AccountId: 011433970860
ContactId: 3cb8e11f-9006-4146-a32e-84c605b4d87e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 932419 ms
Total Talk Time (AGENT): 195988 ms
Total Talk Time (CUSTOMER): 210167 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=-1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/3cb8e11f-9006-4146-a32e-84c605b4d87e_20250220T14:21_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Good morning. I'm calling because I had um entered some claims into the system.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I answered.
[CUSTOMER][NEUTRAL] One or, yeah, I think 2 of them were under hospital indemnity. And I'm looking at my pending claims and I don't see those hospital indemnity claims anymore.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I
[CUSTOMER][NEUTRAL] I only see
[AGENT][NEUTRAL] Mhm, go ahead.
[CUSTOMER][NEGATIVE] I only see um critical illness and cancer.
[AGENT][NEUTRAL] OK, I can check if they're working on it, you probably will not see them, so I can check and see if they're working on it. Um, may I have the policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, for hospital indemnity, hold on, that 218447-3.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] May I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] OK, thank you, Miss [PII]. Let's see.
[AGENT][NEUTRAL] OK, and I need um your um date of birth, mailing address and email address for verification.
[CUSTOMER][NEUTRAL] [PII] [PII] [PII].
[AGENT][POSITIVE] Thank you, Miss [PII].
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] What, what type of claims were those?
[CUSTOMER][NEUTRAL] I, I, I, I uploaded it under, um,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Critical illness, probably um cancer and hospital indemnity.
[AGENT][NEUTRAL] OK, um, but what
[CUSTOMER][NEUTRAL] So I see the hospital.
[AGENT][NEUTRAL] Uh-huh, go ahead.
[CUSTOMER][NEUTRAL] So I uploaded the information and then I selected um when it asked which claim.
[CUSTOMER][NEUTRAL] Hold on one second, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, ma'am. I'm sorry about that. So, when I initially did it, I filed it as a wellness claim because that was for my mammogram and um
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Then I uploaded the information as regular claims.
[CUSTOMER][NEUTRAL] And I just don't see the hospital indemnity um listed in my pending claims.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So was it um was it for your wellness exams or was it um in a hospital stay, um, you had surgery, OK. And did you stay in the hospital for the um for more than one day?
[CUSTOMER][NEUTRAL] Like I had surgery.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] It was one day.
[AGENT][NEUTRAL] Was it more than 24 hours or was it less? Like was it in and out or?
[CUSTOMER][NEUTRAL] It was less than 24 hours.
[AGENT][NEUTRAL] Less, OK, so it's not gonna be, OK, um.
[AGENT][NEUTRAL] I'm asking this because I'm trying to determine what happened. Mhm.
[CUSTOMER][NEUTRAL] But the procedures themselves, oh, OK.
[AGENT][NEUTRAL] OK. Um,
[AGENT][NEUTRAL] Let me check them.
[CUSTOMER][NEUTRAL] Cause I know for my breast exams, I should get paid on the cancer and I think it's either critical illness or hospital indemnity.
[AGENT][NEUTRAL] Um, I believe it's critical illness. Mhm.
[CUSTOMER][NEUTRAL] And then I also have
[CUSTOMER][NEUTRAL] And then for the 2 surgeries I had was um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You have surgeries and stuff.
[CUSTOMER][NEUTRAL] You know, they were outpatient, but yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. Uh.
[AGENT][NEUTRAL] OK, let me, I'm gonna put you on a brief hold. I'm gonna check with the claims department and see what happened to those claims, OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Good morning. Thanks for calling ATL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, [PII], how are you? This is [PII].
[CUSTOMER][NEUTRAL] Fine. How are you?
[AGENT][NEUTRAL] I'm good, thank you. Um, I have a member on the line that she submitted some claims to her hospital indemnity and um somebody DMO to them. I didn't say that to her, but I, I said I was gonna check and see what happened. But oh yeah, they're OK, that's 218-447-3.
[CUSTOMER][NEUTRAL] OK. What's the policy number?
[CUSTOMER][NEUTRAL] OK, on the Javananda Le Lear Morris, OK.
[AGENT][NEUTRAL] Mhm, yeah, Miss [PII]. Mhm.
[CUSTOMER][NEUTRAL] Hmm, let's see here.
[AGENT][NEUTRAL] Yeah, I know. I said, oh, what happened?
[AGENT][NEGATIVE] I opened one and the one that I opened says that it's cancer.
[CUSTOMER][NEUTRAL] Uh, it looks like [PII] [PII] did this. It says see claim 356-4672. Let's see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, look like she put on her what claims to refer to, let me see is this under this policy or different policy? Let me see.
[AGENT][NEUTRAL] Yeah, she said she sent some to the cancer and she sent some to the um critical illness, but she did send some to the HI because there were some surgeries and um she has that surgery benefit, so that's why she sent it here.
[CUSTOMER][NEUTRAL] Yeah, looks like [PII] sent them all to the cancer policy. Let me look at these documents here.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Let's see here.
[CUSTOMER][NEUTRAL] And pull some up and see if I can look at them.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, I have to get with [PII] about it to let her know that she did intend to have these processed under her hospital indemnity.
[AGENT][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Yeah, and have her review them and let her know that the insured did intend to have these processed cause [PII] processed these and DM them and send them all under the cancer policy. So I will get with [PII] and let her know.
[AGENT][NEUTRAL] OK, um, do I transfer the call or I just go ahead and route that information?
[CUSTOMER][NEUTRAL] Yeah, just let her know that we'll, we'll we'll review it and um have them reprocess under the hospital indemnity.
[AGENT][NEUTRAL] OK, I'll go ahead and let her know that um we're just, we're working on it. That's, that's all I'm gonna say. OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, just let her know, yeah.
[AGENT][NEUTRAL] I
[AGENT][POSITIVE] OK, thank you. Have a good day, Ms. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you, bye-bye.
[AGENT][POSITIVE] Thank you for holding and being patient for me Miss [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK. Um, so, um, it looks like they're working on it right now and that's the reason you're not able to see them. Um, once they are worked on, you will see a claim number beside it.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there
[CUSTOMER][NEUTRAL] Wait, let me see cause yeah, I didn't see them listed at all.
[AGENT][NEUTRAL] Mm mm. No, I see that they are somebody got them. That's why you're not able to see them. I that's why I was trying to see and determine who got them and what they're doing and um they were letting me know that they're working on it, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] You're welcome. Is there anything else I may help you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] No, that was it.
[AGENT][POSITIVE] All right. Well, thank you for calling APL. You have a good day, Ms. [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Bye bye.
[CUSTOMER][NEGATIVE] You are on hold.