AccountId: 011433970860
ContactId: 541b73ec-3b47-4a84-86fe-892c131881f0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 642210 ms
Total Talk Time (AGENT): 189656 ms
Total Talk Time (CUSTOMER): 315492 ms
Interruptions: 5
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/541b73ec-3b47-4a84-86fe-892c131881f0_20250212T13:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, good morning. Um, I was expecting to leave a message. That's what I was told. This is [PII], and I'm checking on a claim that was, uh, we got a message saying it is completed, and I was wondering what my husband would be expecting out of that claim and how that works from here on out.
[AGENT][NEUTRAL] OK. [PII], what's the policy number?
[CUSTOMER][NEUTRAL] I have the claim number here in front of me.
[AGENT][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] 356-226-1. When I try to log in it's not gonna do anything. I'm not sure what happened there.
[AGENT][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] What's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] No, should have been filed under a work accident claim, but
[CUSTOMER][NEUTRAL] You tell me what's going on there.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], is the claim for you?
[CUSTOMER][NEUTRAL] That's for [PII].
[AGENT][NEUTRAL] It's for [PII], OK. And what is your date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] All right. Thank you.
[CUSTOMER][NEUTRAL] This is [PII], yeah, I'm, uh, he authorized me a while ago.
[CUSTOMER][NEGATIVE] We had so much to deal with. I'm not sure why we're chosen.
[AGENT][NEUTRAL] And what's the date of service of the claim?
[CUSTOMER][NEUTRAL] Um, OK, now, now you got me here. That should have been, I wanna say [PII].
[CUSTOMER][NEUTRAL] Uh, I don't have that in front of me right now. That was when he had an ax, a splinter in the eye.
[CUSTOMER][NEUTRAL] At work.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] There was a reclaimed that and then we were told that's not everything is, isn't there and we had to resubmit it or the insurance guy had to resubmit it.
[AGENT][NEGATIVE] Was, was the previous copies ineligible, like hard to read?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Uh correct, yes.
[AGENT][NEUTRAL] Is that OK and then you resubmitted something?
[CUSTOMER][NEUTRAL] Yes, he did, yeah, the, the insurance, uh, representative.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] [PII].
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] All right, so we did receive, um, information on [PII].
[AGENT][NEUTRAL] And it's in line it's in line for processing it hasn't been complete yet.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] But my, my message here says your claim is now complete. reference the following claim number which I gave you.
[CUSTOMER][NEUTRAL] I just received a message here at [PII]
[AGENT][NEUTRAL] OK, so that's not for his claim that claim is for you, [PII].
[CUSTOMER][NEUTRAL] That is the support of broken foot or a broken leg. OK, we, that's, that's what was my next question.
[AGENT][NEUTRAL] Yeah, so I'm showing that that claim number was processed under your name.
[CUSTOMER][NEUTRAL] We have
[AGENT][NEUTRAL] And it says,
[CUSTOMER][NEUTRAL] Yeah, yeah, that, that's my, was my, was my next question. I have, I'm sitting here with a broken foot, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it was processed and it says that we need the enclosed claim form completed by the insured, giving a detailed description of the accident or diagnosis of sickness. So you're gonna be receiving that explanation in the in in the mail shortly.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and then it'll have that remark.
[CUSTOMER][NEUTRAL] OK, but that, that was, that was, that was submitted though, that was submitted by me, by [PII], and by the physician. I had everything, I mean, I even sent the CD along, I sent the reports along.
[CUSTOMER][NEUTRAL] I filled out what happened. The doctor filled out what happened and what transpired. So what, what else should I say?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I mean, I'm just wondering.
[CUSTOMER][NEUTRAL] And it says the claim is complete. Are we missing something here?
[AGENT][NEUTRAL] Give me a second.
[AGENT][NEUTRAL] Well, that just means that it's been processed. That doesn't mean that it has been paid. So in this instance we're requesting additional information so let me look at the documentation that was submitted give me one moment.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Please, yes, thank you.
[AGENT][NEUTRAL] Did you complete the, the APL accident claim form?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That should have all been submitted. What I did, I sent the whole package to [PII].
[CUSTOMER][NEUTRAL] And he said he would, you know, submit that to you guys.
[CUSTOMER][NEUTRAL] So we, we know it's coming, it's there, I have copies.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, so the documents that we received on [PII], the claim form is not in that documentation. Let me look at the claim received prior to that.
[CUSTOMER][NEUTRAL] I'm not sure
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I see, I see your looks like it could be your emergency room records. Um.
[CUSTOMER][NEGATIVE] Well, there, there was one emergency room record that I claimed that has nothing to do with that. We determined already that's not payable because it's not a critical illness. But this year I'm referring to, I broke my foot on the 2nd on my, my fibula on the [PII], and that should have been the one admitted.
[AGENT][NEUTRAL] Yeah, so I do
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] You see that?
[AGENT][NEUTRAL] Well, I see the claim, but I don't show where we received the APL accident claim form, which is what is being requested.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, but he had all this. I, I wonder why that's true.
[CUSTOMER][NEUTRAL] And every time we have to do something.
[AGENT][NEUTRAL] Uh, may have received his, but not yours.
[CUSTOMER][NEUTRAL] Well, that's the one that's, that's APL. Let's see. I'm looking payment statement.
[CUSTOMER][NEUTRAL] OK, accident and health, the claimant statement. I have that right in front of me, and he sent, I have the copy, he sent the original. He, he has the original Cody birth.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] On that claim on that, on page 2, who does it show as the patient?
[CUSTOMER][NEUTRAL] Page 2.
[AGENT][NEUTRAL] The claim
[CUSTOMER][NEUTRAL] The patient is clim[PII].
[CUSTOMER][NEUTRAL] The patient is let me go through all this.
[CUSTOMER][NEUTRAL] OK, this is less. Yeah, I'm afraid to put anything away because there's literally every time an issue.
[CUSTOMER][NEUTRAL] Uh, OK, I have to.
[AGENT][NEUTRAL] Yeah, I'm showing [PII]'s name in both of those spots, claimant and name of primary insured is [PII].
[CUSTOMER][NEUTRAL] OK, well, the
[CUSTOMER][NEUTRAL] OK, [PII]'s is a completely different claim. [PII]'s claim is the
[AGENT][NEUTRAL] I know it. I know I'm so that's what I'm saying we received the claim form for [PII] but not for you.
[CUSTOMER][NEUTRAL] OK. So you need which page? this one that says claim and statement?
[AGENT][NEUTRAL] For you we need the entire claim completed.
[AGENT][NEUTRAL] There's a part for the attending physician to fill out as well.
[CUSTOMER][NEUTRAL] Yeah, but I
[CUSTOMER][NEUTRAL] I sent that to [PII]. He did that.
[AGENT][NEUTRAL] OK, and so ma'am what I'm saying is for you I don't show that we received the claim form, which is why we're requesting it so you may wanna reach out to [PII] and let him know that we did not receive the accident claim form for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, what about [PII], this is blender?
[AGENT][NEUTRAL] We have it for [PII]. We do have his claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so [PII] [PII].
[CUSTOMER][NEUTRAL] Just looking. OK, I looked through my things here again and I reach out to [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Uh, I just think it's, I mean, literally every time I send everything and I double send it, I make copies, I send it, he is sending it into you guys, and it is always something missing, it's ridiculous. It is really, and I made sure, I make sure.
[AGENT][NEUTRAL] OK, so maybe, maybe you want to have [PII] call us and we can explain it to [PII] if you would like.
[CUSTOMER][POSITIVE] I will do that. In fact, I will do that because he's trying to, I mean, he's trying to be helpful but something is not right there on his end, so thank you. I, I'm gonna get this with him right now, thanks.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK. All righty. And can I give you your, your policy number that way you'll have it?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, the policy number for the this particular accident here.
[AGENT][NEUTRAL] For the, your accident policy number?
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] That number is 228.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 665 8.
[CUSTOMER][NEUTRAL] OK. That's the accident policy. That would be for my claim and [PII]'s claim, correct?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, this is the number for the accident policy, so that is correct.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK. Well, I'll get with him here shortly and then we'll see where we go with that. Thank you, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. You're welcome. Anything else I can assist with [PII]?
[CUSTOMER][POSITIVE] Good one bye.
[CUSTOMER][NEUTRAL] No, not at the moment, no, thank you. Bye-bye. Bye.
[AGENT][POSITIVE] All right. Thank, thanks for, thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] OK bye.