AccountId: 011433970860
ContactId: 37df6e0d-8730-40be-906b-8e512f154e39
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 413540 ms
Total Talk Time (AGENT): 160011 ms
Total Talk Time (CUSTOMER): 149871 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/37df6e0d-8730-40be-906b-8e512f154e39_20250415T13:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi. My name is [PII], and I placed the claim, and I'm just having some difficulty. It seems like all my claims are getting denied and I apparently I am doing something wrong on my end. Um, I've never used a secondary, um, medical insurance before, so maybe this is all new to me, but hopefully you can help me going forward.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, [PII], yes, ma'am. Let me just verify some information with you first, do you have your policy number?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, what is that?
[CUSTOMER][NEUTRAL] 01
[CUSTOMER][NEUTRAL] You ready?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] 01975687 M as in Mary L as in Larry 8.
[AGENT][NEUTRAL] What's your last name, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Can you verify your date of birth for me, please, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And last name your email please.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Can I get your email address please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, Ms. [PII], and let me get your callback number just in case we get disconnected please.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you so much for verifying your information, Miss [PII], and I understand you're having some trouble with some claims, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, what, tell me exactly what's going on. If I can't help you, I can certainly find someone that can. What's going on with your claim?
[CUSTOMER][NEGATIVE] OK, um, hang on, let me get off speaker. This doesn't have a good connection here.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Uh, I broke my arm, so it's kinda hard to.
[CUSTOMER][NEUTRAL] Yeah, hang on a second.
[AGENT][POSITIVE] Sure, take your time.
[CUSTOMER][NEUTRAL] OK, so I put a claim number, the confirmation number is OSC 96472.
[CUSTOMER][NEGATIVE] And I paid out of pocket $500. I had to have surgery. And so the doctor um took $500 out of my pocket before surgery, and that's the claim that I put in, and now it's being denied, and I don't know why.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and that claim number is OSC 96472. Is that correct, Miss [PII]?
[CUSTOMER][NEUTRAL] Um, the confirm that's the confirmation number that I got OS.
[AGENT][NEUTRAL] The confirmation number OK got you OK.
[CUSTOMER][NEUTRAL] Yeah, OSC 96472.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, what I'll need to do is transfer.
[CUSTOMER][NEUTRAL] I have a claim number 3 the claim number is 358-86775.
[AGENT][NEUTRAL] 358-867-5. OK, thank you, Ms. [PII]. I'm gonna have someone assist you. Can you please hold for just a moment for me?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII], did you hear me?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII], can you hear me?
[CUSTOMER][NEUTRAL] Yes, I can. Can you hear me?
[AGENT][POSITIVE] OK. Yes, ma'am, I can. We have a bad connection. I apologize. Yes, ma'am, hold just a moment. I'm gonna get the representative all your information and have someone assist you with this, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Thank you for calling APO. This is [PII]. How may I help you?
[AGENT][NEUTRAL] You said [PII], is that right?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Hey [PII], this is [PII] in [PII], and how are you doing today?
[CUSTOMER][POSITIVE] I'm good. How are you doing?
[AGENT][POSITIVE] I'm doing well, thank you. Look, I have an insured on the line, um, the policy number is 19756887.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And I, I got a [PII].
[CUSTOMER][NEUTRAL] Sorry, what was her name?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and I verified her information, um, and her callback number ready for it is [PII].
[AGENT][NEUTRAL] 239
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] She's calling about a claim that was denied. She's stating she had surgery and she paid out of pocket $500. She gave me the claim number.
[AGENT][NEUTRAL] Do you want that?
[CUSTOMER][NEUTRAL] OK, yes, please.
[AGENT][NEUTRAL] Yes, ma'am. It's 358.
[AGENT][NEUTRAL] I believe that's 8675. It's it's not 8675, it's 0. I'm sorry, I can't read my writing.
[CUSTOMER][NEUTRAL] OK, 358-067-5?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, would you be able to help with that?
[CUSTOMER][NEUTRAL] OK, and she wants to know why it was denied?
[AGENT][NEUTRAL] Yes, and she says she's just been having trouble getting that paid. She just, she's, she's confused because she pays out of pocket $500 before the surgery and she's wanting to know.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, well, that was the no.
[CUSTOMER][POSITIVE] OK, you can send her my way.
[AGENT][NEUTRAL] OK, this is my first time transferring. Do I do leave calls?
[CUSTOMER][NEUTRAL] No, it's OK. I'm still kind of new too, so it's fine.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] I didn't noticed, what about you? Oh my gosh, is it swap?
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I always do I always click join and then I like leave I in the in the call once um the.
[AGENT][POSITIVE] And I know that I have you on the line. OK, let me do that. I'm sorry. Hang on one second, OK? [PII]. You have a good day.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Ms. [PII],
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am, I have [PII] on the line. She's gonna be able to assist you, OK?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Have a great day.
[CUSTOMER][NEUTRAL] You too