AccountId: 011433970860
ContactId: 526a1a3e-e1d7-4314-8eea-8a803f915758
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1198709 ms
Total Talk Time (AGENT): 460457 ms
Total Talk Time (CUSTOMER): 379825 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/526a1a3e-e1d7-4314-8eea-8a803f915758_20250212T19:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], um, I have a file. I have a, a claim right now going on with you guys. I was on the phone earlier with another agent. I'm not sure if it was you or not, but.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Uh, I was told to create a, a, a, an account because you guys denied the claim, because I don't, whoever turned in my stuff didn't send the itemized bill.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I, I just made the account and I uploaded the, the itemized bill to the, to the APL uh uh account I made.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You just wanna make sure that we got it.
[CUSTOMER][NEUTRAL] So I just
[CUSTOMER][NEGATIVE] Yeah, I wanna make sure that you got it and that you guys can look at it, man, it's possible, as soon as possible because I've already been waiting two weeks. I've been having a hard time, um, contacting the person that sold me the insurance. I haven't been able to get a hold of him for like 2 weeks. I've texted him, I've called him and uh all I've gotten from him was the paper that I needed to file to, to um.
[CUSTOMER][NEUTRAL] To file up to send you guys. And that's it. I haven't heard from him, I haven't.
[CUSTOMER][NEUTRAL] Gotten a text back or a call back from him. And then I called right now. I have to, I have to get the number from my employer, uh, for, for the main company, I guess, you know, for this, and um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I'm told that it, it got denied.
[CUSTOMER][NEGATIVE] It's just the whole deal and it's frustrating, so I'm just trying to speed the process up because I've already been waiting for like 2 weeks.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] OK, let's take a look. What's your policy number?
[CUSTOMER][NEUTRAL] I can it is.
[CUSTOMER][NEUTRAL] 02283755.
[AGENT][NEUTRAL] All right, let me pull this up.
[AGENT][NEUTRAL] And if I can verify please your first and last name and your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII]. And then I need to also verify your address and email address on file.
[CUSTOMER][NEUTRAL] So [PII] and my email is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] All right, thank you so much. So I do show that we received your claim information that you submitted today. I'll just pull it up and make sure everything looks good here. Give me one second.
[AGENT][POSITIVE] OK. Perfect. All right.
[AGENT][POSITIVE] So I do see the upload, [PII] and I see the diagnosis codes and everything on there so it looks like that's exactly what we were requesting so good to go on that. Um, it's in progress right now being looked at, so you're just gonna need to give it a little time to get processed.
[CUSTOMER][NEUTRAL] How, how long are you talking about?
[AGENT][NEUTRAL] Generally, um, we ask for 5 business days to process a claim.
[AGENT][NEUTRAL] At minimum.
[CUSTOMER][NEUTRAL] Is there a is there like a, is there like a speed a speed boost you can put on that or a or a urgency, uh note or something that you can do to speed it up?
[AGENT][NEUTRAL] All I can do is, you know, honestly, like all we can do is just they go in order as far as how they're received so I don't have a way unfortunately to expedite it or anything like that. Claims examiners work claims as they come in.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, um, I don't think, you know, from what I, go ahead.
[CUSTOMER][NEGATIVE] So, as, as far as, as far as why, no, as far as the, why the claim got denied, is that the reason why I got denied? Because you guys did not receive this paper, this uh file?
[AGENT][NEUTRAL] Uh, let me read the denial back here. Give me just a second.
[AGENT][NEUTRAL] So yeah, so itemized bill for actual charges. This policy provides benefits for actual charges incurred as a result of a covered accident, placement fully itemized bill with diagnosis and procedure codes for consideration.
[AGENT][NEUTRAL] Let me look what was originally uploaded when you did or what was filed on the [PII]. Let me pull that up.
[AGENT][NEUTRAL] And just make sure.
[AGENT][NEUTRAL] Everything's filled out on the scale.
[AGENT][NEUTRAL] So yeah, I mean that was the denial um on the original claim.
[AGENT][NEUTRAL] So in the claim form that you submitted.
[AGENT][POSITIVE] With the accent, well everything let's see, filled out.
[AGENT][NEUTRAL] I'm just gonna double check because I think you got the form from the agent, right?
[CUSTOMER][NEUTRAL] Uh, yeah, I got the form from the agent, which was the only thing I got back from him and I
[CUSTOMER][NEUTRAL] When I spoke to him the first time, all he told me that was that.
[CUSTOMER][NEUTRAL] He was gonna give me the form, but he told me to get the itemized bill and I got it, and I handed it to my employer, and whenever uh I received the form, I filed, I, I filled it out.
[CUSTOMER][NEGATIVE] The, the agent gave me an envelope with an address in a PO box. So I sent it out. I, I was never told to put the, the paper, the itemized paper in the envelope. I, you know, I, I was never told that from [PII] didn't tell me anything. I gave it to my employer thinking that's all I had to do.
[CUSTOMER][NEGATIVE] So, I've been trying to communicate with [PII], the guy who sold me the insurance, the agent that, but I haven't received a single message from him. I haven't received a call back from him in over 1 week and a half, almost 2 weeks now, and it's just been really frustrating having to deal with this.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] You know, if I don't call today and I wait for, you know, the, the, you know, the denial claim to, to get home, to get to me, you know, it's just more time and more time that, that I don't have.
[AGENT][NEUTRAL] Right, OK, um, I'm gonna, [PII], I'm gonna call somebody over in claims that processes these and have them look at it because I see the claim form you submitted it's just an older claim form and I just wanna like you said you've been not getting a lot of communications so I just wanna make sure that this is everything before I tell you that and if not then they can advise you if you need to.
[AGENT][NEUTRAL] Upload anything else and you can go ahead and do it, OK?
[CUSTOMER][POSITIVE] I would appreciate it thank you.
[AGENT][POSITIVE] Yeah, you're welcome. Give me one sec.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[AGENT][NEUTRAL] Hey, [PII], this is [PII]. How are you?
[CUSTOMER][POSITIVE] I'm doing good, [PII] how are you?
[AGENT][NEUTRAL] Hey, I'm good. I have a guy on this, on the line asking about an accident claim. I don't think I called the right line.
[CUSTOMER][NEUTRAL] OK, um, I may be able to assist you. We do have accident policies. Um, are you calling, wait, are you calling with the group?
[AGENT][NEUTRAL] No, no, no, so this is [PII] in customer care, [PII], you didn't realize.
[CUSTOMER][NEUTRAL] Oh, I [PII], I didn't even catch that. OK, so wait, I'm like.
[AGENT][POSITIVE] It's OK, girl. Don't worry about it. Yeah.
[CUSTOMER][NEGATIVE] OK, yeah, no, you didn't call the right person.
[AGENT][POSITIVE] I know, it's all good, girl. Don't worry about it. Thank you.
[CUSTOMER][POSITIVE] All right, you're welcome. Bye.
[AGENT][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Bring
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hi, [PII]. This is [PII] in customer care. How are you today?
[CUSTOMER][NEUTRAL] Fine, how are you?
[AGENT][NEUTRAL] I'm good, thank you. Um, I don't know if you can help me with this or not. I just have a question on an accident claim. Is that something you could help with maybe?
[CUSTOMER][NEUTRAL] Sure, what's the policy number?
[AGENT][NEUTRAL] 228
[AGENT][NEUTRAL] 37554 [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Um, insured's on the line and he's, you know, a little frustrated. The original claim was denied, um, and so he submitted some additional paperwork. My question is, when I looked at the claim that was submitted originally on [PII], it seems like a really old claim form, and I don't even know if it has everything that you guys need, so that's what I was double checking on.
[CUSTOMER][NEUTRAL] Yeah, depending on what he sent, cause yeah, that was the old claim form. We didn't even have the date of accident on that form.
[AGENT][NEUTRAL] Yeah, so.
[CUSTOMER][NEUTRAL] Um, so let me see what the new mail is that he sent. Let's see.
[AGENT][NEUTRAL] He just sent us like an itemized bill with diagnosis code.
[CUSTOMER][NEUTRAL] Um, yeah, I know we submitted on that claim on another claim form and we requested the itemized billing so let me see what we got here.
[CUSTOMER][NEUTRAL] So we will need that accident claim form completed um with the accident details and the date of the accident because from here, his date of service is [PII], so we don't know the actual date the accident occurred or anything like that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, I'm just gonna send him this new one because he got that he said from the.
[CUSTOMER][NEUTRAL] Yeah, the new one. That's what we need. The new one on this one we did resend out the new one, which he says he's turned around and sentence. I'm sure he hadn't got that yet since this was yesterday when it was processed. But yeah, we'll need that, uh, the new accident claim form with him providing the date of accident and accident details on that information.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And does the attending physician and all that, it has to be signed by them, yeah?
[CUSTOMER][NEUTRAL] No, it's not required.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK, I'll let him know that cause he probably flip out if he saw.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it's not required.
[AGENT][POSITIVE] OK, alright, thank you so much. I will keep that as a good rule of thumb and just send this off to him. Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Alright bye bye.
[CUSTOMER][NEUTRAL] Mm bye.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Alright [PII] thank you so much for your patience and waiting on that um I spoke with somebody over in the claims department and had her look at everything that was submitted originally and then what you just submitted the itemized bill.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, she said the bill was good. The claim form that the broker or whoever sent to you is an old claim form. Um, there are some portions on it that are different than the, the current claim form. So what I'm gonna do is I'm gonna email this to you and you need to fill this out and then upload it because the other claim form, like I said, is old and there's other information that we need.
[AGENT][NEUTRAL] Um, once you feel.
[CUSTOMER][NEUTRAL] So I'm I'm right here on the website. I'm sorry to interrupt you. I'm here on the website and there's an option that says need to file a wellness claim. Would you like to file a wellness claim? Is that what I need to do?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You need the accident claim form from our website.
[AGENT][NEUTRAL] But if I can send it to you if it's easier to do that.
[CUSTOMER][NEUTRAL] Yeah, just, just send it to me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm gonna email you the accident claim form, the newer one, because what the agent, like I said, sent you is very old um page one of this form is just instructions so you're gonna see you need to fill out the statement of the insured.
[AGENT][NEUTRAL] And details about the accident, date of the accident, and location.
[AGENT][NEUTRAL] Now, when you are looking at these pages, there is a statement from the physician and a signature. She did tell me that that's not required.
[CUSTOMER][NEUTRAL] OK, so a statement of the insurance is basically my statement, correct?
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] Mhm. Yeah. But you're not, you don't need to reach back out to the physician to get a signature or anything like that. You should be able to just fill it out now and get it right back to us.
[CUSTOMER][NEUTRAL] OK, just, just to, just to make sure I don't need to file it even though that, that doesn't increase the chances of.
[CUSTOMER][NEGATIVE] You know, approving my file, right? Because I don't want it to get back and it and it's denied again.
[AGENT][NEUTRAL] The information that I got from the examiner and claims was that it was not required. I did ask that and I did explain that you know you had been waiting so I wanted to make certain it wasn't needed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So the claim form is on its way to your Hotmail address.
[AGENT][NEUTRAL] Um, so you should have that in a few moments.
[AGENT][NEUTRAL] And there's nothing else that, you know, uh she said the bill was good and everything like that, so that shouldn't cause any issues as far as the upload today, OK?
[CUSTOMER][NEUTRAL] OK. And then, um,
[CUSTOMER][NEUTRAL] As far as
[CUSTOMER][NEUTRAL] As far as the, you know, once I file, once I do the or do the form that you're sending over.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I still have to wait the
[CUSTOMER][NEUTRAL] 5 days.
[AGENT][NEUTRAL] Um, yeah, it's gonna take at least a day or two to, to get it processed for sure, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. I see the, the.
[CUSTOMER][NEUTRAL] Form here.
[CUSTOMER][NEUTRAL] Uh, and then, uh, I, do I just fill it up right here and just upload it to that website?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Correct where it says upload yep, that's where you're gonna upload it to and the online service center will update as far as the claims you should get updates as well as far as when a claim's been processed, and that number that you called to reach me, you can call any time if you have questions or concerns. We are here from [PII] Central time Monday through Friday.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I'll fill this out and then.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'll call back to see if any if everything's good, if not, so I can correct things. Alright, sounds good.
[AGENT][POSITIVE] All right, [PII]. All right, have a good rest of your day.