AccountId: 011433970860
ContactId: f4ab8633-1bb9-4da6-b5fd-34614a81608d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 263559 ms
Total Talk Time (AGENT): 117620 ms
Total Talk Time (CUSTOMER): 124849 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/f4ab8633-1bb9-4da6-b5fd-34614a81608d_20250415T21:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] over on the care team. How are you today?
[AGENT][POSITIVE] I'm good how are you [PII]?
[CUSTOMER][NEUTRAL] Doing alright, thank you. So I've got a member on the line um she's calling about she's called several times and she's not listed. Uh, she submitted the third party authorization. Um, I don't know that it's been received just yet, but I've spoken to her a million times. Uh, she's calling regarding a claim for her husband, uh, cancer claim.
[CUSTOMER][NEUTRAL] And it's stating there's a lot of things that are missing like the pathology report, but it's only for certain surgeries. Uh, some of them, some of the surgeries that pay, and she's really confused. She believes that everything was sent over, uh, that needs to be sent over. Um, so I think she wants clarification as to why these specific surgeries, um, are stating they need a pathology report.
[AGENT][NEUTRAL] OK, what's that policy?
[CUSTOMER][NEUTRAL] It is 110443.
[AGENT][NEUTRAL] OK, and what's the claim number?
[CUSTOMER][NEUTRAL] It is 3561762.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Um, do you think that she would be open to me researching and looking at all the documents so that I can kind of get a better idea of what we have and what we don't, um, and then, OK, I mean it's already 4:30 so I can't promise that it'll be today, but I can call her back tomorrow.
[CUSTOMER][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] Yeah, she's
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] That is perfectly fine. Um, she is super sweet, um, she just, she calls all the time, um, and her husband's not with her at the moment, so that's fine anyway, um, as we're still waiting for that authorization, um, so yeah, that would be great.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, because what they sent in, yeah, what they sent in for that claim is 40 pages.
[CUSTOMER][NEUTRAL] I can let her know um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And then um yeah 00 that's that's so small in comparison we've gotten a member to submit 5 different times and all of them were well over 200 or 300 pages.
[CUSTOMER][POSITIVE] Oh my gosh.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Oh my gosh, see, I have some people that will say I think I might have sent too much and I was like, uh, too much is better than not enough, but I never considered that, so I am sorry.
[AGENT][NEUTRAL] So, yeah.
[AGENT][MIXED] No, it's OK. So 40 pages is not a lot in comparison, but um we do have that authorization by the way.
[CUSTOMER][NEGATIVE] I guess that's so time consuming.
[AGENT][NEUTRAL] It came in yesterday. Yeah, it's under.
[CUSTOMER][NEUTRAL] Oh, we do.
[CUSTOMER][NEUTRAL] Is that what's on Amtrak?
[AGENT][NEUTRAL] It is mhm it's the authorization.
[CUSTOMER][NEUTRAL] OK, I see it being processed. I didn't see it in the awesome. OK, I didn't see the what is it? CLHIP. I didn't see it there, so I guess it's just not done processing, so OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah they haven't pulled it right they haven't pulled it to add it and send it over to you guys and everything so we do have it so you're good um yeah let me let me look through this that we do have and kind of try and figure out what we have what we don't have, why we need what we are asking for and then um I can give her a call back is the number that's on the policy a good number or is there a better number to contact her at?
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][POSITIVE] Cool, OK, awesome.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me check that.
[CUSTOMER][NEUTRAL] No, um, I've got the callback number whenever you're ready.
[AGENT][NEUTRAL] OK, yeah, go ahead.
[CUSTOMER][NEUTRAL] That is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, it looks like they've listed that as their home phone so cell phone must be in the system.
[AGENT][POSITIVE] OK, all right, um, yeah, I'll look at this and I will give her a call back just as soon as I can figure everything out.
[CUSTOMER][POSITIVE] Awesome I appreciate it I'll let her know thank you [PII].
[AGENT][POSITIVE] OK. You're very welcome, [PII].
[CUSTOMER][POSITIVE] All right thank you bye bye.
[AGENT][NEUTRAL] All right, bye bye.