.
[CUSTOMER][NEUTRAL] Now I verified all of this information. Thank you. Let me get him on the line.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] OK, uh, [PII] that, OK.
[CUSTOMER][POSITIVE] OK OK gracias. OK, [PII], thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] My name is [PII] and I'm in the claims department, and you're calling because we had to request medical records from your credit provider, and I can explain to you why. OK, your policy effective date was [PII]. Anytime you get a new policy and it's still within the 12 months.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Preexisting period and you submit a claim before any benefits could be considered for payment, we have to rule out that this is not a pre-existing medical condition. So what we do, we get medical records. Go ahead.
[CUSTOMER][NEUTRAL] Hey
[AGENT][NEUTRAL] What did you say?
[CUSTOMER][NEUTRAL] No, I'm sorry, keep going.
[AGENT][NEUTRAL] OK, what we do, we have to request medical records from your treating doctors that you don't see within the last 12 months. So we ask for medical records from [PII] from Doctor [PII].
[AGENT][NEUTRAL] LA. That's who we requested medical records from, and we also sent out a delay letter that would go out to you letting you know that we're requesting those medical records and who they were requesting it from. That letter was sent out on the [PII]. It was mailed out of office. Have you not gotten that letter?
[CUSTOMER][NEUTRAL] Yeah, that's the reason why we're calling, uh.
[AGENT][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] Um, OK, so, yeah, [PII] is his primary doctor. Uh, the reason why we fill out the, the dis the disability or whatever you wanna call it, um, request it was because he was just, uh, under, uh, he went through surgery on, on [PII] for uh thyroid cancer. So this is not a pre-existing condition. This is something that it was just uh found and
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Ah.
[CUSTOMER][NEUTRAL] And he had to get it uh removed.
[AGENT][NEUTRAL] OK. That, that's fine. That's fine, but before we can determine that, we have to get the information from the provider that we request the medical records from, telling, you know, sending either the medical records during that time period or telling us in our letter that there's no medical records before that time period of.
[AGENT][NEUTRAL] Uh, [PII], between [PII], but we have to go to the the proper process when we get a claim and the insured claim is within that 12 month preexisting period. Now if he ever sent something in after uh
[AGENT][NEUTRAL] Uh, [PII], then there would be no pre because he'd be on me his one year period. But since he sent a claim in and it's still in the one year period, his one year period would be from [PII]. So we have to request medical records and that's what we don't get medical records and that's why you got the delay letter.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, hold on, I'm confused. So, because we submitted the request when?
[AGENT][NEUTRAL] OK, if you submit a claim.
[AGENT][NEUTRAL] And your disability is during the 12 months of [PII]. His client came in our office. He haven't had our policy a year yet. He's still within that 12 month preexisting period, so we have to get medical records to rule out that this is not a preexisting medical condition, meaning that he did not treat.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] Yeah, I get, I get, I get the reason why you need the, the, the, the medical records, but his surgery happened on [PII] this year.
[AGENT][NEUTRAL] I know, OK, so he had the surgery, but he was, he, he had medical treatment. We don't know. Did he had he had.
[AGENT][NEUTRAL] Diagnosed with this particular medical condition or treated. Seeing a doctor for his medical condition between [PII]. That's what we got to make sure that he hadn't treat, whether he had surgery or not after his policy effective today. Did he take medication? Did he seek medical treatment with a doctor during that time period about this particular medical condition.
[AGENT][NEUTRAL] That's what we need to know from the providers that we request the medical records from. If they don't have any medical records during that time period, they would send us something saying no medical records during that time period. If they got medical records [PII]uring that time period, they would.
[AGENT][NEUTRAL] the medical records, they would go to our medical director doctor. Our doctor will review those medical records to see what he got now is related to any medical treatment before he took out this policy within the last 12 months.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] All right. Anything else I can help you out with today?
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] No, so you guys you said you sent, uh, Doctor [PII] the letters, right? You sent him everything.
[AGENT][NEUTRAL] It went the request went out to him on the [PII]. We mailed out a request for medical records to him.
[AGENT][NEUTRAL] And we have to give them time to get those medical records to us. If they got some or respond to our letter, letting us know they don't have any. That's why you got that letter, then you know we give them at least up to 30 days to try to get those medical records to us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much I appreciate it have a good day.
[AGENT][POSITIVE] All right. Thank you for calling.