AccountId: 011433970860
ContactId: 1d475fba-a7b6-4917-b03c-112eaf07d104
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 550469 ms
Total Talk Time (AGENT): 143833 ms
Total Talk Time (CUSTOMER): 172927 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/1d475fba-a7b6-4917-b03c-112eaf07d104_20250127T18:55_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII], and we received a letter here, uh, I'm not exactly sure what you guys want because the claim is not an accident and you told me to fill out an accident form. Everything has been submitted via [PII].
[CUSTOMER][NEUTRAL] Our agent and not exactly sure what you guys want here because you don't wanna pay out apparently but it was an emergency room visit. Could we give you the reference number and you look, please?
[AGENT][NEUTRAL] I need to make sure I understand. So you have a claim that was not paid and you're wanting to know the reason why?
[CUSTOMER][NEUTRAL] Well, there's actually 2 claims pending. One is for [PII] and one is for [PII]. This one I'm calling you about is for [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and may I have your name?
[CUSTOMER][NEUTRAL] Crime and [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], may I have a good contact number in case we're disconnected and your policy number?
[CUSTOMER][NEUTRAL] [PII] and the policy number would be 02286658.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Because my claim pertains to a, an emergency room visit.
[CUSTOMER][NEUTRAL] Um, and the claim for Leslie was an accident, so I'm not sure something got mixed up here, but neither of them got paid.
[AGENT][NEUTRAL] OK. May I have your date of birth and the mailing address on file?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And so it's the, it's the most recent claim for Leslie and for you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well, one is for Leslie and one is for me. The one for Leslie was supposedly turned in a couple of weeks ago. Uh, that was an accident.
[CUSTOMER][NEUTRAL] And again, mine is not an accident. It was an emergency room visit.
[AGENT][NEUTRAL] Right, but I'm just asking, it's the two most recent claims that were processed, so I know what to look for. Is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK. And do you mind if I place you on just a brief hold so I can take a look at the claims?
[CUSTOMER][POSITIVE] No, that's fine. Thank you.
[AGENT][NEUTRAL] You're welcome. Hold on one moment.
[CUSTOMER][NEUTRAL] For sure. You are on hold.
[AGENT][NEUTRAL] OK, so I can think now what happened?
[AGENT][NEUTRAL] So [PII].
[AGENT][NEUTRAL] 355393 0 why is this not paying?
[AGENT][NEUTRAL] Alright. So let me pull it up and see.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Mrs. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So there's two things. So for your husband's claim, the documents that were received, we can't read them, like they're, they're literally dark. I I just looked through all of them. The first page, um, you can see like that first claim form page and then everything else is like dark. So they're just asking for
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, so that, that, oh OK, that accident form might be just fill out and then mail it into you, correct?
[AGENT][POSITIVE] Yes, yes, ma'am, for your husband.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then for yours, um, it's asking for the claim form because it was the same thing with the image. So the claim form to be resubmitted and then um giving a detailed description of the accident or diagnosis of sickness. So whatever you went to the emergency room for and what you were.
[AGENT][NEUTRAL] Um, what the diagnosis was.
[CUSTOMER][NEUTRAL] OK, so what, uh, I'm I'm using, I'm using the accident form for my husband and I'm using the what form do I use for my ER visit.
[AGENT][NEUTRAL] It's still the same form because this is an accident policy.
[CUSTOMER][NEUTRAL] Oh, OK, so I'll put both accident forms I resubmit them, and then, yeah, I'm, I'm not sure why he submitted that like that. It is always a little bit like an issue every time we have to submit something that's always an issue. I'm not sure why that is.
[CUSTOMER][NEUTRAL] But um yeah, I redo it. That's fine.
[AGENT][NEUTRAL] OK, and as soon as we receive it, we'll continue processing and just make sure on yours you give the description of um the sickness or whatever you went to the hospital for.
[CUSTOMER][NEUTRAL] OK, I will do that and there was a couple of tests done. I, I also submit all that. Um, can I, OK.
[CUSTOMER][NEUTRAL] Yeah, I do that. I just send it in the mail or what do I do?
[AGENT][NEUTRAL] Um, well, that's up to you. You can mail it, you can fax it, um, or you can, um, do it electronically on the online service center, um, whichever you prefer.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, I'll, I'll figure it out and then I will resubmit that.
[AGENT][NEUTRAL] All right, Mrs. [PII].
[CUSTOMER][POSITIVE] Thank you, I appreciate that.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, not necessarily. thank you. I appreciate you. bye bye.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.