AccountId: 011433970860
ContactId: 28ad9174-4917-4dcb-b909-576296c04b5b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 516770 ms
Total Talk Time (AGENT): 120731 ms
Total Talk Time (CUSTOMER): 201627 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=-1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/28ad9174-4917-4dcb-b909-576296c04b5b_20250102T18:24_UTC.wav
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[AGENT][NEUTRAL] Calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good afternoon. This is [PII] at Bear's Furniture Company calling. Our group number is 18691.
[CUSTOMER][NEUTRAL] And I just see on the website that one of my employees' claims for hospital indemnity was processed. I was just curious as if you have the date that that check was issued for her because apparently she's a little anxious.
[CUSTOMER][NEUTRAL] Um, do you want the claim number or her name?
[AGENT][NEUTRAL] OK, give me one moment. So, OK, so you said this is [PII] from Behr Furniture?
[CUSTOMER][NEUTRAL] Bear's Furniture Company B A E R S.
[AGENT][NEUTRAL] Thank you, you say you're just want to know the check date of a claim that was processed?
[CUSTOMER][NEUTRAL] Yeah, yeah, just to ease her mind that it really is processed, she got nervous waiting for her benefits.
[AGENT][NEUTRAL] OK. And so, may I get your callback number in case this call is disconnected?
[CUSTOMER][NEUTRAL] Absolutely [PII] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I'm the group administrator here and again my group number is 18691.
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] Thank you. And may I also have your email address?
[CUSTOMER][NEUTRAL] Sure. It's the letter [PII] [PII] and that's the letter [PII].
[AGENT][NEUTRAL] Thank you. And do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 1840962
[AGENT][NEUTRAL] Thank you, and it was 01840962?
[CUSTOMER][NEUTRAL] No, 184-096-2.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And may I have the member's first and last name?
[CUSTOMER][NEUTRAL] Her name is [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have her date of birth?
[CUSTOMER][NEUTRAL] I do. It's [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yeah, I showed the most recent claim that was processed was the [PII]. Looks like there was no payment. We requested additional information. Looks like we had requested the diagnosis code.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I know it wasn't available. I called on the [PII] and they said it wasn't gonna be needed because she put the diagnosis on her claim form, so I said to the customer service person.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I said, can you please get that information over to claims so when they look at it they'll know you're satisfied with high blood pressure as being the diagnosis because hospitals are really a pain lately. They are clearly told by the members because I give them instructions that they need that UBO4 form that has the diagnostic code.
[CUSTOMER][NEUTRAL] And they provided her with a summary of the bill, but it doesn't have the code on it, so I knew there'd be an issue. I knew there'd be an issue, but when I spoke to someone on [PII], they said, oh no, it's OK. She put the diagnosis on her claim form, it will go through, so you're telling me it can't go through.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] It was, it was denied, but let me put you on a brief hold. I'm gonna look at it a little further. Give me one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey.
[AGENT][NEUTRAL] Oh, OK. Yeah, this claim, I'm not sure why it was denied cause
[AGENT][NEUTRAL] The, they put the diagnosis description on the claim form which was high blood pressure was why they were seen on this claim. I see we requested the diagnosis code.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] If they have the description listed, we can use that information if they have that listed.
[AGENT][NEUTRAL] Yeah, if they if they indicate on the claim what they were seeing for, then we can use that information.
[AGENT][NEUTRAL] Yeah, can you reprocess it? I have the agent on the phone.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, we've always been able to use if they indicate while, while they're being seen and treated. Just like if we get a pregnancy claim and they put pregnancy and we can kinda tell what they're being seen for.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thanks.
[AGENT][NEUTRAL] That's fine.
[AGENT][NEUTRAL] Bye.
[AGENT][NEUTRAL] Thank you for holding, holding. We're, I have reached out to the examiner and they're gonna get that claim reprocessed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Is there anything else I can assist you with today? So yeah, we'll get that claim reprocessed.
[CUSTOMER][NEUTRAL] OK, so, no, no.
[CUSTOMER][POSITIVE] OK, OK, thank you so much. I'll be so happy to hear that. Thank you.
[AGENT][POSITIVE] You're, you're welcome.
[CUSTOMER][NEUTRAL] OK bye bye.
[AGENT][POSITIVE] Thank you for calling APL. You have a good day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Mm bye.