AccountId: 011433970860
ContactId: 37887c1f-0d97-4c3e-821c-25c20ec97967
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 517097 ms
Total Talk Time (AGENT): 212514 ms
Total Talk Time (CUSTOMER): 266445 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/37887c1f-0d97-4c3e-821c-25c20ec97967_20250303T19:28_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, hi, [PII]. This is [PII] in the um Medling claims department. Um, I have a caller on the line. She's calling in regards to her disability policy. The policy is canceled, but the incident she's referring to happened when she had coverage. Would you be able to further assist her?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. Her policy number is 02206496 for [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on 1 2nd.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] I did something wrong. 220. That's what it was.
[AGENT][NEUTRAL] OK, and I have it here and then, um, OK, so what did you say for the coverage? I'm sorry, I'm getting teams all at the same time.
[CUSTOMER][NEUTRAL] Yes, she's saying, she's referring to an incident that happened. I think she said it was in [PII]. She's been on hold for a while. Um, when she had coverage and she, she was also saying that um her policy started out as a disability policy, but then it was converted to an accident policy. And I only showed this disability policy on file, but she's saying that she filed a claim um for [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The accident for [PII]. OK, you can send it through.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK. Here she is. Thanks a lot.
[AGENT][POSITIVE] Thank you. You're welcome.
[CUSTOMER][NEUTRAL] Mhm. Bye.
[AGENT][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Hey, thank you so much for holding. This is [PII] on the customer care team and so I was speaking with the other, the previous representative, so there was an accident claim previously, is that I want to make sure I'm understanding so I know what to do.
[CUSTOMER][NEUTRAL] OK. No, so.
[CUSTOMER][NEUTRAL] I submitted a claim for accident injury that I've been off work. I got hurt, [PII]. So at whatever, at some point in time, I guess my policy changed like it was on and off the job, whatever, prior to, um, come on dog, get out of here. Um, now it's I guess off the job, not on the job. However, um, the lady was saying that at the first person I was speaking to was saying.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That they were gonna try to see because I think the injury happened prior to when the policy changed. They were gonna try to see if they would um what is it called, um, they would honor it. However, I guess they didn't. So the letter I just got said that.
[CUSTOMER][NEUTRAL] Um, because it was an injury on the job, I needed to go to workers' comp. however, if I got a denial letter to send that in, so I received the denial letter from workers' comp on that injury. I did send it to the, what is that? the whatever customer service um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The email
[CUSTOMER][NEUTRAL] Yeah, the customer.
[AGENT][NEUTRAL] Was it like care team at something something.
[CUSTOMER][NEUTRAL] 00 service. No, I sent it to [PII]. That's what I was sending all my other stuff too, so I asked the lady like I would want to know like where do I need to send this because the letter.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Didn't state where to send it to and I mean it may have said fax, but I don't have a fax machine. It just states um.
[CUSTOMER][NEUTRAL] Yeah, just say to send submit a copy the denial letter um and that we they may reconsider benefits.
[AGENT][NEUTRAL] And I see that here. Hold on one second, let me see what this data service is. This is all for.
[AGENT][NEUTRAL] Hold on one second. I see just what you're talking about. I'm just trying to see this old claim here. I'm trying to get the date so that I can look at the new claim, um, because there was a claim that was just, just finished processing, looks like yesterday or today. Well,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, so that's what I'm saying. I don't know what, so I've been getting like letters, so I did, like I haven't submitted anything recently, however, I, whatever I did was submitted, maybe they're just catching up with the paperwork I sent, I'm not sure. However, it was a little while ago, you know, it's been about a month or two.
[CUSTOMER][NEUTRAL] Since I submitted the new stuff cause they said they needed the doctor's notes from like when I first went to urgent care saw Kaiser, like all these other in-between doctors up to fill in the gap. So that was the last stuff I sent them, and then I got this letter today, which is the one dated.
[CUSTOMER][NEUTRAL] Um, 226 I guess.
[AGENT][NEUTRAL] I this 2:26, let me see what's on this one.
[AGENT][NEUTRAL] OK, here we go. So there's two claims. So, and they are the ones that, um, so they've been paid out on. Let me go back. Hold on one second. I just had to get all these dates.
[CUSTOMER][NEUTRAL] They've been paid out on? What do you mean they've been paid out on?
[AGENT][NEUTRAL] Oh, OK, hold on one second. So we just finished processing two claims for you, so you have two checks coming. So I, so what I was doing was going through the date so I can see which one is which. So one check is for $5100. This includes um August, [PII] and [PII].
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There's another check. Um, how much is this one?
[AGENT][NEUTRAL] $9650. This is for March, April, May, June and July. Um, so like I said, this it literally has like a [PII] date on it, so they just finished processing this, so you should be um
[CUSTOMER][NEUTRAL] Oh, OK. And
[CUSTOMER][NEUTRAL] That that whatever something through July, that's [PII], correct?
[AGENT][NEUTRAL] Well, this is back pain, so this is [PII] for right now.
[CUSTOMER][NEUTRAL] Oh OK, OK, no problem, OK.
[AGENT][NEUTRAL] Yeah, let me see, July, and then the other one starts in August. So yeah, they're doing [PII] right now.
[CUSTOMER][POSITIVE] OK, no problem. OK, thank you, mhm.
[AGENT][NEUTRAL] But let me see, um, you're welcome. Hold on one second, and I do see that you have direct deposit. So at [PII] tonight, because like I said, it just finished. At [PII] tonight is when we send everything over to the banks. So, um, you're going to be getting 2.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you signed up for the online service, or you just get the letters in the mail?
[CUSTOMER][NEUTRAL] I just get the letters in the mail if I'm not mistaken. I don't know what's the online service center.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the online service center is like a secure portals where you can go to like file your claims, check on your claims. Um, I was gonna say that you would get a notification there because our systems are linked. So it will be a notification letting you know that this is finished processing, but you'll also get it in the mail and then it's direct deposit as well. So, you know, depending on your bank, we usually say 3 to 5 days to get it depending on how your bank releases.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then I also submitted that because it said, you know what I'm saying, submit the denial letter. I also submitted that as well, so if that helps, whatever.
[AGENT][NEGATIVE] The denial.
[CUSTOMER][NEUTRAL] Yeah, because the, the whatever the the letter that I got, I don't know if I give you a reference number if that'll make a difference, but I have a letter with a reference number. I don't know if that's anything. OK, so this one has a claim number too this one claim number is 349-864-9.
[AGENT][NEUTRAL] Mhm. That's all the ones that were. So basically when you sent that paperwork in it voided out these denials and then we reprocess it and that's why you're getting the payment.
[CUSTOMER][NEUTRAL] 00, so maybe the letter is just I'm getting it late cause I'm like I just got this letter so I'm like, OK, well just just so happened I did get, you know, uh, OK, alright, cool.
[AGENT][NEUTRAL] Oh, yes, then you got, you, you're getting them late. Oh, that's what's going on. OK, yes.
[CUSTOMER][NEUTRAL] Yeah, cause
[CUSTOMER][NEUTRAL] Yeah, because it says like it say check date [PII] but it just came in the mail today, so yeah, OK, well, either way it go, I sent in that as well, so.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that'll be it.
[AGENT][POSITIVE] Alright, well, thank you so much for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] All the food.