AccountId: 011433970860
ContactId: 569da9ec-003b-4cab-946b-70f439e31c08
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 526539 ms
Total Talk Time (AGENT): 282280 ms
Total Talk Time (CUSTOMER): 240840 ms
Interruptions: 6
Overall Sentiment: AGENT=0.3, CUSTOMER=-1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/569da9ec-003b-4cab-946b-70f439e31c08_20250226T17:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. You're speaking with [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hey [PII], um, I have [PII] with the broker's office calling about a claim status for a patient, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Policy number 243-5155.
[CUSTOMER][NEUTRAL] And I tell her it looks like on this, oh, it's just for part 4.
[AGENT][NEUTRAL] OK, let's go to 4, OK.
[CUSTOMER][NEUTRAL] And I told her it looks like we were needing additional information, but she is stating that they have already sent that and want some um help as far as this claim.
[AGENT][NEUTRAL] OK. Let me see, let me see what that, that denial saying.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And this is done by [PII]
[AGENT][NEUTRAL] Let's see what she needing.
[AGENT][NEUTRAL] Uh, need itemized bill. OK, I need itemized bill.
[AGENT][NEUTRAL] Or medical records for your claim receipt or your claim is not need automatic bill or medical records for your claim receipt of your claim. I have, in order to provide further consideration of your claim, we need the itemized bill for treatment receipt and medical records for this date of service. OK. Uh, let me go over to the claim, which, and this is [PII] with the broker office.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, I, I would speak with and tell them what, what, uh, you know, you're saying that they would know, saying tell what they need. OK. You can let me speak to him.
[CUSTOMER][POSITIVE] Awesome. Thank you, Ms. [PII]. Have a great day.
[AGENT][POSITIVE] OK, thank you, [PII].
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] My name is [PII] and I'm in the claims department and you're calling in reference to uh a cancel policy claim on Mr. [PII].
[CUSTOMER][NEUTRAL] Yeah, it's a critical illness claim.
[AGENT][POSITIVE] Uh-huh, yes, uh-huh. And, uh, you, how can I help you with today?
[CUSTOMER][NEUTRAL] Well, because I mean documents were sent over there were 9 documents sent over to the care team at [PII] on [PII]. That's been two weeks ago.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] She's received no communication.
[CUSTOMER][NEUTRAL] I mean, there's bills there, everything from the hospital.
[CUSTOMER][NEGATIVE] Uh, I don't know why claims with you guys take so long.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And are so confusing.
[AGENT][NEUTRAL] Now I see a claim came in our office on [PII] and we processed this is on part 4 on [PII] and we processed a claim on [PII]. We haven't received anything on [PII] since we processed that claim on [PII] asking for the itemized bills and the medical records for that data.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, yes, you have. I sent on [PII], which is now almost two weeks ago, I sent over to the care team at [PII] all of the documentation. She has submitted this several times. I've submitted it now you're telling me you don't have anything.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, on file we don't. Now I can get with the care team over in that area and ask them did they receive an email on [PII] for this person, but in the system we don't have anything new since we processed. OK.
[CUSTOMER][NEUTRAL] 000, OK.
[CUSTOMER][NEGATIVE] OK, but my point of it is, is that not who I'm supposed to send this to? I mean, if it goes to them and there's documents in there and then, I mean, obviously what are they doing? They're just sitting there holding the stuff?
[CUSTOMER][NEGATIVE] Like, like I said, this is upsetting.
[AGENT][NEUTRAL] I, I can, I can't say, but, but usually claims come through by fax, mail, mail, mail, fax, or upload on our system, or it goes to that care team uh email uh address. So usually when they get that email they respond back letting whoever they sent the email know that we thank you for your email. So did y'all get anything like that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Yeah I'm sure that I did. I, I don't know. I'm really upset you this has not been anything with you guys and this group has not been good. It has not been good with claims. I don't know what happens over there, but I'm.
[CUSTOMER][NEGATIVE] It's, it's not good. I mean we.
[AGENT][NEUTRAL] Well, Ms. Ms. [PII], I can, I can check with the care team to see do they have that email that you said you sent on [PII] and
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes, and, and when you do.
[CUSTOMER][NEGATIVE] You please ask them why it was not given to the claims team and we're now 2 weeks behind on it.
[AGENT][NEUTRAL] I will find out if they got it and can I get your phone number? I can give you a call back if they say they got it.
[CUSTOMER][POSITIVE] Uh, um, I, I'll be happy to wait.
[AGENT][NEUTRAL] Oh, no, I, I have, I have to, I have, I have to get, I can't get, well, I can try to get back to them, hold on, but go ahead.
[CUSTOMER][NEGATIVE] I need to get this resolved.
[CUSTOMER][NEUTRAL] OK, so, so I, what do you what's your email? I will forward all of this to you right now.
[AGENT][NEGATIVE] You can't, you can't send anything to the adjuster. You can't send anything to the adjuster. It has to be faxed, mail, uploaded on our system.
[CUSTOMER][NEUTRAL] Of course not.
[CUSTOMER][NEUTRAL] OK, alright, I'm gonna uh, uh, OK, what is a good fax number because I'll go ahead and do that that way, you know what, I guess if you guys get things several times you get things because you paid nothing on this claim yet, correct?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, ma'am. Nothing has been paid on this on this claim yet. Our fax number, Ms. [PII] is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] put attention claims department.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And Ms. [PII], what is your phone number? I can give you a call back when I get over with the care team to find so they can research to see did they receive an email from you on [PII].
[CUSTOMER][NEUTRAL] Yeah, my phone number is [PII].
[AGENT][NEUTRAL] Alright, [PII]. So I will give you a call back and find out that they received an email from you on [PII] on this insured and I'll give you a call back, OK?
[CUSTOMER][NEGATIVE] OK, I'm also faxing this information, but again I I mean I I'm not, I'm not happy about.
[AGENT][NEUTRAL] Well, Ms. [PII], when, when it comes when a fax come in our office, it takes uh 24 to 40 hours for them to get faxes set up in the system. Now it can be uploaded, but it it it be uploaded on our website and it's, you know, since you're a broker, you should have access to get set up on there and upload it on the website also.
[CUSTOMER][NEUTRAL] We've had issues with that. They have, they've had a couple of, yeah, yeah, like I said this whole process with you guys has not.
[AGENT][NEUTRAL] OK, all right.
[CUSTOMER][NEGATIVE] I've never dealt I deal with all kinds of carriers and claims and I have never had as many issues with anything being received anything being processed, any correspondence it's, it's by far terrible and just like that it was sent to the care team. The care team should have done something and we're now 2 weeks.
[AGENT][NEUTRAL] Um, yes, ma'am.
[CUSTOMER][NEGATIVE] And they still haven't done anything.
[AGENT][NEUTRAL] All right. Well, let me get over there with the care team and speak with them and I'll give you a call back regardless one way or the other, if they say they got it or not, I will give you a call back, but in the meantime, you can fax it to uh to that fax number. OK. All right then. All right.
[CUSTOMER][NEGATIVE] That's terrible.
[CUSTOMER][NEUTRAL] Yep, and what
[CUSTOMER][NEUTRAL] I already faxed it.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] And, and what was your name?
[AGENT][NEUTRAL] My name is [PII]. I'm in the claims department.
[CUSTOMER][NEGATIVE] OK, because I mean I'm telling you right now this group is getting really close to when anything comes up considering not using you guys anymore and dropping coverage because it's just all of their stuff with claims has been terrible and has not been good for them so we need to we need to get that, you know, on your end we need to fight figure out how we can get that streamlined much, much better.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, ma'am. I will pass that information on, OK?
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][POSITIVE] Thank you, thank you for calling American Public Life, and you have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah.