AccountId: 011433970860
ContactId: 3ab686dc-5ac0-406e-babe-9f9eb37548e4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 475459 ms
Total Talk Time (AGENT): 193355 ms
Total Talk Time (CUSTOMER): 108790 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/3ab686dc-5ac0-406e-babe-9f9eb37548e4_20250311T16:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], um, I have an insured or a spouse calling about her claim for accident policy and she just want to know why the walker or the appliance was not paid.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, policy number is 2286658.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, give me just a second, let me get over there and get the documents pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is this for the primary insured?
[CUSTOMER][NEUTRAL] Oh no, it's for Ms. [PII], part two. I'm sorry.
[AGENT][NEUTRAL] I think you said spouse, but I wasn't sure like which which claim I guess. Is it the one ending in 9683?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, alright, let me get that pulled up.
[AGENT][NEUTRAL] Um, what is that now?
[AGENT][NEUTRAL] Says that we previously paid a benefit.
[CUSTOMER][NEUTRAL] Yeah, and I looked at um a claim, but I didn't see, oh, it's I would say I didn't see anything as far as um I saw in [PII], but I didn't see anything in this year, so I don't know, I could have been, I could missed it.
[AGENT][NEUTRAL] Do
[AGENT][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] Yeah, the last one I showed was uh [PII].
[AGENT][NEUTRAL] OK. Um.
[AGENT][NEUTRAL] Yeah, I see that is it.
[AGENT][NEUTRAL] The same accident?
[CUSTOMER][NEUTRAL] Um, I don't know.
[AGENT][NEUTRAL] I'm gonna pull that up as well.
[CUSTOMER][NEUTRAL] See.
[AGENT][NEUTRAL] 3 97 62.
[AGENT][NEUTRAL] Mm, it doesn't look like it is. Looks like we have different diagnosis codes.
[AGENT][NEGATIVE] Oh hang on I'm looking at the wrong one, good grief.
[AGENT][NEUTRAL] That would be why I was like I'm so confused different person let's see.
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] OK, still different diagnosis codes, so let me.
[AGENT][NEGATIVE] Figure out what the heck's going on here.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so the
[CUSTOMER][NEUTRAL] The one was for the right hip, the other one looks like for a foot.
[AGENT][NEUTRAL] Right. Uh.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Unilateral primary osteoarthritis right here, so that's the one you're looking at, OK.
[AGENT][NEUTRAL] And then this one that she's saying we didn't pay.
[CUSTOMER][NEUTRAL] That's like for a foot.
[AGENT][NEUTRAL] Fracture of the upper and lower left fibula.
[AGENT][NEUTRAL] Hm.
[AGENT][POSITIVE] Hm, that's a good question.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] And she
[AGENT][NEGATIVE] Wasn't willing to like let us look into this and figure out what was going on.
[CUSTOMER][NEUTRAL] I mean, I can um just do you want me to send a hub request to have someone look at it and give her a call back?
[AGENT][NEUTRAL] Yeah, because what we're gonna have to do is we're gonna have to review both of these claims and um the documents received and then from there either reach out to the examiner or something and figure out.
[AGENT][NEUTRAL] Like
[AGENT][NEUTRAL] Do we need to go back and pay it? Was this an error or they related like we're gonna have to review both claims to figure out why this examiner didn't move forward with it and then go from there, um, because I truly I mean like you said it looks like they're different and so I truly don't know.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Um, and I, I don't want.
[AGENT][NEUTRAL] I mean just to be honest, I'm gonna get her on the phone and I'm gonna have to say, you know, essentially.
[AGENT][NEUTRAL] It's gonna have to be looked into so if she's willing to get a call back that's what we'll do is we'll review it and I can keep reviewing it now you can still submit it um the hub request and I'll I can continue reviewing it now and just let you know anybody else know that I'm reviewing it but it's gonna just take me a minute to look at everything and and really figure out what was going on.
[CUSTOMER][NEUTRAL] OK, well, I'll ask to see if she would rather call back, um, and that someone is looking into it.
[AGENT][NEUTRAL] OK, do you want me to stay on hold that way you already have me available if she wants to talk.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Oh, what does she do? Hold on, someone sent me.
[CUSTOMER][NEUTRAL] Oh, she got one.
[CUSTOMER][NEUTRAL] How much are the calendar max thing? Oh, I'm sorry. I was training somebody today and she sent over her assessment, uh, thing, but yeah, hold on, hold on one second. OK, I got, I got sidetracked, OK.
[AGENT][NEUTRAL] It's OK, OK.
[AGENT][NEUTRAL] You're fine.
[CUSTOMER][NEUTRAL] Hey.
[AGENT][NEUTRAL] Hey.
[CUSTOMER][POSITIVE] She was real sweet. She said, yeah, I'd rather call back and just be placed on hold, and she said any time. So, um, do you want me to give you a callback number or just go ahead and send that hub request?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, go ahead and give me a call back and I'll just go ahead and look into it so you don't have to submit the hub since I'm aware of it.
[CUSTOMER][NEUTRAL] OK, it's uh 814.
[CUSTOMER][NEUTRAL] 279-571-6.
[AGENT][POSITIVE] OK, I will take a look at that and try to give her a call back just as soon as I can get it all figured out.
[CUSTOMER][POSITIVE] You rock. Thank you so much.
[AGENT][POSITIVE] Yeah, you're very welcome.
[CUSTOMER][NEUTRAL] I have and she said any time is fine. She said she doesn't go anywhere, so.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, if she's got a broken foot, I would imagine not.
[CUSTOMER][NEUTRAL] Yeah, right.
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][POSITIVE] Alright, appreciate it. Bye.
[AGENT][POSITIVE] All right. No problem. Bye.