AccountId: 011433970860
ContactId: 52a95f92-8aa0-4c4f-919e-286254e1f2b3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 625260 ms
Total Talk Time (AGENT): 185665 ms
Total Talk Time (CUSTOMER): 191370 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/52a95f92-8aa0-4c4f-919e-286254e1f2b3_20250418T15:49_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] we
[CUSTOMER][NEUTRAL] Hi, my name's [PII]. I recently submitted a claim, actually two claims for my daughter. She went to the emergency room and then I had a follow up appointment with um her ENT afterwards, and both were approved, but I had a question on the approved payout. I was under the impression that an emergency room visit was $300 and then a follow up appointment was $100 but I received $200 and $100 so I'm wondering, um.
[CUSTOMER][NEUTRAL] If I don't have that information correct or why the discrepancy?
[AGENT][NEUTRAL] OK, what is the policy number?
[CUSTOMER][NEUTRAL] Uh, sure, hold on one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, 258.
[CUSTOMER][NEUTRAL] 4397.
[AGENT][NEUTRAL] OK, let me have a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, for security, may I have your date of birth, mailing address and email address on file?
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Let me go ahead and pull the benefits really quick, OK, one moment.
[AGENT][NEUTRAL] There we go
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] You say you went to an ER visit.
[CUSTOMER][NEUTRAL] The second claim that I submitted, which was the one I was most recently paid out for that I included the paperwork with the ER visit.
[CUSTOMER][NEUTRAL] Summary from the emergency room facility Auschner and the first one I submitted was signed by her ENT.
[AGENT][POSITIVE] Thank you
[AGENT][NEUTRAL] So the physician's office was more like a follow-up and then the first occurrence happened on the emergency room.
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is for, let's see.
[AGENT][NEUTRAL] For Cora.
[AGENT][NEUTRAL] OK, so this is actually.
[AGENT][NEUTRAL] OK, recently, OK, so it looks like we sent 200 recently.
[AGENT][NEUTRAL] So we have 100 with the physician.
[AGENT][NEUTRAL] OK, let me get the examiner to see if she can look at the paperwork. Um, if I don't get an examiner, is it OK if they give you a call back in 24 hours?
[CUSTOMER][NEUTRAL] Yes, and if I need to include the after visit summary from her ENT I can also do that.
[AGENT][NEUTRAL] It looks like um based on what I'm seeing, they just paid the physician, so I'm not sure if they're just missing anything from the ER which it does say here that um there is an ER visit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I just, yeah, let me just go ahead and get them.
[CUSTOMER][NEGATIVE] Because they did pay out 200 when I submitted the ER it just seemed like it should have been 300.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Let me see if it's
[AGENT][NEUTRAL] for dependent spouse, children.
[AGENT][NEUTRAL] Children.
[AGENT][NEUTRAL] treatment.
[AGENT][NEUTRAL] Yeah, let me see if I can get an examiner on the line. OK, one moment please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Hi [PII], how are you? This is [PII].
[CUSTOMER][NEUTRAL] Hi [PII] how are you?
[AGENT][NEUTRAL] I'm good, thank you. Um, I have a member on the line with an accident, uh, claim, and she said that she did send all the information and that we underpay the, the, the claim. Um, can you take a look at into this and see what happened?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And the policy number, OK, it's 2584397.
[CUSTOMER][POSITIVE] Absolutely what's possible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is it for which number part 4?
[AGENT][NEUTRAL] Cora, part 4. Yes, yes. Mhm. Yeah, it looks like she had an emergency room visit and then she had a follow-up appointment, um, which it looks like we paid $100 for the uh physician.
[AGENT][NEUTRAL] And we paid $200 for the ER, um, it looks like the ER visa I'm not sure, but and based on the benefits, she said that it's supposed to be $300 for the ER visit.
[AGENT][NEUTRAL] And she wants to know what we underpay.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I have to pull the policy up and take a look and everything's been verified.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I did verify the information. The callback number is [PII].
[CUSTOMER][NEUTRAL] [PII] sorry.
[AGENT][NEUTRAL] Mhm. Yeah. Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alrighty, and it's [PII] I'm speaking to Al Media.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, [PII], mhm, yes.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I made that, OK.
[CUSTOMER][NEUTRAL] Alright, you can go ahead and transfer.
[AGENT][NEUTRAL] Okey dokey, here she comes.
[CUSTOMER][POSITIVE] Thank you so much have a good day.
[AGENT][POSITIVE] You're welcome. Have a good day. You too. Thank you.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Miss [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] I got Ms. [PII] on the line. She's in the claims support team and she's gonna assist you from here, OK?
[CUSTOMER][POSITIVE] OK great thanks so much.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[CUSTOMER][POSITIVE] Hi, hi, Ms. [PII]. My name is [PII]. I'm on the support team. Doing well, thank you. How are you?
[CUSTOMER][POSITIVE] Good thank you and just taking a look at the claim if you'll bear with me for just a moment.
[CUSTOMER][NEUTRAL] And it looks like there's a question about uh the benefit amount that was paid for chorus claim, is that right?
[CUSTOMER][NEUTRAL] Yes, I had submitted two claims. The first one was for a follow up appointment after her emergency room to her ENT, and that one was paid out as 100, which looked correct to me based on the benefits I had seen associated with the plan, and I called back asking what else I needed to show for the emergency room visit and so I included the same paperwork with the.
[CUSTOMER][NEUTRAL] And after summary notes from her emergency room visit, and that was paid out, but it was paid out for 200, so I was under the assumption that the emergency room visit.
[CUSTOMER][NEUTRAL] Paid out 300 and then any follow up associated with the accident paid 100.
[CUSTOMER][NEUTRAL] OK, just bear with me for one moment.
[CUSTOMER][NEUTRAL] Because sometimes