AccountId: 011433970860
ContactId: 4b1b8f46-d3c5-4d6a-98f4-237fe554c3f4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 619500 ms
Total Talk Time (AGENT): 209607 ms
Total Talk Time (CUSTOMER): 215275 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/4b1b8f46-d3c5-4d6a-98f4-237fe554c3f4_20250515T16:53_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII]. I was actually calling on um about my son, um, insurance claim.
[AGENT][POSITIVE] OK, I'm happy to check on a claim for you. Do you have the policy number, claim number?
[CUSTOMER][NEUTRAL] Um, I have the policy number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's 01 01392608.
[AGENT][NEUTRAL] Thank you for that, [PII]. And then I'll need to verify on the account, uh, name, date of birth, and then address, please.
[CUSTOMER][NEUTRAL] [PII] [PII] [PII].
[AGENT][POSITIVE] Thank you so much. Who is the claim for?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I had talked to the lady. She said I had to fill out the papers, and I did that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I do see the last claim submitted under [PII] was on the [PII]. Is that the one that we're speaking of? It looks like it was done earlier this week.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so that one at this time, [PII] is still under review. Uh, no decision has been made, so it looks like it just needs a little bit more time to process. Claims generally take between 5 to 7 business days.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, but what I wanted to know is everything they needed ended that that's what I was calling basically to make sure that I did turn in all the paperwork that was needed.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm just pulling up the submission here, so give me just one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the previous claim before that was denied because of the claim form, so I see that here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, let's just make sure.
[AGENT][NEUTRAL] I filled out here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then [PII], on the attending physician statement, did you send a copy of that to whoever is treating [PII]?
[CUSTOMER][NEUTRAL] Well, he went to the ER. There's no one's treating him. He kinda sprained, uh, his shoulder or something. There, there wasn't any other further treatment after that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Let me go back and just double check on the front of the form what it says here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You put your thing in the book.
[AGENT][NEUTRAL] 8
[CUSTOMER][POSITIVE] It is, it's strong.
[CUSTOMER][NEUTRAL] You know why? Because the sun beats on it, I guess because it's just sitting there, um, but I put it on this side. Oh, I don't smell it. Maybe that's what you should have did I put it on this.
[CUSTOMER][NEUTRAL] OK get me, you smell it. Yeah, I'm gonna put it that way.
[CUSTOMER][NEGATIVE] Oh yeah, smell it now. Yeah. Mhm. But it was frightening.
[CUSTOMER][NEUTRAL] They, they sell fish at this, uh, fish market right here, um it's somewhere right here I think oh right here all seafood out.
[CUSTOMER][NEUTRAL] I wanna go there 2 sacks for 100 bucks, huh? That's, that's cheap or hell yeah. That's 2 sacks for 100 bucks. 2 sacks for $100. 2 big sacks, [PII] so it's $50 a piece, yeah.
[CUSTOMER][NEUTRAL] The only thing I don't have is the bowling pot.
[CUSTOMER][NEGATIVE] For what? I got the boiling pot to boil the. I got it that you can use the the bucket. I ain't got, I ain't paying too. I ain't paying. I ain't got $100 right now. I have to wake up in the morning. I'm gonna just tell [PII] we could come here tomorrow. I'll boil it on the stove, me, yeah, or in the pot. It's better to boil it in the pot. I know, I mean in the bucket, in the bowl that bucket you got, yes, gosh, I forgot about all my cousin them use that, but stop. I told you I had brain fog.
[CUSTOMER][POSITIVE] That's so you don't have to have a man, yeah, and you can do it yourself, yeah.
[CUSTOMER][NEUTRAL] The fish must be good. I'm about to show act if she looking in. Oh, look, you know don't, yeah, she was checking you. I was trying to, I was trying to see what why you were looking at her man, uh, the blood of Jesus.
[CUSTOMER][NEGATIVE] Tell me what she said. I'm about to get out and see what page they got personally no.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Good, it it's time you get in here again girl all my stuff falling on my God. Oh shit. Then you got all short. Wanna come pick up this change.
[CUSTOMER][NEUTRAL] Oh my
[AGENT][NEUTRAL] All right, so the only other things that I'm seeing that are not included, so the accident form was submitted. I see that there's not a signature on there and so it does need to be signed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, the accident claim form does say that for an accident, medical expenses, we need an itemized bill and then a copy of an explanation of benefits from whomever your major medical is.
[CUSTOMER][POSITIVE] OK, alrighty.
[AGENT][NEUTRAL] Uh, I didn't see that attached in the original one, and it looks like
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So, the signature on the form, explanation of benefits.
[CUSTOMER][NEUTRAL] So we need the signature.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Explanation of benefits from your, from your major medical for the date of service. Yeah.
[CUSTOMER][NEUTRAL] And that's it and we just send it.
[CUSTOMER][NEUTRAL] Benefit
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Since he wasn't, since he's not seeing an attending physician, I would honestly recommend contacting the hospital and get an admin discharge summary with the diagnosis on it.
[AGENT][NEUTRAL] Um, because what you provided was, you know, the receipt with the procedure codes and, you know, so that's, you know, basically what was administered and done while in the emergency room. Uh, the diagnosis code is, you know, what they were being treated for.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and if they can't, if they can't give that to you, they should be able to give you, like I said, an admin discharge summary which would have that also.
[AGENT][NEUTRAL] So those are the 3 things that I see that are gonna be needed that I would go ahead and submit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Of the signature explanation of benefits.
[CUSTOMER][NEUTRAL] Um, and the admit discharge summary.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And that could be emailed or?
[AGENT][NEUTRAL] Um, it can be uploaded, faxed, or it can be put in the US postal mail, so you can do it through an upload on the online service center. You don't, um, or you can fax it to us, whatever is more convenient.
[CUSTOMER][NEUTRAL] OK. OK. I just wanted to check and see.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] OK, not a problem.
[CUSTOMER][POSITIVE] Alrighty well thank you for your time, have a good day thank you.
[AGENT][POSITIVE] You're welcome. Have a good day.