AccountId: 011433970860
ContactId: 3f2d6004-1fd8-4b74-a42b-818034309526
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 524789 ms
Total Talk Time (AGENT): 187997 ms
Total Talk Time (CUSTOMER): 309741 ms
Interruptions: 3
Overall Sentiment: AGENT=1.3, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/3f2d6004-1fd8-4b74-a42b-818034309526_20250520T12:36_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, I'm trying to get some clarity on um the processing of my claim.
[CUSTOMER][NEGATIVE] I, uh, I got a, uh, one of this, the, the letter that I'm looking online it says, uh, this policy doesn't have a benefit for surgical procedures.
[CUSTOMER][NEGATIVE] But that doesn't correspond with the 75 documents I had to upload because of the length of the treatment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That like all of that doesn't correspond with all of the documents that are attached to that section, so I'm confused. There's physical therapy which is covered. There's an emergency room visit an ambulance ride from the accident scene, you know, all of the things that definitely are covered on the policy, and so I'm super confused as to like how it's being processed.
[AGENT][NEUTRAL] OK, so you have submitted a claim for yourself in which it's been denied and you just have some questions on the denials. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, uh, yeah, cause it only shows like, like a, a very, very, very small portion of the medical records that I uploaded on this, uh.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] On this document. This accident happened in [PII] and it was really bad. I was in a wheelchair. I'm still receiving treatment for it. Um, but we're not covered under the policy anymore, so I'm just, I don't know.
[AGENT][POSITIVE] Goodness, I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, I don't know. I was in a wheelchair for 6 months, so imagine all of the MRIs and X-rays and, and, and physical therapy and chiropractic, all the things that go along with that. So I'm just, yeah, if you, if when you open the file you'll see.
[AGENT][POSITIVE] OK. So, yes, ma'am. I'll be happy to take a.
[CUSTOMER][NEUTRAL] All the documents I uploaded.
[AGENT][POSITIVE] OK, yes, I'll be happy to try and answer some questions regarding your claim. So first off, who am I speaking with?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] OK Miss, thank you, and your call back number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And your policy number, please?
[CUSTOMER][NEUTRAL] 19932997.
[AGENT][NEUTRAL] 1993297, is that correct?
[CUSTOMER][NEUTRAL] Yeah, it's a a closed policy now because my job went to a different carrier but the accident happened at the time that I was covered under this policy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes and that.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so first off, Miss [PII], I will have to verify several things with you for security and any information provided will be a verification of benefits and not a guarantee of payment. So if you could first please verify your date of birth.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Wait, [PII], yeah, [PII], sorry, I forgot. It's either, it's either says [PII] or [PII]. They keep changing the city lines at [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you. The phone number that's on file for you is the same as the one you gave me. So that is your best.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Contact number, is that correct? OK. And then lastly, what is your work email address?
[CUSTOMER][NEUTRAL] Contact number. Yup. Mhm.
[AGENT][NEUTRAL] Even though
[CUSTOMER][NEUTRAL] Uh, my [PII].
[AGENT][NEUTRAL] Yeah, because that's
[AGENT][POSITIVE] OK, thank you very much.
[AGENT][NEUTRAL] Alright, Ms. [PII], so is there a specific date of service that you're calling about or a specific claim number? Is it the most recent one that we was processed?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] I think so the claim number that I'm looking at it.
[CUSTOMER][NEUTRAL] Oh, you know what? Did I click on the wrong one?
[CUSTOMER][NEGATIVE] Oh my God, I just wasted your time.
[AGENT][NEGATIVE] You don't waste any of my time, Mrs. You don't waste.
[CUSTOMER][NEUTRAL] Wait a minute, let me see.
[CUSTOMER][NEUTRAL] Let me double check. I think I may have been looking at an old, wait, no, cause it's, oh my God, yup, that says I uploaded it [PII]. That is not my [PII]. 0 my [PII], I'm so sorry. Um yup.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh
[AGENT][POSITIVE] Ms. [PII], you are perfectly fine.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEGATIVE] This is a this is the current claim, it just said that you guys requested a uh a um a what you call it, uh, uh, the claim form, and I did send that I uploaded that, um, but I, I, I saw, you know how the, the USPS mail delivery email saying you have mail coming. It looks like there's a big fat envelope from you guys coming in the mail and I'm like.
[AGENT][NEUTRAL] Ah,
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, what is that? But I know I can usually also see it online, so I went online to look so I could see before the mail got here and yep, OK, well.
[AGENT][NEUTRAL] So yes, I I say yes. So the most recent claim that has been processed that ends in 37.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] 359-693-7. Yes, ma'am. That is the one that we need the claim form.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Completed in return and then I can see.
[CUSTOMER][NEUTRAL] OK, I uploaded that on.
[AGENT][NEUTRAL] On [PII] maybe. I see there's two uploads on [PII] that are in line for review. Those have not been, those uploads have not yet been uh reviewed, but they are in line for review.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And the other question I had was on the claim form, it has like the physician statement part. I didn't do the physician statement part because I uploaded all of my medical bills from my doctors.
[CUSTOMER][NEUTRAL] Like there's so many different doctors that I had to see. I don't know, I don't even know who to send that part to. I would have to go to 12 different.
[CUSTOMER][NEUTRAL] The, you know, the, the diagnosis. I had an orthopedist, I had a chiropractor, I had a physical therapist. I had a, a mobile chiropractor at first because I couldn't even get out of bed. Like I don't, I don't know who to give that part to.
[AGENT][NEUTRAL] OK, so,
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Give me just a moment
[CUSTOMER][NEGATIVE] There's so many files. I'm like, uh, and of course the diagnosis codes, etc. and the the physician information is included in all of it. I'm also going through a lawsuit uh with a lawyer for this accident. It was not my fault.
[CUSTOMER][NEUTRAL] Um, and due to the significant injuries, I, I was like, I need a lawyer, so I have, my lawyer is the one that gathered all of these files, um, in preparation to file my, um, my suit against that company, so like that's a compilation of all of the files from my treatment.
[AGENT][NEUTRAL] OK, so let me.
[CUSTOMER][NEUTRAL] It took me forever to reduce the PDF size so I could upload it cause it wouldn't accept the documents. That's why it all separate. That's why there's so many individual ones because the, the file sizes were massive. Yeah.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Upwards right.
[AGENT][NEUTRAL] OK, so do you mind letting me place you on a brief hold for just a moment to check on something for you?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and the, the claim form, did have you received that in the mail yet? You should have, I would think.
[AGENT][NEUTRAL] Or no, you did because you said that you have.
[CUSTOMER][NEUTRAL] Yeah, yeah, I, I, I received it in the mail and then I.
[CUSTOMER][NEUTRAL] Yeah, I uploaded, uh, the, I, I, I found the digital claim form I I downloaded the claim form as if I was gonna mail it in and I filled it out PDF online and then uploaded it from my computer.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So, yes, ma'am. Now, once.
[CUSTOMER][NEUTRAL] It it looked like it didn't upload so I, I accidentally put it twice.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, yes, the, the documents, now, the documents, once they have been reviewed, if there is any additional information that's needed, Ms. [PII], um,
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Then obviously you would be notified of that as well. You'll be able to see that in your portal, yes, ma'am, and let you know what else we need.
[CUSTOMER][NEUTRAL] They'll reach out, OK.
[CUSTOMER][POSITIVE] OK, awesome sauce, thank you.
[AGENT][POSITIVE] Well, you are certainly very welcome. Is there anything else though at the moment I can help you with?
[CUSTOMER][NEUTRAL] Nope, that's it.
[AGENT][POSITIVE] OK, Ms. [PII]. Well, it was my pleasure in speaking to you this morning and I hope that you have a very nice day today.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Yes, ma'am. Thank you so much. All right. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.