AccountId: 011433970860
ContactId: 0d508e36-8963-483e-bac8-b9c17245d743
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1475560 ms
Total Talk Time (AGENT): 499704 ms
Total Talk Time (CUSTOMER): 733315 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/0d508e36-8963-483e-bac8-b9c17245d743_20250224T15:41_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, Mr. [PII], my name is [PII]. I'm a uh
[CUSTOMER][NEUTRAL] I have a policy with APL and I filed a claim, uh, accident that I had surgery with.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I was informed to upload my medical bills, which I have done a couple of like 5 days ago and I was just calling to see about the status of the claim.
[AGENT][POSITIVE] It, it would be my pleasure to assist you, Mr. [PII]. Do you have the policy number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I do. My policy number is 255.
[CUSTOMER][NEUTRAL] 9, wait, I don't know if it's accident or hospital. It's hospital. I'm sorry, 2559445.
[AGENT][NEUTRAL] Thank you. And do you mind verifying your date of birth and current mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you. And then what is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] All right, thank you. And I will be happy to check that claim status for you.
[AGENT][NEUTRAL] And you said this is for your hospital, your medical policy?
[CUSTOMER][NEUTRAL] Yeah hospital policy, they said that it, uh, I got a policy if I have to go in in the hospital and get surgery or anything done and I had a shoulder surgery done [PII].
[AGENT][NEUTRAL] All right, thank you. Now, I'm checking on that claim, bear with me just one moment.
[AGENT][NEUTRAL] I'm just checking a couple of things, so bear with me just a second.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] I'm checking your accident policy as well, so.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yeah, my broker, uh, for y'all that I deal with my company said.
[CUSTOMER][NEUTRAL] That my policy, uh, I should be getting a benefit of $1200 for every time I'm going to the hospital.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Which would help me a lot to workless comps only paying me a certain amount.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] On the
[AGENT][NEUTRAL] Wa hospital charges are the costs to medical policy these days, anything helps, doesn't it?
[CUSTOMER][POSITIVE] Oh my goodness.
[CUSTOMER][POSITIVE] Yes, ma'am, it sure does.
[AGENT][NEUTRAL] So it looks like that that was processed on the [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And
[AGENT][NEGATIVE] And saying that it's non-covered. Now, the reason it's non-covered is because according to the diagnosis information that we have, it is just caused pain by pain. It's a pain diagnosis code. Now, what they need is something to indicate that it was, in fact, from an accident.
[AGENT][NEUTRAL] And that could be medical notes like when you first um.
[AGENT][NEUTRAL] When you went for medical attention.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Something showing that it was caused due to an accident.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But as of right now, the only information we have is that it's paying.
[CUSTOMER][NEUTRAL] I'm not, I'm looking at it right.
[CUSTOMER][NEUTRAL] Right, it's not pain. I had a, I had a, uh, rotator cup. I'm gonna call my, I'm gonna call my, uh.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] My
[CUSTOMER][NEGATIVE] Uh, the guy that have my insurance, Mr. [PII], and I let him deal with this cause he said all I need is my hospital bill because it's not for an accident. It's like I stay in a hospital. I had a rotary cuff surgery done. I can send that also, but I feel once I send it, it's gonna be something else. I mean, I just sent that, I sent everything that they said he said I needed for the accident. I needed to state that I had an accident and it stated that I had a surgery and the paperwork.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, on [PII], now you're saying I need a, uh, uh, itemized copy of what happened to me?
[AGENT][NEUTRAL] Let me check this, hang on just a second. Let me take a quick look and see what we have on file.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Give me just a second.
[CUSTOMER][POSITIVE] Thank you so much ma'am.
[AGENT][POSITIVE] Sure. No, I don't mind looking at this real quick for you.
[AGENT][NEUTRAL] So, what, what it is is that the diagnosis code that the surgery center put on this information.
[AGENT][NEGATIVE] It's all due to pain. For example, they put on here.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, complete rotator cuff tear.
[AGENT][NEUTRAL] But that does not tell us what the accident was.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Like, you know, it's possible that somebody could have to have the, have a tear from just overuse or it could be from, um,
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] Falling, you know, that you tear your rotate.
[CUSTOMER][NEUTRAL] So what would a cop with a copy of my with a copy of my accident report on from Shamrock Marine He cause I have that. I, I saw that out the day.
[AGENT][NEUTRAL] That should help, yes sir. If that has the, um, now that, see, so this surgery was on [PII]. When was your accident?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] My accent was uh [PII].
[CUSTOMER][NEUTRAL] That's why the uh the accident policy doesn't have it doesn't cover it because it was 2 or 3 days prior to my insurance kicking in, but my agent said being at my hospital stay, my hospital surgery was in January and my my my policy was covered.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Hang on just a second, let me check something.
[AGENT][NEUTRAL] I'm gonna check it check on the information that we have on your accident policy so if there's any dates of service that might help.
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][POSITIVE] Yes ma'am, thank you.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] The other thing is, when you went to see the surgeon, if he has something showing that.
[AGENT][NEUTRAL] You know, that you're having to have rotator cuff due to
[AGENT][NEUTRAL] Your accident.
[AGENT][NEUTRAL] But because this is an accident policy, we do have to have
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Something with that surgery.
[CUSTOMER][NEUTRAL] No, this is a hospital. This, this is supposed to be a hospital policy, ma'am.
[AGENT][POSITIVE] I'm sorry, that's correct. You're right. You're, you know, you're right, I said it wrong. I'm so sorry.
[CUSTOMER][NEUTRAL] Can I give you? OK.
[AGENT][NEGATIVE] I was looking and, and reading and talking all at the same time and it didn't work. I apologize.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] That's fine, man.
[AGENT][NEUTRAL] So, yeah, let's see.
[AGENT][NEUTRAL] So I don't know. I'll tell you what, you wanna hold just a minute and let me get you to the uh let me I'm just trying to see if we can what what we can do. Now they're probably still gonna need that information but I'm gonna try my best if you'll hold just a minute.
[CUSTOMER][POSITIVE] Absolutely.
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][POSITIVE] I sure will thank you so much, ma'am.
[AGENT][POSITIVE] My pleasure. One moment, Mister [PII].
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], it's [PII]. How are you doing?
[CUSTOMER][POSITIVE] I'm good how are you [PII]?
[AGENT][POSITIVE] I'm doing fine on this wonderful lovely Monday.
[AGENT][POSITIVE] Hey, at least we're blessed enough to have a job, right?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] That's right. That's right.
[AGENT][NEUTRAL] Listen, I've got a Mr. [PII] on the line. His policy number is 255.
[AGENT][NEUTRAL] 9445.
[AGENT][NEUTRAL] Now he's calling to check his.
[AGENT][NEUTRAL] Um, claim status.
[AGENT][NEUTRAL] And we were going over and, you know, I was stating that we need to have something indicating that it was for an accident.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now, he also has an accident policy and everything is, he had to have rotator cuff due to his accident.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But now his
[AGENT][NEUTRAL] Accident
[AGENT][NEUTRAL] Claim was denied.
[AGENT][NEUTRAL] Um, wait a minute, let me make sure I'm looking at this the right policy, um.
[AGENT][NEUTRAL] It was denied as non covered the date of his accident.
[AGENT][NEUTRAL] was
[AGENT][POSITIVE] Wait a minute what? Hang on, I'm so sorry.
[CUSTOMER][NEUTRAL] You're fine.
[AGENT][NEUTRAL] Prior to.
[AGENT][NEUTRAL] Insured's effective date, the date of the accident was [PII].
[CUSTOMER][NEUTRAL] Hm, I don't make no sense, does it?
[AGENT][NEGATIVE] No, no.
[AGENT][NEUTRAL] No
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] That just hit me.
[CUSTOMER][NEUTRAL] 1:[PII] to 1:[PII].
[CUSTOMER][NEUTRAL] Accident occurred prior to effective date of coverage.
[AGENT][NEUTRAL] Oh, the date of the date of the accident was [PII]. OK.
[AGENT][NEUTRAL] I don't know why those dates of service are on the claim, but anyway, that's, that's not the.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's probably just follow up.
[CUSTOMER][NEUTRAL] Like if he had the accident in October, he probably didn't actually, I mean, that's only a couple of months between the accident and when he actually had treatment, so.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So he, um, he, he knows that his accident policy is not covered.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] benefits. But he's stating, you know, when I was telling him that we would need something showing that the surgery was due to his accident.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And he said, well, it's all, we should have everything.
[AGENT][MIXED] He's kinda, he was kinda getting a little frustrated, but then when I said, well, let's just take a deeper look, you know, he was like, thank you, you know.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So is there anything that we can use that we have?
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] So we deny this anesthesia not covered and then we need an itemized bill. So let me look at the accident policy and see what we have.
[AGENT][NEUTRAL] All we have is a claim form.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK, well let me look at what we have here on the HR.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEGATIVE] Yeah, it's just a claim form and it doesn't give us anything.
[CUSTOMER][NEUTRAL] So, like,
[CUSTOMER][NEUTRAL] I don't really know.
[CUSTOMER][NEGATIVE] What we're supposed to be using for this because all he uploaded for HI was the claim form it doesn't say.
[CUSTOMER][NEUTRAL] Anything about like, so the thing is though, um.
[AGENT][NEUTRAL] And then we should
[AGENT][NEUTRAL] Surgery.
[AGENT][NEUTRAL] And I told it, we did talk about the diagnosis code, you know, that does not indicate that it was from a, an accident. It just showing rotator cuff, but it, and it says um
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Not trauma traumatic I can't.
[AGENT][NEUTRAL] I need another pot of coffee.
[CUSTOMER][NEUTRAL] I hear you. I hear you.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So I would say, so.
[AGENT][NEUTRAL] We have
[AGENT][NEUTRAL] It looks like maybe from the surgeon, the the the CMS 1500.
[CUSTOMER][NEUTRAL] Yeah, we have um.
[CUSTOMER][NEUTRAL] An attending physician's statement.
[CUSTOMER][NEUTRAL] On when he got his treatment and that that it was due to his left rotator cuff, but there's not any diagnosis codes on that.
[CUSTOMER][NEUTRAL] Um, and that was under the accident policy and then under the HR it's just a claim form on that one, but let me see what this one is.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, the most recent one is the CMS 1500s.
[CUSTOMER][NEUTRAL] And it was 284.
[CUSTOMER][NEUTRAL] Accident surgery, surgery due to a sickness is not covered.
[CUSTOMER][NEUTRAL] It's those diagnosis code or yeah those diagnosis codes because let me see what they are exactly 75122.
[CUSTOMER][NEGATIVE] Complete rotator cuff tear. I don't think that that would be.
[CUSTOMER][NEGATIVE] A sickness.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] I'm just confused with all this. I'm sorry.
[CUSTOMER][NEUTRAL] No, it's fine, so.
[CUSTOMER][NEUTRAL] I'm going to.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] I'm gonna have this reprocessed because that I know it's an M code and a lot of times the examiners will automatically be like oh M codes are not accident related and a lot of times they're not however this one clearly indicates that it's a complete rotator cuff tear and based off of what we have under the accident policy.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I'm gonna look at that again to see what that claim form looks like because I might be able to.
[CUSTOMER][NEUTRAL] Tell them to reference that.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Cause I wanna see.
[AGENT][NEUTRAL] I mean, he hit his shoulder.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] My own base is so slow.
[AGENT][NEGATIVE] My personal base is slow too today.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh my gosh, all of it, all of it is like it is Monday.
[AGENT][NEUTRAL] you're staying in [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] In my brain
[CUSTOMER][NEUTRAL] OK, he caught himself. OK, so he fell, he caught himself tore his rotator cuff, and then the physician.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's kind of
[CUSTOMER][NEUTRAL] Says that he had a left rotator cuff tear that he was treated for.
[AGENT][NEUTRAL] I mean, I know you
[AGENT][NEUTRAL] I mean, I know we have to have documentation, but at all points.
[AGENT][NEUTRAL] Toward an accident to me.
[CUSTOMER][NEUTRAL] Yeah, all it does, and a rotator cuff tear doesn't happen. That's not a wear and tear. It would say like there's a completely separate thing for wear and tear. I am gonna look though because sometimes, um.
[CUSTOMER][NEUTRAL] The HR if.
[CUSTOMER][NEUTRAL] I wanna make sure that it doesn't say anything about the injury having to take place prior to.
[AGENT][NEUTRAL] Oh, yeah.
[CUSTOMER][NEGATIVE] Because if so then that's gonna be denied too and there's no.
[CUSTOMER][NEUTRAL] There's no reason to get him to.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Do anything else so I just wanna make sure because I sure would hate to be like, hey, we're gonna get this reprocessed and I was like, mm just kidding, we're not, we can't right, don't wanna do that. He's already feeling frustrated, so let's not do that.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Just, just trying, just get your hopes up to drop you down.
[AGENT][NEUTRAL] Right.
[AGENT][NEGATIVE] Well, shoot. Any time you go to the doctor or have any medical costs, you're already frustrated by the amount of dollars you have to spend.
[CUSTOMER][NEUTRAL] Oh, for sure.
[AGENT][NEUTRAL] Oh my God, it's just crazy.
[CUSTOMER][NEUTRAL] Oh, I cannot find.
[CUSTOMER][NEGATIVE] Oh [PII], the, the not having these policies and on base is going to drive me absolutely insane one day.
[AGENT][NEUTRAL] You and me too, girl.
[CUSTOMER][NEGATIVE] Oh my gosh, like it, it seems so trivial, like why, why, why is this a thing?
[AGENT][NEGATIVE] And it's so difficult for us as well as our clients as well.
[CUSTOMER][NEGATIVE] Yeah, yeah, I've been, I mean y'all get more calls than we do so and I've been frustrated so.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I can only imagine.
[AGENT][NEGATIVE] It's not fine.
[CUSTOMER][NEGATIVE] No, I was telling [PII] the other day I said, look, I, I don't know the ins and outs of getting these to on base or anything like that, but I truly do not understand.
[CUSTOMER][NEUTRAL] If they're getting something, why do we not have that also?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You know, our last, uh.
[AGENT][NEGATIVE] Uh, company meeting I told [PII] I said it's frustrating and I said I really don't understand why the policies aren't available prior to the effective date. I mean, me as a consumer.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I would expect it to be there.
[CUSTOMER][NEUTRAL] At least, yeah, because if they're going to be able to.
[CUSTOMER][NEUTRAL] Submit a claim and us process it.
[AGENT][NEUTRAL] We've got to have it.
[CUSTOMER][NEUTRAL] Both of us are doing it blindly.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You know, so I don't, I don't understand. OK, so here's something for HR.
[AGENT][NEUTRAL] Hang on just a second, [PII]. I'm gonna go back to him and tell him we we're reviewing it. Please hold another moment, OK? OK, thanks.
[CUSTOMER][NEUTRAL] Yeah, go ahead.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mr. [PII], I've got a claims adjuster reviewing that. Do you mind holding just another moment?
[CUSTOMER][POSITIVE] I sure don't. Thank you so much.
[AGENT][POSITIVE] You're very welcome and thank you for your patience. We'll get right back with you. Thank you.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] I appreciate it thank you so much.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] He's good and he really appreciates it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] So under the accident surgery it says we will pay the applicable accident surgery benefit per day when a surgical procedure due to an injury is performed on a covered person in a hospital, hospital outpatient facility or freestanding outpatient surgery center.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Or they also have it when it's covered in a physician's office, so let me make sure.
[CUSTOMER][NEUTRAL] Ah.
[CUSTOMER][NEUTRAL] OK, so injury.
[CUSTOMER][NEUTRAL] Which is caused directly by covered accident independent of sickness, disease bo infirmity, or any other calls.
[CUSTOMER][NEUTRAL] And a covered accident occurs on or after the effective date.
[CUSTOMER][NEUTRAL] So
[AGENT][NEGATIVE] But he knows that his accidents not on the accident policy there's no benefits.
[CUSTOMER][NEUTRAL] That's under the HR.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So under his HI that accident surgery coverage that was denied.
[CUSTOMER][NEUTRAL] Um, the accident surgery benefit that.
[CUSTOMER][NEUTRAL] Let me see if there's anything else took place in an outpatient surgical facility.
[CUSTOMER][NEUTRAL] And so it's just surgery, so that would not be covered. Let me see if there's anything else on here that we might be able to cover. I know.
[AGENT][NEUTRAL] Dang.
[AGENT][NEUTRAL] An accident surgery benefit facility?
[CUSTOMER][NEUTRAL] Yeah, so it occurred at an outpatient facility, so literally everything about this would be covered, but.
[CUSTOMER][NEUTRAL] It still has that definition of it has to be due to a covered accident and because covered accident is defined as happening prior to.
[CUSTOMER][NEUTRAL] The effective date, it doesn't meet that now because we have documentation that says his accident occurred prior to not on or after the effective date, so that's not gonna be covered under HI either.
[AGENT][NEUTRAL] Oh, ding ding dong.
[CUSTOMER][NEGATIVE] Yeah, I would have definitely sent this back.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Dang.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] With the accident occurring prior to and that language also being in in the HR um.
[CUSTOMER][NEGATIVE] It's not gonna be covered.
[AGENT][NEUTRAL] Uh, sugar muffin.
[CUSTOMER][NEGATIVE] I know it sucks pretty hard. I would say like I, I was looking to see if there was anything else but literally every charge is from that surgery center, so there's not anything we can pay, we can't pay outpatient accident and sickness because.
[CUSTOMER][NEUTRAL] All of that has to take place in either an ER, an urgent care or physician's office, and that's not any of this. That's the surgery center. So it's very clearly for the surgery only and that language is in there as well. So his accident occurred prior to.
[AGENT][NEUTRAL] OK. Can you kinda, kinda go over that with him and then maybe if he had any.
[AGENT][NEUTRAL] Doctor's visits or, I mean, at least he could file for that, right?
[CUSTOMER][NEUTRAL] Yeah, he should, as long as the doctor's visits are.
[AGENT][NEUTRAL] In one of the
[CUSTOMER][NEUTRAL] After, on or after the effective day, we would be able to consider those for accident or um sickness. Um and then,
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] And then also he has a right to an appeal.
[CUSTOMER][NEUTRAL] He does have a right, a right to an appeal, but I mean it's right there in the policy language which I'm sure he doesn't have, but it is in his policy language so.
[AGENT][NEUTRAL] Yeah, because if it's not on base, he can't access it. He's got the portal account.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I mean I can I can do my best and he's not gonna like it, but I'll do my best.
[AGENT][POSITIVE] Yeah, well, he's really nice and he really appreciates the time we put looking into it, so.
[CUSTOMER][NEUTRAL] Yeah, of course.
[AGENT][NEUTRAL] Well, let me get him on the line and I verified all of his information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, [PII]. One moment. Have a good day. Thanks. One moment.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] All right, Mr. [PII], thank you so much for your patience. I have [PII] on the line. She's been reviewing your policy benefits and the documents that we have on file, and she's going to assist you further, OK?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Yes, ma'am. Thank you.
[AGENT][POSITIVE] You're very welcome. You have a wonderful day and I hope that shoulder gets to feeling better.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] Thank you bye bye.
[CUSTOMER][NEUTRAL] Hey, Mr. [PII], how are you?
[CUSTOMER][NEUTRAL] How you doing, ma'am? What's your name? [PII].
[CUSTOMER][POSITIVE] OK, Ms. [PII], how are you doing today? I'm doing well how are you?
[CUSTOMER][NEGATIVE] Uh, we recovering just hanging around. I got a doctor appointment today at [PII] to see how much longer it's gonna be that I can't work. Oh goodness, I can't even imagine. I know that the surgeries can, can take some time to recover from. This is this is ridiculous.
[CUSTOMER][NEUTRAL] Well, I was reviewing everything because I see that under your accident and under your HR policy we've we've denied everything that you've submitted so I was digging into the HR um because it looks like the accident was a valid denial based off of the accident occurring prior to your effective date so I was like OK well maybe we can pay something up under the HI so under the HI your benefits um specific to accident are.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Any type of hospital confinement.