AccountId: 011433970860
ContactId: 0b6ae2ab-6c09-4694-94fd-f36b3e141086
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1002549 ms
Total Talk Time (AGENT): 348793 ms
Total Talk Time (CUSTOMER): 374966 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/0b6ae2ab-6c09-4694-94fd-f36b3e141086_20250528T16:50_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey, this is [PII] in [PII]. How are you doing?
[AGENT][NEUTRAL] Hi, I'm fine, Mr. [PII]. How are you doing today?
[CUSTOMER][POSITIVE] Doing great, doing great. I, um, I was calling earlier to check on a claim for one of our customers, but we, after doing some research, you realized that the claims have been uploaded incorrectly and it was a mixture of like two different claims in one. So I'm trying to see if um if I give you some info if you can connect me with the examiner.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Uh, what is that policy number, please?
[CUSTOMER][NEUTRAL] Policy number is 237-0392.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes ma'am, it's [PII].
[AGENT][POSITIVE] Awesome and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK. And Mr. [PII], what office are you calling from?
[CUSTOMER][NEUTRAL] Crescent City benefits.
[AGENT][NEUTRAL] Have they caught those escapees yet?
[CUSTOMER][NEUTRAL] They I think they still have a couple on the loose.
[AGENT][POSITIVE] Bless it.
[CUSTOMER][NEUTRAL] Yeah, it's, it's kind of wild, you know.
[AGENT][NEUTRAL] I had talked to someone that lives there and um I think she was an agent and she was saying that there is a $20,000 reward.
[CUSTOMER][NEUTRAL] It was 5000, they may have raised it.
[AGENT][NEUTRAL] Oh, it sounds like to go hunting, but be careful.
[AGENT][NEUTRAL] See.
[CUSTOMER][POSITIVE] Yeah, it's uh it's wild it's always something in [PII], let me tell you it's.
[AGENT][POSITIVE] That is true. That's always tell people to be cautious. It might be fine. It is a great place. I love the food and the, the art and everything, but you have to be careful.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Absolutely.
[AGENT][NEUTRAL] I think people take advantage of that.
[CUSTOMER][POSITIVE] Yep, you're right.
[AGENT][NEUTRAL] Uh, let's see, well, um, all the time I'm showing received payment in today through the online service center, but it hasn't been processed yet, so it hasn't been assigned to an examiner.
[CUSTOMER][NEUTRAL] This is actually what I did was
[CUSTOMER][MIXED] Normally we're really clean on our claims. Everything is perfect and we submitted perfect, but what happened was it looks like if you see there's a bunch of other claim numbers in the system or one that ends in 813, um, but what happened was when these claims are being uploaded this lady had.
[CUSTOMER][NEUTRAL] Like two different claims and instead of it being separated into two accidents, it was somehow uploaded altogether, which in turn confused the system because the date of loss for her car accident was [PII], and a lot of the bills that were being produced were from before that, but that was from a prior injury of something completely different. Um, so what happened was I think it really confused the examiner because all these dates were before the actual accident date on the claim form.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So what I did was I went and cleaned up the paperwork, took out just the things that pertain to this specific accident, and I just uploaded them, um, but it's stuff that's already been sent in, but I just keyed it into one upload so they can see this is the only things that pertain to this specific accident.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So that's what I was trying to talk to them about, because it's all the info they already have, but I just organized it for them perfectly so they can see what applies just to that car accident.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 1
[AGENT][NEUTRAL] Uh, it should be fine, but I can definitely see on the information as far as the data service of that 2:15.
[AGENT][NEUTRAL] Um, let me look at the history.
[CUSTOMER][NEUTRAL] Because what happened was they, they shot out about like 5 EOBs from the accident plan. They were all zeroed out and it was all basically like the examiner was confused because all the dates, most of the dates on the paperwork were before the actual accident date. So it was the, I think the examiner was like, what is this, you know.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] So this technically applies to the claim that ends in 81.
[CUSTOMER][NEUTRAL] 813 but I was trying to do a clean and fix it because um there was a lot of information in the first uploads that didn't even apply to this accident so it was confusing the whole the whole process.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Let me see if I can get an examiner for you, OK?
[AGENT][POSITIVE] So they can look at it and they can make note of it. All right, you're welcome, Mr. [PII]. Y'all have a great day and be safe.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][POSITIVE] Alright, thank you.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[AGENT][NEUTRAL] Oh, hungry.
[CUSTOMER][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey, [PII], this is [PII]. How are you doing?
[CUSTOMER][NEUTRAL] What's not [PII]?
[AGENT][NEUTRAL] I haven't talked to you in forever.
[CUSTOMER][NEUTRAL] I know I keep forgetting that you are even on the care team.
[AGENT][NEUTRAL] Girl, push.
[AGENT][NEUTRAL] Sometimes I forget to.
[AGENT][NEUTRAL] Well, not that I miss claims. I miss processing claims. I really do.
[CUSTOMER][NEUTRAL] What you get
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEGATIVE] I don't know why it was fine to me, uh, processing claims.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But um I have a broker on the phone. It's in regards to an accident claim, and they uh just recently uploaded some documents to this insured's claim, but they just want to let us know that, um, so there's no mix up. He wanted to inform the examiner that it's all for a particular data service that was initially uh claims information sent previous to the accident and he just want to make sure the examiner won't get confused.
[CUSTOMER][NEUTRAL] What's that policy number?
[AGENT][NEUTRAL] 237-039-2.
[AGENT][NEUTRAL] How are your babies doing?
[CUSTOMER][NEUTRAL] Aren't they doing good, just growing, growing, growing.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yeah, not babies anymore, big girl.
[CUSTOMER][NEUTRAL] They are, honey, everybody's.
[CUSTOMER][NEUTRAL] Big and
[CUSTOMER][NEUTRAL] About to be out of school and I'm like, oh my God.
[AGENT][NEUTRAL] Are they still in school right now?
[CUSTOMER][NEUTRAL] Oh yeah they are but they.
[CUSTOMER][NEUTRAL] I think we got, I got 3 more left in school.
[AGENT][POSITIVE] Oh, yeah, [PII] is already out for summer break, which he is so happy about.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And he's growing. Keep telling me every day he's getting taller than me, so.
[CUSTOMER][NEUTRAL] 584.
[CUSTOMER][POSITIVE] Oh wow, 57 pages. Look, look, look, that's uh I love you so.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] What?
[CUSTOMER][NEUTRAL] I'm listening and I'm like, 0, 57 pages. OK. All right. Um, so.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] He wants to make sure that she knows.
[AGENT][POSITIVE] Gosh, that's funny.
[CUSTOMER][NEUTRAL] This was for accident date [PII].
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] And he said he made sure that the information he sent was
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Perfect. And what we need, he said, even though he sent it previously, but he just wanna make sure there's no mistake about it.
[AGENT][NEGATIVE] I am hungry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I know that's what I was just trying to drink my coffee and eat me some breakfast.
[AGENT][NEGATIVE] It's coughing and kicking it.
[CUSTOMER][NEUTRAL] See what did we?
[CUSTOMER][NEUTRAL] I my statement.
[CUSTOMER][NEUTRAL] OK so we have to go through this thing.
[CUSTOMER][NEUTRAL] Cause [PII] already has it.
[CUSTOMER][NEUTRAL] So she's probably getting ready to review it.
[AGENT][NEUTRAL] Oh, she
[AGENT][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] It's already it's in her queue.
[AGENT][NEGATIVE] Really? I didn't even look.
[CUSTOMER][NEUTRAL] Mhm. Yeah.
[CUSTOMER][NEUTRAL] So it's in her queue, so she's probably gonna get ready to uh review it.
[AGENT][NEUTRAL] OK. Should I, um, just, well, I don't know, should I transfer him to her so she can speak with him?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I don't know because I mean whatever he tell me I'm gonna have to relay it to her anyway, but I would.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] See.
[CUSTOMER][NEUTRAL] But I would just let him know that the the examiner already has it in their queue and they're probably gonna review it.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] He is one of those, I think he's a, well, I wonder if he should talk to, let me, I am [PII] just to let her know and see if she wanna talk to him since he is uh with one of those uh brokers, you know.
[AGENT][NEUTRAL] I believe.
[CUSTOMER][NEUTRAL] Like one of the ones that we have to cover.
[CUSTOMER][NEUTRAL] That we kinda uh hold their hands or whatever.
[AGENT][NEUTRAL] Yeah, he's from Crescent City Benefit. I think that's [PII] Group in it.
[AGENT][NEUTRAL] Let's see now.
[CUSTOMER][NEUTRAL] I'm not sure.
[AGENT][NEUTRAL] It is [PII], yeah, he is an agent on there. um, let me IM her real quick.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] I am so hungry.
[CUSTOMER][NEUTRAL] But you say he wanted to make sure it was what now? that it wasn't.
[AGENT][NEUTRAL] That the examiner don't get confused.
[AGENT][NEUTRAL] 237-0392.
[AGENT][NEUTRAL] That was
[AGENT][NEUTRAL] Or
[CUSTOMER][NEUTRAL] So she was in a car accident on [PII].
[CUSTOMER][NEUTRAL] [PII] she was patient use multiple rooms.
[CUSTOMER][NEUTRAL] Or up.
[AGENT][NEUTRAL] scientist.
[CUSTOMER][NEUTRAL] So was he thinking that we were not gonna pay it or something?
[AGENT][NEUTRAL] Oh it's gonna overlook it, I'm assuming.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That we're gonna overlook the stuff for 2:15?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK then.
[CUSTOMER][NEUTRAL] I mean because she was requesting information for 2:15.
[CUSTOMER][NEUTRAL] So we need a toxicology report for 2:15.
[CUSTOMER][NEUTRAL] And I haven't I with the diagnosis.
[AGENT][NEUTRAL] Oh, fudge, and she just went on break.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, I just sent her and I am.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Will he let us give him a call back or no?
[AGENT][NEUTRAL] Uh, look like she came back. Let me see what she said. Uh, and I did get his callback number.
[AGENT][NEUTRAL] Oh was she responded quickly. Oh, we didn't overlook it. She has two different accents.
[AGENT][NEUTRAL] Uh, but she can talk to him.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] Cool beans. What is your phone number? She says she'll talk to him. Uh, what is her phone number? [PII]. Awesome. Well, I'll call her. Thank you, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, no problem, [PII].
[AGENT][POSITIVE] All right have a great one.
[CUSTOMER][NEUTRAL] Talk to you later you too.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Claims, this is [PII].
[AGENT][NEUTRAL] Hey, Ms. [PII], it's [PII]. How are you doing?
[CUSTOMER][POSITIVE] I'm good how are you?
[AGENT][NEGATIVE] I'm starving.
[AGENT][NEGATIVE] I'm hungry.
[CUSTOMER][POSITIVE] Oh goodness.
[AGENT][NEUTRAL] It's
[AGENT][NEGATIVE] I don't eat breakfast until it's, I don't eat until it's lunchtime, but then it makes me hungry. I try to supplement it by drinking coffee, but they don't work.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Oh goodness.
[AGENT][NEUTRAL] But, yeah, and he just wanted to make sure that um he wanted to speak with an examiner and make sure it's not overlooked cause there was uh
[CUSTOMER][NEUTRAL] Well, what is he worried about some, what is he worried about being overlooked cause everything is being reviewed. So what does he think is being overlooked?
[AGENT][NEUTRAL] That the accident happened on [PII], even though, uh they, yeah.
[CUSTOMER][NEUTRAL] But she
[CUSTOMER][NEUTRAL] So she, we have a claim form for the accident on [PII], but she's also submitted charges for something in December. That's a separate accident.
[AGENT][NEUTRAL] OK. Yeah, he said there were two different accidents. Yeah.
[CUSTOMER][NEUTRAL] So that's what I'm saying there's nothing, yeah, that's what I'm saying. There's nothing being overlooked, but she submitted everything together and as we went through and looked at everything, we, that's how we were able to determine that there's two separate accidents. So for the accident on [PII],
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We don't have no diagnosis codes or anything. So we requested the itemized billing with the diagnosis codes for the [PII] accident. But then for the [PII], looks like it might not, it might have been before, but the data service on the bill was 12:30. We need a claim form cause that's something different.
[AGENT][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] So that's what it is. But I can talk to him. Yeah.
[AGENT][POSITIVE] Awesome. And it's [PII], I can't say his last name.
[CUSTOMER][NEUTRAL] Mm, pet a [PII], mhm. It's something like that. Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You know, you know those [PII] folks' last name.
[CUSTOMER][POSITIVE] Yes, ma'am. But yeah, I can talk to him.
[AGENT][NEUTRAL] I
[AGENT][POSITIVE] OK. Well, I appreciate you. Have a great day.
[CUSTOMER][POSITIVE] Yes ma'am. You're welcome, you too.
[AGENT][NEUTRAL] All right, bye.
[CUSTOMER][NEUTRAL] Bye bye.