AccountId: 011433970860
ContactId: 159bac93-7046-4920-9cc7-be784f715524
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 530119 ms
Total Talk Time (AGENT): 175889 ms
Total Talk Time (CUSTOMER): 244885 ms
Interruptions: 2
Overall Sentiment: AGENT=1.7, CUSTOMER=2.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/159bac93-7046-4920-9cc7-be784f715524_20250326T20:33_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII]. I'm a broker. I'm just calling to check on some claims for one of our customers.
[AGENT][POSITIVE] Well, Mr. [PII], it would be a pleasure to assist you. How are you doing today?
[CUSTOMER][POSITIVE] I'm doing great. How about yourself?
[AGENT][POSITIVE] I'm doing good, thank you for asking. What is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes ma'am, it is [PII].
[AGENT][NEUTRAL] Thank you. And do you have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes ma'am, it's gonna fall under two different policies, but I'll give you the first one, it's 2605149.
[AGENT][NEUTRAL] And what is the
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] It is Ms. [PII] [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][POSITIVE] I'm getting that pulled up and I'll be happy to help you with that claim status. What is the date of service? Do you have that available?
[CUSTOMER][NEUTRAL] Let me see if it's on here anywhere.
[CUSTOMER][NEUTRAL] It's not, it's not only it should be her only data loss in the computer. Let's see, let me take a look, see if.
[AGENT][NEUTRAL] OK, because I have two claims on file actually for [PII].
[CUSTOMER][NEUTRAL] OK, let me, I'm trying to check all of them trying to see kind of what's been paid for her, um.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Not a problem.
[CUSTOMER][NEUTRAL] Um, let me see if I can get, sorry about that. I was trying to get to that for you but screen's not really wanting to do that. Let's see.
[AGENT][POSITIVE] No problem. I got you. I got you, [PII].
[AGENT][NEUTRAL] I can help you. So for.
[CUSTOMER][NEUTRAL] Sometimes my APL system goes really fast and sometimes it, it kind of locks up and then it goes oops, and it says some a message on the screen.
[AGENT][POSITIVE] Don't you just love those oopses?
[CUSTOMER][POSITIVE] Absolutely, absolutely.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] I can help you. So for data service 31225.
[AGENT][NEUTRAL] We did pay the insured $350.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And these are via direct deposit.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And then for.
[AGENT][NEUTRAL] Day of service [PII], we paid $50.
[AGENT][NEUTRAL] And those were paid
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] Uh, the first one was paid on [PII]. The second one was paid yesterday on [PII].
[CUSTOMER][NEUTRAL] OK, and that was on the accident plan?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So let's see what else we've got for her, and this is all for [PII].
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, let me check her identity policy.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And it looks like, let me get this claim pulled up.
[AGENT][NEUTRAL] We yesterday also processed a claim.
[AGENT][NEUTRAL] On the indemnity.
[AGENT][NEUTRAL] In the amount of $100 that was for $31225 and 31925.
[CUSTOMER][NEUTRAL] 812 and 319, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, so we, so we got $100.
[AGENT][NEUTRAL] And that also went via direct deposit.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it, so that was $100 because that was the $50 twice, the $312 and the $319.
[AGENT][POSITIVE] That's right.
[CUSTOMER][POSITIVE] Perfect. Um, so anything else that was processed?
[AGENT][NEUTRAL] On her policy, let me check this other claim. It wasn't paid. Let's see what's going on.
[AGENT][NEUTRAL] Yeah, we have a claim that was submitted, but it was not um.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK, um, the only thing I was trying to figure out is on the accident plan normally if they go to the doctor's office, they get the $100 benefit and there's a $100 follow up visit benefit, but on the accident plan it looks like they paid $300 for the X-ray then they paid $250 benefits, um, and I'm trying to figure out, um.
[CUSTOMER][NEGATIVE] Why they didn't get the doctor's office benefit.
[CUSTOMER][POSITIVE] Sorry about the noise. My [PII] has a marble set that.
[AGENT][NEGATIVE] Oh no.
[AGENT][POSITIVE] I love it.
[CUSTOMER][NEGATIVE] Makes a lot of noise.
[AGENT][POSITIVE] I love it. I was just thinking you got lots of help.
[CUSTOMER][NEUTRAL] Yeah, yes, ma'am.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] I'm checking further, so bear with me.
[CUSTOMER][POSITIVE] Sure, take your time.
[CUSTOMER][POSITIVE] I appreciate all your help.
[AGENT][POSITIVE] I. Oh, it's always a pleasure to help you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] So I'm showing the chiropractor now on that, um, for [PII] does not look like there was.
[AGENT][NEUTRAL] This is gonna be chiropractic services.
[CUSTOMER][NEUTRAL] OK, so chiropractic services fall under different than the doctor's office benefits?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so chiropractic services would be like a $50 benefit where if it was a regular doctor's office, it would be a $100 benefit.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah, I believe so, and I'll have to get that policy pulled up just to make sure on that for you.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] Uh, you probably know the benefits.
[CUSTOMER][POSITIVE] And it's really no big deal. I just wanted to be able to, I know I'm pretty good, but, uh, this is the first time I've actually run into a situation where the doctor's office or urgent care benefit wasn't paid, and I do tons of claims, but it's just good to know. So if somebody asked me a question, I'll be able to answer correctly, um.
[AGENT][NEUTRAL] Right. Now, I'm looking for that. Was that on one of those dates of service that I mentioned?
[CUSTOMER][NEUTRAL] I'm gonna
[CUSTOMER][NEUTRAL] I'm showing the, we paid the 350, which was, I believe the X-ray and was that a chiropractic visit as well?
[AGENT][NEUTRAL] I gotta go back so hang on.
[CUSTOMER][NEUTRAL] I'm trying to find I have the brochure up. I'm gonna go pull it just so I wanna be able to tell people correctly, you know.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] If there's a situation where they're not gonna get the.
[CUSTOMER][POSITIVE] I can only get these claims within $50 to $100 normally, just because I do so many of them, I see them in my sleep, but this one, this one's new to me, so I wanna, I wanna memorize this one because I know.
[CUSTOMER][NEUTRAL] Let's see, I don't even see chop chiropractic visit on the brochure. Maybe I'm scanning it too fast.
[AGENT][NEUTRAL] Well, it's under the extended treatment benefit.
[CUSTOMER][NEUTRAL] Oh let me go look right there.
[AGENT][NEUTRAL] It's how they paid their, how they paid that one.
[CUSTOMER][NEUTRAL] Let's see extended treatment extended treatment. I'm looking right now.
[AGENT][NEUTRAL] I'm looking to see that line.
[CUSTOMER][NEUTRAL] Oh, I see. $50 up to 5 days, got it extended treatment. That's good to know. I, I mean I remember that so they can go up to 5 days per claim.
[CUSTOMER][NEUTRAL] Benefits include chiropractic, therapy, acupuncture acupuncture therapy, mental health service, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, that's good to know. So if she has to go back to the chiropractor, she can go a few more times and go max out at 5 days if, if it's the doctor saying she needs to come back. OK, that's good to know cause, uh, I did not even notice that benefit in there. I always thought about either the ER urgent care or doctor's office visit or I was, you know, I've never even realized that, so that's good to know. Perfect. Well, I greatly appreciate your time today.
[AGENT][POSITIVE] That's right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Well, it's been a pleasure to assist you. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, ma'am, I hope you have a great day.
[AGENT][POSITIVE] I hope you do too, [PII], and make sure now that she, that little [PII] keeps making good noise now, cause that's happy noise.
[CUSTOMER][POSITIVE] That's right. That's right.
[CUSTOMER][POSITIVE] I appreciate you. I hope you have a great day.
[AGENT][POSITIVE] Hope you do too, [PII]. Thank you for calling APL. Have a wonderful afternoon. Take care.
[CUSTOMER][POSITIVE] Thank you. You too. Thank you.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.