AccountId: 011433970860
ContactId: 3b14890c-f90e-4339-b15a-e3c5dd13e5bd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 368359 ms
Total Talk Time (AGENT): 116825 ms
Total Talk Time (CUSTOMER): 129675 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/3b14890c-f90e-4339-b15a-e3c5dd13e5bd_20250227T17:36_UTC.wav
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[CUSTOMER][NEGATIVE] Don't get that.
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, I was calling, uh, want to follow up on the status of a, of a accident claim that I had turned in extra paperwork to you guys, but apparently something is off as far as the status of approval. Could you check on that for me, please?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I can give you claim status and may I have your name?
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[AGENT][NEUTRAL] And Mr. [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's, uh, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Do you have the policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yeah, uh, I think it's 244-4566.
[AGENT][NEUTRAL] OK. And for security, may I have your date of birth, mailing address and email address?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] And uh email address is uh [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right. Um,
[AGENT][NEUTRAL] Let me pull the documents on this um explanation of benefits, one moment.
[AGENT][NEUTRAL] OK, so, um,
[AGENT][NEUTRAL] It looks like the claim was denied. Um, the reason for the denial based on the paperwork is saying that the policy provides benefits due to an accident which is a bodily injury.
[AGENT][NEUTRAL] Um, which means physical damage to an insured person or covered person.
[CUSTOMER][NEUTRAL] That's, that's what I don't understand because if you look.
[CUSTOMER][NEUTRAL] At what I, at the poly policy I sent earlier was proof of the bodily injury, and I said,
[CUSTOMER][NEUTRAL] Proof of the MRI. So on that one you guys asked me proof of, proof of a receipts. So then I sent the receipt which you're reading now, now they're saying the opposite. So if you look at the one before that, did you do that one?
[AGENT][NEUTRAL] OK, we don't do claims in this department, OK, so, um, we have two options. Either I can go ahead and send the request for the claim department to give you a call back.
[AGENT][NEUTRAL] Or I can get somebody on the line if I can find somebody on the line right now.
[CUSTOMER][NEUTRAL] You can see if you can find somebody.
[AGENT][NEUTRAL] OK, alright, and let me see if I can get claims department on the line for us, OK, one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Hi [PII]. How are you? This is [PII].
[CUSTOMER][NEUTRAL] Hi [PII] how are you?
[AGENT][POSITIVE] I'm good, thank you. I have a member on the line um he's calling about a claim and he don't want to call back.
[AGENT][NEUTRAL] Um, so, um, the policy number is 2444567.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And he's stating that he did send out the information indicating it was a bodily injury and he don't understand why it's still being denied.
[CUSTOMER][NEUTRAL] It's for [PII].
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] OK, and I'm gonna pull that.
[CUSTOMER][NEUTRAL] Information up and he has been verified so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, it's fully verified. The callback number is the same one in the system.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, is that the one that appears on the screen, the [PII]? OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm [PII]. Yeah, that's it. OK, let me know when you're ready.
[CUSTOMER][POSITIVE] Um, you can send them through. Thank you.
[AGENT][POSITIVE] OK, thank you. Have a good day.
[CUSTOMER][POSITIVE] Too thank you.
[AGENT][POSITIVE] Thank you're welcome. Thank you for holding and being patient for Mr. [PII]. I've got Ms [PII] on the line. She's in the claims department. She's gonna assist you from here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you have a good day bye bye.
[CUSTOMER][NEUTRAL] Hi, good afternoon, Mr. [PII]. This is [PII] in the claims department. Um, I understand you had some questions in regards to a denial for your claim on the accident, uh, policy, is that correct? OK, so let me just pull up, I'm gonna pull up that documentation if you'll bear with me for just a moment while I do that. My system's being a little slow, so it'll just take a moment.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Let's try a different way.