AccountId: 011433970860
ContactId: 0783a2e1-189f-44cf-a4b0-80227100f05b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 851000 ms
Total Talk Time (AGENT): 254402 ms
Total Talk Time (CUSTOMER): 198311 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/0783a2e1-189f-44cf-a4b0-80227100f05b_20250410T17:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hello sorry, uh, I'm calling because like I received a text message.
[AGENT][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Hello, um, I, I'm calling because I received a text message saying that my claim has been completed, and I'm calling.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't, I don't understand what that means. This is my first time doing an accident claim, so I'm not sure.
[CUSTOMER][NEUTRAL] If I submitted everything, if I maximize my benefit, I don't know.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm just, I don't know what this means.
[AGENT][NEUTRAL] OK, well, I can um help you with your claim status. Can you please give me your name and your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you [PII] and then what is your call back number just in case our call is dropped?
[CUSTOMER][NEUTRAL] Callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, sir. And do you know your policy number?
[CUSTOMER][NEUTRAL] So it says I have.
[CUSTOMER][NEUTRAL] Since your claim is complete.
[CUSTOMER][NEUTRAL] And I have 2 claim numbers.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I don't know what my policy.
[AGENT][NEUTRAL] OK, if you give me a claim number that'll pull your po.
[AGENT][NEUTRAL] See in for me so I can look at it.
[CUSTOMER][NEUTRAL] OK, so the first claim number is.
[CUSTOMER][NEUTRAL] 358
[CUSTOMER][NEUTRAL] 7010.
[AGENT][NEUTRAL] OK, let me pull that claim up real quick.
[AGENT][NEUTRAL] OK [PII], I'm gonna need for you to verify your um policy for me. Can you please give me your date of birth?
[CUSTOMER][NEUTRAL] Sure, uh, my date of birth is [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Alright, address, phone number and email address is [PII].
[CUSTOMER][NEUTRAL] Um, the email is [PII]
[CUSTOMER][NEUTRAL] [PII] and what was the other one phone number?
[AGENT][NEUTRAL] Yeah, the phone number that you gave me to call you back on is that also your cell phone number?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] OK, thank you very much. I appreciate you verifying that information for me.
[AGENT][NEUTRAL] Alright, so let me see, and what was the 2nd number that you have, sir?
[CUSTOMER][NEUTRAL] Second claim number is 358.
[CUSTOMER][NEUTRAL] 7021.
[AGENT][NEUTRAL] OK, we'll start with that one.
[AGENT][NEUTRAL] OK, that claim was paid $350.
[AGENT][NEUTRAL] It's in the process right now, um.
[AGENT][NEUTRAL] To go direct deposit?
[CUSTOMER][NEUTRAL] OK, can I, can I ask what that one was for?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And like what, what benefits did I receive?
[AGENT][NEUTRAL] Yes, you received $350. Now, I have um.
[AGENT][NEUTRAL] The date of service for you is [PII].
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Or
[CUSTOMER][NEGATIVE] That was my injury. That was my injury day.
[AGENT][NEUTRAL] Uh, we've got
[AGENT][NEUTRAL] OK, and then we also have a data service for X-ray of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, another physical exam on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, the MD [PII].
[AGENT][NEUTRAL] And then we have a non-covered service that has procedure code 99213.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that was from [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So, can I, do you, do you have a breakdown of what I received for each one? So like the injury and the X-ray, physical therapy.
[AGENT][NEUTRAL] Yes, OK, so looking on.
[AGENT][NEUTRAL] Looking on the data service of [PII], the benefit that was paid was $100.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On data service for the X-ray of [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Benefit was paid $50.
[CUSTOMER][NEUTRAL] $60 OK.
[AGENT][NEUTRAL] 50 and then on [PII] the benefit amount paid uh to the MD was $200.
[CUSTOMER][NEUTRAL] I wonder what that was for
[CUSTOMER][POSITIVE] Good
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so that would equal your $350.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Alright, can you, uh, thank you for that. Can you, can you explain to me the other one?
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Yes sir, let me look that one up for you.
[AGENT][POSITIVE] OK, this one has a remark on it.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Treatment not timely. So the treatment must occur within the specific number of days after.
[AGENT][NEUTRAL] The covered accident occurs as outlined in the policy based on the information on file, this service does not meet the provision requirements for covered under this benefit, so it looks like your treatment wasn't within the specified time that your policy states, so it was non-covered.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, is there someone I could speak to about that? I, I wanna.
[CUSTOMER][NEUTRAL] Um, so I was, I got this accident policy insurance and you know, once I got injured.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because it was on workers' comp, I had.
[CUSTOMER][NEGATIVE] I found it very difficult to get the proper paperwork.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Um, to submit it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Things were, things were just not given to me in a timely manner.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] And I, I, I just, it was, it was very, very difficult, and I'm wondering if there's some way I can, if there's some kind of uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, forgiveness or some kind of exemption that I could be there's, and you could see the date on the paperwork.
[CUSTOMER][NEUTRAL] You know, when they were giving it to me.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, it just wasn't given to me. I didn't get it until this this year.
[CUSTOMER][NEUTRAL] Well, not this year. Maybe, maybe the end of last year. I was like I, you know, trying to get trying to get the paperwork to submit was very difficult for a first time user, so I'm kind of hoping.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] You know, I pay for this all year. I'm kind of hoping somebody can.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Give me some kind of exemption to get that stuff covered.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there anything I can do?
[AGENT][NEUTRAL] Uh, what I can do for you is I can get um a claims specialist to call you back. Would you like for somebody in the claims department, a specialist to call you back and go over that with you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, that'd be awesome.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold. I'm gonna get that um request sent in so that somebody will give you a call back. It's gonna be a brief hold while I get that together for you.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you [PII]. I appreciate your patience while I got that request in for you. I have it in and you should be receiving a phone call back within 24 hours to the telephone number that you gave me to call you on if we were disconnected, your number on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you again for your help.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh, well, you're so welcome. Very welcome.
[AGENT][NEUTRAL] Is there anything else, [PII], I can help you with?
[CUSTOMER][NEUTRAL] OK. All right, well.
[CUSTOMER][POSITIVE] No ma'am, no ma'am, that's it thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome you have a wonderful day and thank you for calling APL.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][NEUTRAL] Bye-bye, sir.