AccountId: 011433970860
ContactId: 0546618d-b3a6-41c8-9826-f9fcc93d46a3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 617049 ms
Total Talk Time (AGENT): 327004 ms
Total Talk Time (CUSTOMER): 199460 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/0546618d-b3a6-41c8-9826-f9fcc93d46a3_20250325T20:50_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. And I recently um had called and filed a claim with you guys on um an emergency visit um that I had.
[CUSTOMER][NEUTRAL] And I got some information back saying, I guess, um,
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] That it was denied. I'm not sure or if it needs um more documentation so I just wanted to call and see exactly what I needed to fill out and what you guys needed from me.
[AGENT][NEUTRAL] OK. OK, [PII]. So you have filed a claim that you've received something back from us and you're wanting to just see exactly what it is that we're needing or it was missing, is that correct? Sure, yes, ma'am. I can, I can help you with that. And so first off, [PII], what um is your last name?
[CUSTOMER][POSITIVE] Yes, yes, yes.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] My last name is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you. And your callback number?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Huh?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. And your phone number, please, [PII].
[CUSTOMER][NEUTRAL] My what? I'm sorry.
[AGENT][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And let me see where I would have my policy where would that be my Social Security policy number no I got it right here. OK, it's um [PII].
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you, so give me just a couple of moments please to get your information pulled up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No problem.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and Ms. [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment, and I will have to verify several things with you first for security. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. Also your home mailing address.
[CUSTOMER][NEUTRAL] OK, I noticed that I um moved since um.
[CUSTOMER][NEUTRAL] Y'all have, I just moved apartments.
[CUSTOMER][NEUTRAL] Um, but you'll have [PII].
[CUSTOMER][NEUTRAL] And you all have [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But I'm just moved to [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, alright, so I can get that updated once we finish verifying the rest of the information. Alright, you're welcome. And then city, state and zip.
[CUSTOMER][POSITIVE] OK cool thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number we have on file for you is the same as the one you gave me, so that is the best contact number that we should have, is that correct?
[CUSTOMER][POSITIVE] Oh good.
[AGENT][NEUTRAL] Is that the number? OK, thank you. And then lastly, your email address and this does appear to be your work email.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, thank you. All right, so you, you have moved from [PII] to [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes, uh-huh.
[AGENT][NEUTRAL] Alright, so I have gotten that updated for you in the system.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] I've got an apartment numbers now. Have you updated it with your employer also?
[CUSTOMER][NEUTRAL] Yes I have and I know they were supposed to get it out to y'all as well but I don't know but I did fill out the paperwork with them.
[AGENT][POSITIVE] OK, good.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, that's fine. I just wanted to make sure because the way we receive enrollment information for your employer comes to us electronic.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I was just gonna let you know that if you hadn't to make this, otherwise, that electronic information would override my change. So if we received a file that still had your old address, even though I've changed it, it will change it back. So I just.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[AGENT][NEUTRAL] Alright, so let me.
[AGENT][NEUTRAL] Look, I do see we have one claim on file for you.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I let
[AGENT][NEUTRAL] OK, so on, did you receive your explanation of benefits in the mail?
[CUSTOMER][NEUTRAL] Um, um, yes, I did. That's what this is, yes, ma'am.
[AGENT][NEUTRAL] OK. So on page 2.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It should have the remark, so that she can read it to you, but you should have this. This policy provides benefits for actual charges incurred as a result of a covered accident. Please submit fully itemized bills with diagnosis and procedure codes for further consideration of the policy benefits.
[AGENT][NEUTRAL] So you would just need to obtain that from the facility, your itemized bills, including diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Once you have that information, then you can upload it directly into your portal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, now they attached.
[AGENT][NEUTRAL] I think that's how you submitted this initially, OK.
[CUSTOMER][NEUTRAL] Um, yes, ma'am, mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So now, just so you know though,
[CUSTOMER][NEUTRAL] Um, now
[CUSTOMER][NEUTRAL] Yes, go ahead.
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] No, no, no, you're good. There's just like a delay in our phones like.
[AGENT][NEUTRAL] No, I was gonna say you cannot you.
[AGENT][NEGATIVE] If there is, and it has to do with my system today. I'm not quite sure um what I've I've just been having issues with that all day. I feel like I'm talking over people and then they say that it it's a lag so it's definitely not just our call um when you're uploading and this additional information into the portal, you will not.
[AGENT][NEUTRAL] Be able to attach it to that claim number that you see what seemed like you're filing a new claim, OK? But that's the proper way to do it. You're just gonna say file a claim or upload files.
[CUSTOMER][NEUTRAL] OK, you cut out.
[CUSTOMER][NEUTRAL] Say that again because you cut out you said you can't upload it and then you went blank for a while.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Well you won't be OK so you will not be able to upload it to that claim number that you currently see so when you get this additional information it'll almost be like you're submitting a new claim, you're just gonna do upload files.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] And upload it and our system will know that that is information that we were needing, OK?
[CUSTOMER][NEUTRAL] OK, question, um, it also had, um, accident claim form and it had these two forms, but I think I filled all that out online. Do I need to fill that again?
[AGENT][NEUTRAL] No, I can, I saw a note that some were mailed to you, accident claims. Did you receive, yes, because on the [PII], it looks like that um forms were requested to be mailed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Did they come with your
[CUSTOMER][NEUTRAL] OK, so fill those out.
[AGENT][NEUTRAL] You can let me, I don't really think that you need to do that. It doesn't indicate that we're in need of the claim form. It just indicates at this point based on the remark that we're needing the itemized bill and diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, well I can definitely um log in to that, the hospital portal and hopefully that's in there.
[AGENT][NEUTRAL] Give me, give me one second. I'm just making sure.
[AGENT][NEUTRAL] Of what we
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So yes, you can go ahead to say in those.
[AGENT][NEUTRAL] To uh and fill that claim form out as well and then you can just upload all of that together.
[CUSTOMER][NEUTRAL] OK, I sure will.
[AGENT][POSITIVE] It doesn't say that we need it, but since I do see that it was mailed to you, yes, ma'am. I mean, it's not gonna hurt for you to, to complete that as well.
[AGENT][NEUTRAL] And again you can just upload it all together.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, well thank you so very much.
[AGENT][POSITIVE] Well, you are certainly very welcome. Is there anything else, Ms. [PII], I could help you with today?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK, well thank you so much for calling APL and I sure hope you're doing a lot better because I know that can be a.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] A nasty kind of injury there. Been there, I understand, so.
[CUSTOMER][NEUTRAL] Uh, yes.
[CUSTOMER][POSITIVE] Yes, I am [PII] so I'm glad.
[AGENT][POSITIVE] Well, wonderful. Great.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Hey, that's great news. All right, well thank you again for calling APL. If you have any other questions, give us a call. Yes, ma'am. You too.
[CUSTOMER][POSITIVE] OK, have a good day.
[CUSTOMER][NEUTRAL] OK alright bye bye.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.