AccountId: 011433970860
ContactId: 54d67fe6-d322-4234-af05-e82a93ca13f7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 791049 ms
Total Talk Time (AGENT): 207762 ms
Total Talk Time (CUSTOMER): 419666 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/54d67fe6-d322-4234-af05-e82a93ca13f7_20250311T16:28_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey, good morning. This is [PII]. Um, I had just got paid for a claim that I had filed. Can you look that up by our social security number, please, cause I don't have my policy number handy.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh yes, ma'am. Give me one quick moment. OK, and what's your social?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, that is under [PII] and the claim was for [PII] and I have a question on that payout.
[AGENT][NEUTRAL] OK, which type of policy was it for?
[CUSTOMER][NEUTRAL] It was an accident.
[AGENT][NEUTRAL] Because
[AGENT][NEUTRAL] Accident, OK.
[CUSTOMER][NEUTRAL] It was an accident where I had broken my foot.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, and Ms. [PII], verify your date of birth and the mailing address, please.
[CUSTOMER][NEUTRAL] My name.
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][POSITIVE] OK, thank you so much. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] You bet. 1, yeah, [PII].
[AGENT][NEUTRAL] OK. And do you have a claim number or the date of service?
[CUSTOMER][NEUTRAL] Uh, the date of service when the accident happened was [PII].
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] And um I did get, uh, I guess the the payment for it.
[CUSTOMER][NEUTRAL] Um, but there's a question on that, and my, the representative [PII] and I have talked last night.
[CUSTOMER][NEUTRAL] Um, the doctor had prescribed a walking device, well, a walker.
[CUSTOMER][NEUTRAL] And also crutches, and also a walking boot, OK? So initially, I was given the walking, the cast, the cast boot, boot, and then um he gave me prescribed a walker, which I got from a medical company, uh, because I can't walk without any walking device.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Look, but um, [PII] told me there should be a payment because for 6 weeks.
[CUSTOMER][NEUTRAL] In the sidewalker.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] And it hasn't been shown on the payout that the company basically sent to my.
[CUSTOMER][NEUTRAL] Um, yeah, my deposit.
[AGENT][NEUTRAL] OK, let me look at your policy. Give me one moment, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And there was a letter in the mail that also makes no sense to me, and that was about the walker and the walking device, and it says the highest was to be about the highest claim would be paid out, but I don't care about the highest or the lowest, I wanna just know.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So how do I claim that walker being used?
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because here Thursday, I'm going.
[CUSTOMER][POSITIVE] Hopefully, really hopefully to my last appointment with the auto pay.
[CUSTOMER][NEUTRAL] And I was wondering if you need anything from him that
[CUSTOMER][NEUTRAL] states that, I mean, he initially it was stated on my claim that
[CUSTOMER][NEUTRAL] The paperwork was submitted Mr. [PII], but I don't see anything.
[CUSTOMER][NEUTRAL] That it has been
[CUSTOMER][NEUTRAL] Considered.
[AGENT][NEUTRAL] OK, I might have to transfer to an examiner and they can help as far as the um benefit, give me one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looks like they processed it previously.
[AGENT][NEUTRAL] Well, this is per account here. Give me one moment.
[CUSTOMER][NEUTRAL] Because [PII], uh, the insurance guy, he told me,
[CUSTOMER][NEUTRAL] Um, and basically,
[CUSTOMER][NEUTRAL] He, he didn't quote me a, a, a price tag on the walker, but he says it goes by the days used and
[CUSTOMER][NEUTRAL] On my claim and on my payout.
[CUSTOMER][NEUTRAL] I mean, how was that configured there?
[AGENT][NEUTRAL] OK. Yeah, let me transfer you to an examiner, Ms. [PII]. Hold on one quick moment for me, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Thank you, ma'am. Hold on one moment, please.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], um, I have an insured or a spouse calling about her claim for accident policy and she just want to know why the walker or the appliance was not paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Um, policy number is 2286658.
[CUSTOMER][NEUTRAL] OK, give me just a second, let me get over there and get the documents pulled up.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is this for the primary insured?
[AGENT][NEUTRAL] Oh no, it's for Ms. [PII], part two, I'm sorry.
[CUSTOMER][NEUTRAL] I think you said spouse, but I wasn't sure like which which claim I guess is it the one ending in 9683?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, alright, let me get that pulled up.
[CUSTOMER][NEUTRAL] Um, what is that now?
[CUSTOMER][NEUTRAL] Says that we previously paid benefit.
[AGENT][NEUTRAL] Yeah, and I looked at um a claim, but I didn't see, oh, I say, I didn't see anything as far as um I saw it in [PII], but I didn't see anything in this year, so I don't know, I could have been, I could have missed it.
[CUSTOMER][NEUTRAL] Doctor
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEUTRAL] Yeah, the last one I showed was uh [PII].
[CUSTOMER][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] Yeah, I see that is it.
[CUSTOMER][NEUTRAL] The same accident?
[AGENT][NEUTRAL] Um, I don't know.
[CUSTOMER][NEUTRAL] I'm gonna pull that up as well.
[AGENT][NEUTRAL] See.
[CUSTOMER][NEUTRAL] 397 [PII].
[CUSTOMER][NEUTRAL] Mm, it doesn't look like it is. Looks like we have different diagnosis codes.
[CUSTOMER][NEGATIVE] Oh hang on I'm looking at the wrong one, good grief.
[CUSTOMER][NEUTRAL] That would be why I was like I'm so confused, different person, let's see.
[AGENT][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] OK, still different diagnosis codes, so let me.
[CUSTOMER][NEGATIVE] Figure out what the heck is going on here.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] The one was for the right hip, the other one looks like for a foot.
[CUSTOMER][NEUTRAL] OK, so then
[CUSTOMER][NEUTRAL] Right. Uh.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Unilateral primary osteoarthritis, right, yeah, so that's the one you're looking at, OK.
[CUSTOMER][NEUTRAL] And then this one that she's saying we didn't pay.
[AGENT][NEUTRAL] That's my first foot.
[CUSTOMER][NEUTRAL] Fracture of the upper and lower left fibula.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][POSITIVE] Hm. That's a good question.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] And she
[CUSTOMER][NEGATIVE] Wasn't willing to like let us look into this and figure out what was going on.
[AGENT][NEUTRAL] I mean, I can, um, just do you want me to send a hub request to have someone look at it and give her a call back?
[CUSTOMER][NEUTRAL] Yeah, because what we're gonna have to do is we're gonna have to review both of these claims and um the documents received and then from there either reach out to the examiner or something and figure out.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Do we need to go back and pay it? Was this an error or they related like we're gonna have to review both claims to figure out why this examiner didn't move forward with it and then go from there um because I truly I mean like you said it looks like they're different and so I truly don't know.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Um, and I, I don't want.
[CUSTOMER][NEUTRAL] I mean just to be honest I'm gonna get her on the phone and I'm gonna have to say, you know, essentially.
[CUSTOMER][NEUTRAL] It's gonna have to be looked into so if she's willing to get a call back that's what we'll do is we'll review it and I can keep reviewing it now you can still submit it, um, the hub request and I'll, I can continue reviewing it now and just let you know anybody else know that I'm reviewing it but it's gonna just take me a minute to look at everything and and really figure out what was going on.
[AGENT][NEUTRAL] OK, well, I'll ask to see if she would rather call back, um, and that someone is looking into it.
[CUSTOMER][NEUTRAL] OK, you want me to stay on hold that way you already have me available if she wants to talk.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Oh, what does she do? Hold on, someone sent me.
[AGENT][NEUTRAL] Oh, she got one.
[AGENT][NEUTRAL] How much is the calendar max be? Oh, I'm sorry, I was training somebody today and she sent over her assessment, uh, thing, but yeah, hold on, hold on one second. OK, I got, I got sidetracked, OK.
[CUSTOMER][NEUTRAL] It's OK, OK.
[CUSTOMER][NEUTRAL] You're fine.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh, Ms. [PII], thank you so much for holding. I have an examiner who is looking at it, um, and she asked if it's OK if she can review your claim and give you a call back if that's OK, or would you rather just speak with someone now?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, yeah, she, she can do that. That, that would be fine actually. I would prefer that instead of sending it, but, um, yeah, basically the, it says on the paper $500 apparently have to have been paid, but it should be a daily, I, I don't know, I would like to have that reviewed, yes, thank you.
[AGENT][NEUTRAL] Yeah, yes.
[AGENT][NEUTRAL] OK, and yes, ma'am, the callback number you said is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yes ma'am. I'll send a request, uh, so they can review and give you a call back. Is there any particular time would be the best time to call you back?
[CUSTOMER][POSITIVE] No, no, any time is good. I'm not going very many places that for, thank you. Appreciate it. Thank you.
[AGENT][NEUTRAL] Uh, OK. Yes, ma'am, just want to make sure and check, but um they'll review and give you a call back, OK?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][POSITIVE] Thank you so much. You have a great day, Ms. [PII].
[CUSTOMER][NEUTRAL] No, you too bye.
[AGENT][NEUTRAL] Bye.
[AGENT][NEUTRAL] Hey,
[CUSTOMER][NEUTRAL] Hey.
[AGENT][POSITIVE] She was real sweet. She said, yeah, I'd rather call back and just be placed on hold, and she said anytime. So, um, do you want me to give you a callback number, or just go ahead and send that hub request?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, go ahead and give me a call back and I'll just go ahead and look into it so you don't have to submit the hub since I'm aware of it.
[AGENT][NEUTRAL] OK, it's 814.
[AGENT][NEUTRAL] 279-571-6.
[CUSTOMER][POSITIVE] OK, I will take a look at that and try to give her a call back just as soon as I can get it all figured out.
[AGENT][POSITIVE] You rock. Thank you so much.
[CUSTOMER][POSITIVE] Yeah, you're very welcome.
[AGENT][NEUTRAL] I have, and she said anytime is fine. She said she doesn't go anywhere, so.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, if she's got a broken foot, I would imagine not.
[AGENT][NEUTRAL] Yeah, right.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] Alright, appreciate it. Bye.
[CUSTOMER][POSITIVE] Alright, no problem, bye.