AccountId: 011433970860
ContactId: f2c71dee-4118-442f-b853-7b41742100aa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 633369 ms
Total Talk Time (AGENT): 128391 ms
Total Talk Time (CUSTOMER): 202986 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/f2c71dee-4118-442f-b853-7b41742100aa_20250609T19:15_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh yes, ma'am. There is some, I'm just calling to check the status of my, uh, claim please.
[AGENT][NEUTRAL] OK. Happy to check on a claim. Do you have your policy number?
[CUSTOMER][NEUTRAL] Uh, the policy number.
[CUSTOMER][NEUTRAL] I have different ones.
[CUSTOMER][NEUTRAL] It doesn't matter which one is it because there's different claims that have been submitted.
[AGENT][NEUTRAL] Uh, yeah, if you have a policy number, I can bring up all of your policies.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, uh, it is 0209.
[CUSTOMER][NEUTRAL] 1331.
[AGENT][NEUTRAL] What is your first and last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then I'll need your date of birth and address, please.
[CUSTOMER][NEUTRAL] Uh, [PII]. My address is uh [PII].
[AGENT][NEUTRAL] And the claim that was submitted recently, was it for you or for somebody else on the policy?
[CUSTOMER][NEUTRAL] And it was for my son.
[AGENT][NEUTRAL] What's his name?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] So on here it looks like the last claim I see was for or for [PII] was submitted back in [PII].
[CUSTOMER][NEUTRAL] OK, because the, the only thing that it was still pending was um.
[CUSTOMER][NEUTRAL] Uh, they were, uh, requesting that all the sies that he had with his, um,
[CUSTOMER][NEUTRAL] With the uh I might deal and then the, the uh surgeries with the codes and then um the anesthesia as well for those surgeries. And so, um, excuse me.
[CUSTOMER][NEGATIVE] So every time I uh contact them, I submitted what they had sent me, but the last time I called, um they were, which I believe it was on uh [PII].
[CUSTOMER][NEUTRAL] Uh, they were gonna request, y'all were gonna request all those uh documents directly to the surgeon.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][POSITIVE] Yes, ma'am, thank you.
[AGENT][NEUTRAL] When was the surgery for [PII]? Was it in [PII]?
[CUSTOMER][NEUTRAL] He was, they were uh they were gonna call because he they were gonna request that because he had uh several of them. He had um
[CUSTOMER][NEUTRAL] 123456789 surgeries since uh [PII], uh, all the way through [PII]. Excuse me.
[AGENT][NEUTRAL] So I don't see any claims that have been filed in [PII] at all.
[CUSTOMER][NEUTRAL] No, they're still, uh, it was, it's not a new claim. It's the same, it's the same one that they still are working on. But in order to get the benefits for the surgeries, uh, they needed all the surgeon's information, and I believe the last time I spoke with Miss um
[CUSTOMER][NEUTRAL] I believe her name was um
[CUSTOMER][NEUTRAL] Vaccine.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He had two surgeries in [PII] and then uh seven more in [PII].
[AGENT][NEUTRAL] And you don't have the claim number that you were.
[AGENT][NEUTRAL] Specifically looking at.
[CUSTOMER][NEUTRAL] But uh let me see.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, so um.
[CUSTOMER][NEUTRAL] No, we can um.
[CUSTOMER][NEUTRAL] I don't know if you can look this up and see. 3, the claim number 35.
[CUSTOMER][NEUTRAL] 46
[CUSTOMER][NEUTRAL] 279.
[AGENT][NEUTRAL] 354-627-9
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] So I do see that they reached out for medical records.
[AGENT][NEUTRAL] Um, to Texas Children's Hospital. I don't see.
[CUSTOMER][NEUTRAL] OK, uh-huh.
[AGENT][NEUTRAL] Double check to see if we've gotten anything yet. I don't see that anything has been processed yet.
[AGENT][NEUTRAL] But we sent the request out on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then they have the option to return it back to us either via fax or they can mail it.
[AGENT][NEUTRAL] Um, so it looks like there were 2 examiners that reached out to get records for that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it looks like they're still waiting on the medical records and that we haven't gotten anything yet.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Did you need me to check on any other claims?
[CUSTOMER][NEUTRAL] And usually is there any.
[CUSTOMER][NEUTRAL] No, I think that will be it. It was just, uh, it was just the documents that they were not gonna request it and it's uh about the the surgery that he had, the surgery codes, the
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the anesthesia.
[CUSTOMER][NEUTRAL] On those uh surgeries.
[AGENT][NEUTRAL] Yeah, so I mean you can always follow up with the provider. They usually have like a medical records department. They would have been the ones that have gotten the request, um.
[AGENT][NEGATIVE] But it's not unusual. It can take some time, sometimes for them to return, return it back to us.
[CUSTOMER][NEUTRAL] OK. All right.
[CUSTOMER][POSITIVE] OK, well, I will just keep checking. Thank you so much. And may I ask you, what is your name, please?
[AGENT][NEUTRAL] My name is [PII], that's spelled [PII]
[CUSTOMER][POSITIVE] All right, Ms. [PII]. Well, thank you so much. I appreciate your help.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Mhm. Bye-bye.