AccountId: 011433970860
ContactId: 4f82ed56-2007-4a72-b9db-58c4abf911c3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 506040 ms
Total Talk Time (AGENT): 120370 ms
Total Talk Time (CUSTOMER): 223976 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/4f82ed56-2007-4a72-b9db-58c4abf911c3_20250612T19:49_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yes, ma'am. I'm calling to the status of some claims that I had.
[AGENT][NEUTRAL] OK. Do you have a phone number I can get in case we get disconnected, I can call you back?
[CUSTOMER][NEUTRAL] Yes ma'am, it is [PII].
[AGENT][NEUTRAL] Can you give it to me one more time, please?
[CUSTOMER][NEUTRAL] Yes ma'am, it is [PII].
[AGENT][NEUTRAL] Thank you. And do you have your policy number?
[CUSTOMER][NEUTRAL] Yes ma'am, it is 1836605.
[AGENT][NEUTRAL] OK. And what was your name?
[CUSTOMER][NEUTRAL] My name is [PII]. I'm checking on a policy for my daughter [PII].
[AGENT][NEUTRAL] OK. And what's your date of birth?
[CUSTOMER][NEUTRAL] Her date of birth is [PII]. 0, my date of birth is [PII].
[AGENT][NEUTRAL] Your date of birth.
[AGENT][NEUTRAL] And can I verify your address and email address, please?
[CUSTOMER][NEUTRAL] Yes, it's [PII]. Um, email address is [PII], and, uh, is that OK, thank you.
[AGENT][POSITIVE] Thank you, Ms. [PII].
[AGENT][NEUTRAL] And you were checking on a claim for your daughter?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, I can help you with that. Um, what date of service was it for?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I don't know. I think it was [PII]. They're like, they're the [PII] that's pending right now.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is it the one you just sent in?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, I mean a couple of days ago. No, yeah, like.
[AGENT][NEUTRAL] On 669.
[CUSTOMER][NEUTRAL] Not recently, let me see.
[CUSTOMER][NEUTRAL] That was the end, and then there should be 2 more before that one, yes, ma'am.
[AGENT][NEUTRAL] OK, the 1069 hasn't been processed yet. It's in line to be processed.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And what was the data service for the other one?
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] I don't know. I'm trying to pull up the claim number right now if you give me just a sec, um.
[AGENT][NEUTRAL] Was it for physical therapy?
[CUSTOMER][NEGATIVE] No, it was actually for a surgery charge, but it was missing out of the um paperwork that the orthopedic clinic gave me because it was billed from the hospital and the orthopedic clinic did not include it in there. So when they sent the denial, they said they couldn't pay for surgery because there was no surcharge.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then the hospital just sent me.
[CUSTOMER][NEUTRAL] The, the deal.
[CUSTOMER][NEUTRAL] And when I spoke to someone from APL, she said, send, send, go ahead and send that in.
[AGENT][NEUTRAL] OK, now we did receive something on 69, but it hasn't been processed yet and they haven't looked at it yet.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's in line to be processed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's the anesthesia, anesthesiologist one. And so the one, the, the 64 I think is what.
[CUSTOMER][NEUTRAL] Ending right or what's still, I don't know. What I submitted that was received on the [PII].
[CUSTOMER][NEUTRAL] That one is still uh process, in process.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It looks like everything's been processed except for the one you sent on 69.
[CUSTOMER][NEUTRAL] Oh, OK, so what can, would you mind telling me what was the what was the result of the ones that I sent on 64?
[AGENT][NEUTRAL] 64.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, hold on just a second.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, they were processed, but, but they were denied as benefit maximum for this data service had been met.
[CUSTOMER][NEUTRAL] OK, what is the benefit maximum out of curiosity?
[CUSTOMER][NEUTRAL] Um, just because I remember the lady yesterday was like, yeah, you know I said that go ahead and like get that in because that was a piece that was missing that could have been paid out, so I was just curious at this point.
[AGENT][NEUTRAL] The maximum, I'm not sure, but I could get someone to call you back and let you know.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For surgery, let me see if I can see.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah, I'm not sure on the surgery. Let me pull the policy up and it may be able to tell me. Hold on one moment.
[CUSTOMER][NEUTRAL] Or, or I can just, uh, you can even transfer me to the plane, the president of the plane. That's fine too cause it was kind of not sticky, but it was, it was complicated to even try to explain.
[CUSTOMER][POSITIVE] I'm I'm OK with that.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm mhm.
[AGENT][NEUTRAL] Hold on one moment. Let me see if I can pull it up.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] that's true.
[CUSTOMER][NEUTRAL] In.
[AGENT][NEUTRAL] OK, for the surgery benefit is $1000.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, so I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Basically I, I, I know I didn't get that.
[AGENT][NEUTRAL] Ma'am.
[CUSTOMER][NEUTRAL] I know that for a fact because, yeah, I think I do need to speak the same adjuster because like for
[CUSTOMER][NEGATIVE] I don't think I'm gonna pay for a surgery benefit.
[CUSTOMER][NEUTRAL] Because it wasn't on the initial documentation that I sent.
[AGENT][NEUTRAL] OK, I can get someone to call you back and um.
[AGENT][NEUTRAL] Go over the claims with you.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Alright, would it be that like the claims adjuster or somebody else?
[AGENT][NEUTRAL] Yes ma'am, be be a claims adjuster.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK awesome thank you so much thank you for your patience.
[AGENT][NEUTRAL] Is there anything else I can help you with right now?
[CUSTOMER][NEUTRAL] No, ma'am, that's it.
[AGENT][POSITIVE] Thank you, Ms. [PII] for calling APL and I'll get someone to return your call.
[CUSTOMER][POSITIVE] Alright thank you bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.