AccountId: 011433970860
ContactId: 55204395-92dc-47d8-a9b4-9e6a5567b08e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 353510 ms
Total Talk Time (AGENT): 100794 ms
Total Talk Time (CUSTOMER): 225071 ms
Interruptions: 3
Overall Sentiment: AGENT=2.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/55204395-92dc-47d8-a9b4-9e6a5567b08e_20250123T21:44_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, um, I have an accident policy.
[CUSTOMER][NEUTRAL] There and I just have some questions about filing a claim.
[AGENT][NEUTRAL] OK, can I get your name please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, [PII], can I get a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you [PII]. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, 246-876-4.
[AGENT][NEUTRAL] OK, and [PII], can you confirm your date of birth, your address, and your email address for me?
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[CUSTOMER][NEUTRAL] My address is [PII].
[CUSTOMER][NEUTRAL] And my email address is [PII].
[AGENT][NEUTRAL] OK, thank you and you said you have questions about filing a claim, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] OK, I can definitely help.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] So I have a claim form.
[CUSTOMER][NEUTRAL] Section D benefits claimed.
[CUSTOMER][NEUTRAL] Is that accidental injury?
[CUSTOMER][NEUTRAL] Or accident medical expense benefit.
[CUSTOMER][NEUTRAL] Should accidental injury, I guess.
[AGENT][POSITIVE] Yes, ma'am, that is correct.
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEGATIVE] Accidental injury.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what exactly?
[CUSTOMER][NEUTRAL] So it's accidental injury provide an itemized medical bill. Is that what I need on what the instructions say I would just like to know what I need to submit. I have um.
[CUSTOMER][NEUTRAL] You know I can get information from uh my online portal, the chart, my charts.
[CUSTOMER][NEUTRAL] Online portal.
[AGENT][NEUTRAL] Uh-huh. Yeah, did you go to the ER like, do, what kind of doctor did you go to? Let me ask you that.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um, I first went to urgent care.
[CUSTOMER][NEUTRAL] On a Sunday morning.
[CUSTOMER][NEGATIVE] On Saturday, late afternoon, evening, I fell, slipped getting out of the bathtub.
[CUSTOMER][NEGATIVE] Tried to break my fall. I ended up breaking my thumb and bruising some injuries.
[CUSTOMER][NEUTRAL] So first place I went was urgent care.
[CUSTOMER][NEUTRAL] They took X-rays and diagnosed.
[CUSTOMER][NEGATIVE] Uh, that I fractured my thumb.
[CUSTOMER][NEUTRAL] From there
[CUSTOMER][NEUTRAL] Uh, the next day, on Monday, I saw an orthopedist hand specialist, um,
[CUSTOMER][NEUTRAL] They also took X-rays, confirmed that it was broken, had put it in a splint.
[CUSTOMER][NEUTRAL] Um, I'm still wearing the splint. Uh, I've had a follow up.
[CUSTOMER][NEUTRAL] On [PII] and took X-rays. Um, it looked like it might possibly need surgery. He had me do a CT, decided surgery may not be necessary, so I'm continuing to wear this splint, and he's checking it again on the [PII]. So that's basically my history.
[AGENT][NEUTRAL] Oh my goodness. Sounds like you've been through it. I hate that. I'm so sorry.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yes, and so I just want to send this in. I don't know I I just don't want to go on a deadline and at least get this going.
[AGENT][POSITIVE] Right, no, I completely understand. Um, either or. So if you can get the itemized billing that has the diagnosis codes on it, that would be great.
[AGENT][NEUTRAL] Or if you can get the medical records for each visit, that's fine too. So either or.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So if I get the medical records for what each event?
[AGENT][NEUTRAL] Each visit, yes, ma'am.
[CUSTOMER][POSITIVE] I, I, each visit I can get that probably quicker than I can get.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] The itemized bills, yes.
[CUSTOMER][NEUTRAL] The bills because I have not received yeah I haven't seen any of that yet.
[AGENT][NEUTRAL] OK, yeah, if you can get the medical records for each visit, um, that would be fine.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK and then can I just upload those and do all this online? I actually printed the claim form and start filling it out, but what's the best way for me to do it?
[AGENT][NEUTRAL] Yeah, you can do, you can do everything online, you can fax it in or you can mail it in, whichever one's your preference.
[CUSTOMER][POSITIVE] OK, that's what I'll do. I will get these everything together this evening and probably try to just do it online and be done easiest.
[AGENT][POSITIVE] Yes, ma'am. That typically is the easiest. Yes, ma'am.
[CUSTOMER][NEUTRAL] So I can just upload the.
[CUSTOMER][NEUTRAL] Yeah, I can just uh should be able to just upload the forms from each visit.
[AGENT][POSITIVE] Yes, ma'am, that is correct.
[CUSTOMER][NEUTRAL] now.
[CUSTOMER][NEUTRAL] Now, so this happened in December. I did CT and stuff in January. Do you want me to send the CT uh results and.
[CUSTOMER][NEUTRAL] Follow up visit with the.
[CUSTOMER][NEUTRAL] Orthopedist also?
[AGENT][POSITIVE] Yes, I would send in everything, everything that you have, um, that's what I always tell insured, um, I would go ahead and send everything and the worst case scenario, we can tell you you don't have the benefits available or the benefits have been maxed. That's what I would do.
[CUSTOMER][NEUTRAL] I'll just
[CUSTOMER][NEUTRAL] Everything that I can get. OK.
[CUSTOMER][POSITIVE] OK, OK, sounds perfect, thank you so much I appreciate it uh huh.
[AGENT][NEUTRAL] Um, another thing, on that claim form, since you are sending in the medical records, don't worry about the physician's statement. You don't have to have the physician fill that out since you are sending in the medical records.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh good.
[CUSTOMER][POSITIVE] Good thank you because I did have that question also, but you ain't that that helps me. Thank you so much. I appreciate it.
[AGENT][POSITIVE] Yes ma'am well thank you for calling APL. If there's nothing else I can do for you, have a great day.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Thank you, you also.
[AGENT][NEUTRAL] All right, bye-bye.
[CUSTOMER][NEUTRAL] All right, all right, bye bye.