AccountId: 011433970860
ContactId: 09401f8e-9fe2-4b6c-b8b5-268e39d68450
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 689919 ms
Total Talk Time (AGENT): 176594 ms
Total Talk Time (CUSTOMER): 132095 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/09401f8e-9fe2-4b6c-b8b5-268e39d68450_20250103T16:03_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes ma'am. I got a text saying that my.
[CUSTOMER][NEUTRAL] Uh, claim was completed, but it doesn't say anything on my.
[CUSTOMER][NEUTRAL] On your portal.
[AGENT][NEUTRAL] OK, well, I can definitely take a look at the claim for you and let you know um the decision. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that, Ms. [PII]. May I have your policy number?
[CUSTOMER][NEUTRAL] Will that be my claim number?
[AGENT][NEUTRAL] Well, no, but if you have your claim number, I can get to the policy.
[CUSTOMER][NEUTRAL] I don't have a car.
[CUSTOMER][NEUTRAL] 354
[CUSTOMER][NEUTRAL] 7053
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] All right, and I have you here, Ms. [PII]. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Uh, date of birth [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] Alrighty, and thank you so much for verifying your information and all the information provided is a verification of benefits, not a guarantee of payment. And Ms. [PII], do you mind if I place you on just a brief hold while I locate the claim?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I've never seen this before.
[AGENT][NEUTRAL] A claim for and it is incomplete in order additional consideration. Please complete the statement of insurer.
[AGENT][NEUTRAL] Please complete the same we're not sure which is the employees section of the client that's entirety your client being OK, it was 8.
[AGENT][NEUTRAL] Employer.
[AGENT][NEUTRAL] Um um um um.
[AGENT][NEUTRAL] Main site claim all kinds of forms.
[AGENT][NEUTRAL] What is the disability.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Yes it is nice yeah.
[AGENT][NEUTRAL] OK, no.
[AGENT][NEUTRAL] OK, hello Ms. [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So, um, your the claim was denied for two reasons. The claim form was incomplete. So we need your employee section and the employer section, and then once we receive that, we can continue processing the claim. Um, do you have a copy of the claim form? I can tell you which sections that would be.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] See my doctor, I gave him all my paperwork.
[CUSTOMER][NEGATIVE] And uh I even gave them my financial paperwork as well to fill out for short term for that. Well, they had filled out a Humana, which was for my financial, and then they uh refused to do any financial paperwork. Well, they got it all mixed up, I believe, and they sent some paperwork back to me.
[CUSTOMER][NEUTRAL] Uh, with, with my, uh, SMLA paperwork. So I gave everything that I had to HR and asked her to send in to y'all whatever.
[CUSTOMER][NEUTRAL] So what is me?
[AGENT][NEUTRAL] So what's missing is the employee section and the employer section. We received the physician's portion.
[CUSTOMER][NEUTRAL] So what's
[AGENT][NEUTRAL] So if you like, I can
[CUSTOMER][NEUTRAL] So, uh,
[CUSTOMER][NEUTRAL] If I do the employee or can you?
[AGENT][NEUTRAL] If you like, I can
[CUSTOMER][NEUTRAL] I, I'll get it from her.
[AGENT][NEUTRAL] OK. If you'd like, I can send you a copy of the claim form. The the first page of the claim form is the instructions, so it shows you which sections is for each person.
[AGENT][NEUTRAL] Um, did you need a copy of the claim form?
[CUSTOMER][NEUTRAL] Uh, will my HR be able to give me that?
[AGENT][NEUTRAL] Uh, I don't know, they may, um, I don't know what forms your HR department has.
[CUSTOMER][NEUTRAL] OK, uh, I guess just send it to me and then.
[AGENT][NEUTRAL] OK, well, I will go.
[CUSTOMER][NEUTRAL] Are you sending it by email?
[AGENT][NEUTRAL] Yes, ma'am. I can email it to the email address on file.
[CUSTOMER][NEGATIVE] Why wouldn't y'all tell me that's what I needed. I even called to see if I needed any more paperwork, and no one told me that.
[AGENT][NEUTRAL] I mean, I, all I can do is apologize, ma'am. I don't know why you weren't advised of that earlier, but I, I can definitely help you now. I don't, I.
[CUSTOMER][NEGATIVE] And now I have to wait a whole another 10 days, don't I?
[AGENT][NEUTRAL] Yes, it's 7 to 10 days to process the claim.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, uh,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so you, I'll just keep looking through my for my email.
[AGENT][NEUTRAL] Yes, would you like me to send it to you now while we're on the phone just to make sure you have it?
[CUSTOMER][NEUTRAL] Play
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What this claim, uh, I need employer claim or the policyholder.
[AGENT][NEUTRAL] Uh she didn't talk to us.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Oh, come on.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello Ms. [PII].
[CUSTOMER][NEUTRAL] Yes I am.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So the email has been sent, it may go to your spam, but you're looking for care team.
[CUSTOMER][NEUTRAL] OK, I got it.
[AGENT][NEUTRAL] You got it? OK.
[AGENT][NEUTRAL] Well, what
[CUSTOMER][NEUTRAL] I just click on one of these, get the uh oh I see it.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][POSITIVE] All right. Well, thank you so much for calling APL. I hope you have a great weekend and happy New Year.
[CUSTOMER][POSITIVE] All right, well thank you so
[CUSTOMER][POSITIVE] Thank you, you too.
[AGENT][POSITIVE] Thank you. Bye bye.