AccountId: 011433970860
ContactId: 313ddd7f-0ab8-4f1d-84ff-f7f6eb987ee8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 610969 ms
Total Talk Time (AGENT): 163749 ms
Total Talk Time (CUSTOMER): 154275 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/313ddd7f-0ab8-4f1d-84ff-f7f6eb987ee8_20250604T15:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Well, hi, um, I'm unable to get my account online for some reason. It says that I don't exist, um, but I do have a group number, a payer ID number, and all that sort of good things. I'm trying to find out the status of the claim.
[AGENT][NEUTRAL] Um, yes, sir. I can further assist you with the system. Um, first, could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] [PII] My call back is [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, could I get your policy number, please?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Um, I've got a group number. I've got an in-hospital cert number, and I've got an outpatient benefits.
[AGENT][NEUTRAL] OK. The outpatient benefit number is your policy number.
[CUSTOMER][NEUTRAL] Or AI.
[CUSTOMER][NEUTRAL] OK, 02493494 ML 8.
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, please verify your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And please verify your email address.
[CUSTOMER][NEUTRAL] Um, I'm not sure which I've used with this. It's [PII].
[AGENT][NEUTRAL] OK. Yes, sir. That's the one we have on file.
[CUSTOMER][NEUTRAL] Maybe.
[CUSTOMER][NEGATIVE] Yeah, that's the one I was trying to log in with, but it doesn't let me.
[AGENT][NEUTRAL] OK. Yes, sir. Um, we've upgraded our system and I apologize that you didn't receive documentation um relating to that, but we've upgraded our system, so you would need to go in and recreate your account. Um, when you go there.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] I tried and it won't let me. It says that I get an error. It just says that I don't exist.
[AGENT][NEUTRAL] OK. Where it asks you to put in your policy number or your social, um, try not to put the policy number in there, try putting your social in there and see what happens.
[CUSTOMER][NEUTRAL] Yeah, I tried that. I tried myself. I didn't put the policy number because underneath it it says not policy number it says ID number.
[CUSTOMER][NEUTRAL] It's asking for
[AGENT][NEUTRAL] OK. Well, could you go back to the screen again, um, uh, click on where it says create your account.
[CUSTOMER][NEGATIVE] Unfortunately not I'm at work now.
[CUSTOMER][NEUTRAL] No, I can't do that now, but, uh, perhaps you can help me with the claim. I've got a claim number.
[AGENT][NEUTRAL] Um, yes, sir. What's that claim number? Is it for you or one of your dependents?
[CUSTOMER][NEUTRAL] It's for me.
[AGENT][NEUTRAL] OK. And what's the claim number, please?
[CUSTOMER][NEUTRAL] And it's
[CUSTOMER][NEUTRAL] 3608155
[CUSTOMER][NEUTRAL] I don't even know what it's for.
[AGENT][NEUTRAL] 3608155.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I got a text that my claim is now complete.
[AGENT][NEUTRAL] Um, yes, sir. I'm showing that this was a claim for services provided in the um clinic and it actually denied because there are no outpatient benefits under your policy.
[AGENT][NEUTRAL] It was for a date of service, um, [PII].
[CUSTOMER][NEUTRAL] How can I not have outpatient benefits?
[CUSTOMER][NEUTRAL] It says I have an outpatient benefit certificate number. I'm supposed to have them.
[AGENT][NEUTRAL] Let's see, one moment.
[CUSTOMER][NEUTRAL] I've used it before.
[CUSTOMER][NEUTRAL] And it's for lab work.
[CUSTOMER][NEUTRAL] I believe.
[CUSTOMER][NEUTRAL] I was ordered by my physician.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment, I'm waiting on my system.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I should have in hospital and outpatients.
[CUSTOMER][NEUTRAL] In fact, I think you just looked me up on my outpatient benefits or just a certain number.
[AGENT][NEUTRAL] Yes, sir, I did and this was actually processed, let's see.
[CUSTOMER][NEUTRAL] This has been processed several times, I think.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] There's several of them, I think a total of 5 labs that been denied.
[CUSTOMER][NEUTRAL] And it was done at my doctor's office.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm waiting on my system. One moment.
[AGENT][NEUTRAL] OK. Yes, sir. Thanks for your patience and actually for this policy, I need to get you over to a different department so they can further assist you with the status of this claim. Um, is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I guess not. um, did you find me in an outpatient?
[AGENT][NEUTRAL] Um, well, I found you in our system and they'll further explain your benefits for this particular um policy to you in regards to your inpatient and outpatient.
[CUSTOMER][NEUTRAL] Maybe I should get my human resources department on the phone.
[CUSTOMER][NEUTRAL] Oh, I know the difference between the two, but I'm supposed to have both.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir. Let me get you over to someone who, OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] It's gonna be a nightmare.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[AGENT][NEUTRAL] Um, hi, [PII]. This is [PII] in the Medling claims department. Um, I have a member on the line. He, he has a hospital indemnity policy, and he's calling about the status of his claim. Um, it's showing that it denied because there are no outpatient benefits, and he says that he has outpatient benefits. But the claim denied and there's another claim on file that also denied for him not having outpatient benefits. So could you further assist him?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] What's the policy number?
[AGENT][NEUTRAL] It is 230-1578 for [PII].
[CUSTOMER][NEUTRAL] And did he give you a callback number?
[AGENT][NEUTRAL] Um, it's the one in the system, the [PII], and he verified all his information.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK, here he is. Thank you.
[CUSTOMER][NEUTRAL] Mhm.