AccountId: 011433970860
ContactId: 4bb3e1f6-702d-4cf4-843f-a3efee63bddd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 793359 ms
Total Talk Time (AGENT): 340068 ms
Total Talk Time (CUSTOMER): 221069 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/4bb3e1f6-702d-4cf4-843f-a3efee63bddd_20250319T21:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], this is [PII]. So my husband um is right here next to me and um he's the one that filed the claim, um.
[CUSTOMER][NEUTRAL] We uh put in a
[CUSTOMER][NEUTRAL] Uh, sending, we fax, sorry, information last Thursday for um his hospitalization back in January and
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But he hasn't heard anything as far as like if it was declined and why or what.
[AGENT][NEUTRAL] OK Ms. [PII], I can help you guys with your claim status um you're saying that you just sent it in this past Thursday?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, can you please give me the policy number?
[CUSTOMER][NEUTRAL] Where's your um, hold on, he's he's getting it, hold on.
[AGENT][POSITIVE] Yes, ma'am. Take your time.
[CUSTOMER][NEUTRAL] It's a little car.
[CUSTOMER][NEUTRAL] Yeah, but I need your policy number off it's on my card, I think.
[CUSTOMER][NEUTRAL] I don't know what car you're talking about.
[CUSTOMER][NEUTRAL] Oh, hold on, here's it. I have it. It's 02583787.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] this.
[CUSTOMER][NEUTRAL] I said he.
[AGENT][NEUTRAL] OK, is, um, [PII] there where I can speak with him?
[CUSTOMER][POSITIVE] Yes, ma'am, he's right here.
[AGENT][POSITIVE] OK, thank you, ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am. I'm here.
[AGENT][NEUTRAL] Hi, [PII]. Hey, this is [PII]. I'm gonna need for you to verify your policy for me, um, sir. Can you please give me your date of birth?
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Yes, my date of birth is [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] My address is [PII].
[CUSTOMER][NEUTRAL] [PII], uh, and when this [PII], uh, zip code [PII]. My phone number is.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And my email should be [PII].
[AGENT][NEUTRAL] OK, thank you so much. And then is it OK if I speak with Ms. [PII] about your claim?
[CUSTOMER][NEUTRAL] Yes, ma'am, it is.
[AGENT][NEUTRAL] OK, I just needed that verbal consent, sir. I appreciate that. And if we get disconnected, that phone number you just gave me, is that a good one to call you back on?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] OK, thank you so much, [PII]. I appreciate you verifying everything for me.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hi, Ms. [PII].
[CUSTOMER][NEUTRAL] Hey.
[AGENT][NEUTRAL] OK, so the claim that you sent in, let me look at this real quick, is for him and it was submitted on [PII], is that correct?
[CUSTOMER][NEUTRAL] Yeah, I know.
[AGENT][NEUTRAL] OK, let me look and see if there's anything going on with it at this time.
[CUSTOMER][NEUTRAL] Right, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, you've got a few remarks on the claim things that they're needing.
[AGENT][NEUTRAL] Um, 11 is, um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We need supporting documentation to evidence the accident sickness, um, documentation may include but it's not limited to itemized bills with the diagnosis codes and procedure codes.
[AGENT][NEUTRAL] You can also get a super bill from the office, hospital notes, admission and discharge summaries or diagnostic testing results are all things that you, you can submit.
[CUSTOMER][NEUTRAL] I faxed, I faxed in um 13 pages last um Thursday and it was the um itemized uh itemization of the hospital service, the services, and then it was the UVO4 what they asked for.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] I sent all of that.
[AGENT][NEUTRAL] OK, so what they're needing is for it to state that it was accident or sickness.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] They're needing the diagnosis code.
[CUSTOMER][NEUTRAL] So how do, I mean, I'm not.
[AGENT][NEUTRAL] The diner
[AGENT][NEUTRAL] Do you have anything that stated that what he was diagnosed with? And is it for accident or sickness?
[AGENT][NEUTRAL] Either for the diagnosis.
[CUSTOMER][NEGATIVE] Oh my goodness, that is so frustrating cause I got exactly what they.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well, I'll tell you what
[CUSTOMER][POSITIVE] That is a real, it's not fault. It's really.
[AGENT][NEUTRAL] What I can do.
[AGENT][NEUTRAL] To get you further help is I can have a claims examiner call you.
[AGENT][NEUTRAL] And tell you exactly what they need to finish processing this claim. Would that help you?
[CUSTOMER][NEUTRAL] I mean, the only thing is like my husband's driving a bus, so I would have to wait until like this day so that he could be here and give them the OK to talk to me. So like.
[AGENT][NEUTRAL] Or he can or he can fill out a third party authorization form and um you guys can email that in the third party authorization form which gives consent for you to talk about his policy at any time if they add you on there as a third party.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, you said we need accident or sickness and what else?
[AGENT][NEUTRAL] You need diagnosis code showing that it was accident or sickness.
[AGENT][NEUTRAL] And that that can be obtained from.
[CUSTOMER][NEUTRAL] So what about first paper?
[AGENT][NEUTRAL] Saying that the documentation may include but is not limited to itemized bills with the diagnosis codes, super bills, office notes, hospital admission and discharge summaries, and your diagnostic testing results.
[CUSTOMER][NEUTRAL] You, you got your discharge papers? OK, so I can now I can fax it, I can fax that stuff, but it's gonna take a whole another week probably.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh my [PII], that's crazy. OK, uh, now with this hospital indemnity plan.
[CUSTOMER][NEGATIVE] It's so confusing. It's not your fault. OK, um.
[CUSTOMER][NEUTRAL] Is it does so.
[CUSTOMER][POSITIVE] I don't even know what what we're paying for, um, it it covers any hospitalization.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Whether sickness or sit.
[AGENT][NEUTRAL] It says for accident or sickness. Um, let me look real quick.
[AGENT][NEUTRAL] Let me pull up your policy real quick.
[AGENT][NEUTRAL] OK, yeah, it's pulling in now, so let me see what your schedule of benefits state.
[AGENT][NEUTRAL] So it's stating that the definitions are accident or injury means sudden, unexpected or unintended injury. Um.
[AGENT][NEUTRAL] Let me keep scrolling to see if there's anything else.
[CUSTOMER][NEUTRAL] It was
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Yeah, it's, it's saying in the definitions that it should be accident or injury.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] So that's why they're needing it so that you can show that it was accident or an injury.
[AGENT][NEUTRAL] They need to have that diagnosis code of what he was diagnosed with.
[CUSTOMER][NEUTRAL] So it doesn't cover sickness.
[AGENT][NEUTRAL] Let me look and see.
[AGENT][NEUTRAL] Let me, um
[AGENT][NEUTRAL] Let's try to get you a claims examiner so that they can go over this and see exactly what's needed because there might be a reason why that I'm not able to look at.
[AGENT][NEUTRAL] Because I'm only, I've only got limited.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Information that I can see.
[AGENT][NEUTRAL] So let me see if I could get somebody on the phone because.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Like you said, it would be hard for them to get a hold of you and get consent from him again so we're gonna try to get you some help right now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, it's gonna be a brief hold while I transfer you on over. I hope you guys have a good rest of your night.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEUTRAL] Bring
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII]. How can I help you?
[AGENT][POSITIVE] Hi, Ms. [PII], it's [PII] in the care team. I've got, um, hey, I'm good. How are you doing?
[CUSTOMER][NEUTRAL] Mhm. How are you?
[CUSTOMER][POSITIVE] Good.
[AGENT][NEUTRAL] I've got Ms. [PII] on the phone. She is the spouse of the insured and he has given consent for us to talk to her. The policy number is 258.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 3787.
[AGENT][NEUTRAL] They have been verified and the callback number is the one they're calling from.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And they are calling about claim number 357-7656.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, I read the remarks to her and she is stating that she has sent in everything that we have been requesting.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And she just wants to know, and I know it specifically said for accident or sickness that she needs to send in the diagnosis code for.
[AGENT][NEUTRAL] And so she's questioning that also, but she just has further questions after I gave her the remarks.
[CUSTOMER][NEUTRAL] OK, you can send her on over.
[AGENT][POSITIVE] OK, thanks, Ms. [PII]. Have a good night. Bye-bye.
[CUSTOMER][POSITIVE] You're welcome. You too, thanks.