AccountId: 011433970860
ContactId: 0ad80209-d8a5-42b5-881c-bc01d154f299
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 317600 ms
Total Talk Time (AGENT): 123566 ms
Total Talk Time (CUSTOMER): 106675 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/0ad80209-d8a5-42b5-881c-bc01d154f299_20250303T19:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII].
[CUSTOMER][NEUTRAL] And I carry uh hospital indemnity with you guys through my job.
[CUSTOMER][NEUTRAL] Um, I just spent 5 days in the hospital.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And we sent the itemized thing into you guys and I get a letter back saying that.
[CUSTOMER][NEUTRAL] I haven't been approved for the.
[CUSTOMER][NEGATIVE] And uh they upsets me greatly.
[AGENT][NEUTRAL] OK, I can take a look at that claim and uh those denial reasons and get some clarification on that. uh Toa first if you don't mind, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Uh, do you have your policy number?
[CUSTOMER][NEUTRAL] Um, I've got the claim number here. Yeah, I have the policy number.
[AGENT][POSITIVE] Oh sure, that's great. I could go ahead and take that claim number.
[CUSTOMER][NEUTRAL] I've got the policy number.
[CUSTOMER][NEUTRAL] Claim number 3568409.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK thank you one moment please.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK. And [PII], just gonna verify some information really quick. Uh, can I get your date of birth, please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] I'm sorry, could you repeat that claim number? I don't think I heard it correctly.
[CUSTOMER][NEUTRAL] 356-849-7
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 849-7 sorry about that one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, there we are and then if you would, can uh you verify your uh mailing address for me please?
[CUSTOMER][NEUTRAL] Yes, ma'am. [PII].
[AGENT][POSITIVE] Perfect. OK, thank you so much for verifying that information. Alrighty, bear with me just a moment, let me take a look here.
[AGENT][NEUTRAL] OK, so for this claim it's stating that we were still missing that information, the diagnosis code, um, did you send that information?
[CUSTOMER][NEGATIVE] I sent everything in it should have been in there. I mean, I even went to my job with our, our lady that does the, the um the insurance, and she went over everything, you know, so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Finance
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see if that claim number might have been updated. Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] When was that information submitted to us kind of sort of.
[CUSTOMER][NEUTRAL] Um, I sent it in. I go, it's been about 2 weeks.
[AGENT][NEUTRAL] OK, OK, alrighty, [PII] if you would give me just a moment I'm gonna put you on a brief hold and reach out to our claims specialist just so that they can review uh what was submitted.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] All right, thank you. One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Bring
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] This is over on the care team. How are you today?
[CUSTOMER][POSITIVE] I'm doing well thank you how are you?
[AGENT][POSITIVE] Doing good thank you. I've got a member on the line calling regarding an HI claim that she made, um, and it's stating that we're missing some information like diagnosis codes, um, and she's pretty adamant that she sent us what she should have. She said she was with her agent when they got it all together, so she was just wanting to review uh what was submitted to us.
[CUSTOMER][POSITIVE] Certainly I'd be happy to take a look at that. Go ahead and put the policy number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, that is 01768249.
[CUSTOMER][NEUTRAL] OK, just give me one second to pull that up please.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And is that her number listed there?
[AGENT][NEUTRAL] Oh, let's see, yes, 0210, yes.
[CUSTOMER][NEUTRAL] On the screen.
[CUSTOMER][POSITIVE] Yeah, OK, great. OK.
[AGENT][NEUTRAL] And she's just calling about the most recently submitted claim.
[CUSTOMER][NEUTRAL] OK, just give me one second, sorry, I was stuck in a screen. I, I couldn't get out.
[AGENT][NEUTRAL] Mhm. No, you're fine.
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] Uh, [PII], yes.
[CUSTOMER][NEUTRAL] [PII], and it's uh her under her, that 356-849-7?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, I'll pull up that mail number and she's been verified.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and you can go ahead and send her over when you're ready.
[AGENT][POSITIVE] Alright, thanks [PII] have a great rest of your day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Bye bye