AccountId: 011433970860
ContactId: 574dc78e-d9b7-422f-9d51-dcd582830b03
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 958059 ms
Total Talk Time (AGENT): 267930 ms
Total Talk Time (CUSTOMER): 333763 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/574dc78e-d9b7-422f-9d51-dcd582830b03_20250225T16:58_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII]. I'm calling. I just got a text message saying that like our claims have been processed and they're complete. I don't know if it takes a few a day or two for like any amount to show up for like a reimbursement, but they all say like $0.
[AGENT][NEUTRAL] OK, what is the policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] Um, let me look it up. Hold on just a second.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] 214-501-1
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And Ms. [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK. And.
[AGENT][NEUTRAL] OK. Uh, verify your date of birth and the mailing address, please.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And do you happen to have that claim number?
[CUSTOMER][NEUTRAL] Um, they're in the text messages, yes, uh, 356-774-4 and then the other one is 356-774-6.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] OK. Yeah, so the claims processed today. Give me a moment.
[AGENT][NEUTRAL] Uh, it looks like the claim process is receipt of your claim is acknowledged, however, in order to provide further consideration of this loss. Under this policy, we will need supporting documents to evidence that um the claim was and claim when it would occur. The supporting documents may include but not limited to office notes, medical, hospital admission or discharge summaries or the diagnostic testing results.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So it looks like we need additional talk.
[CUSTOMER][NEUTRAL] I submitted all of that stuff.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's, yeah, that's all there. It's like literally like my X-ray reports from my radiology X-rays and then my discharge paperwork summary and everything from when I had to go to the emergency room.
[CUSTOMER][NEUTRAL] There were 2 separate things that I ended up just filing at the same time.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] It was a claim form for both of those and then the immediate care that I went to, it was their discharge paperwork and the radiology report for the X-ray and then for the hospital, it was my discharge paperwork and the claim form and on the discharge paperwork it said all of the tests and scans that they ran.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, I may have to transfer you to an examiner. Give me one moment, please.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL this is [PII]. How may I help you?
[AGENT][NEUTRAL] I don't need you to is [PII].
[CUSTOMER][NEUTRAL] You don't need me, OK.
[AGENT][NEUTRAL] Did they move the accident, um, hospital indemnity?
[CUSTOMER][NEUTRAL] Uh, I
[AGENT][NEGATIVE] I hope not.
[CUSTOMER][NEUTRAL] Then no, um, actually the hospital accident indemnity is gonna be under claim support right now.
[AGENT][NEUTRAL] Claim support.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And how do I do that or do that um I am?
[CUSTOMER][NEUTRAL] No, um, you.
[AGENT][NEUTRAL] And we do chat, I mean.
[CUSTOMER][NEUTRAL] Uh, on, on the phone you're going to, uh, do the quick connects and then click on claim support.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Claim support. Alright, cool beans. Thank you. Have a great one. All right, bye.
[CUSTOMER][NEUTRAL] Uh-huh. OK.
[CUSTOMER][POSITIVE] You're welcome. You too, [PII]. Bye bye.
[CUSTOMER][NEGATIVE] Suffering.
[CUSTOMER][NEUTRAL] Calling PO, this is [PII]. How may I help you?
[AGENT][NEUTRAL] Hey [PII], how are you doing? It's [PII].
[CUSTOMER][POSITIVE] Hey, good. How are you?
[AGENT][POSITIVE] Good and talk to you in forever.
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] But uh I have an insured on the phone calling about her accident claim. Uh she received a text message and I told her it looks like additional information is needed, and she said, oh, I send all the information they need, they will be.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, what's the policy number?
[AGENT][NEUTRAL] Sorry, 2145011, uh, for part two.
[CUSTOMER][NEUTRAL] OK, oh, let's see what we have here.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] See what we received.
[AGENT][NEUTRAL] How's your, I wanna say your baby. She's not a baby anymore, is she?
[CUSTOMER][NEUTRAL] Not anymore, but I still see her as my baby.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] They're always going to be our baby.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] But she's doing good. How about yours?
[AGENT][POSITIVE] Oh, he's good. He's gonna get a haircut today. He needs it so bad.
[AGENT][NEUTRAL] He was starting to look like, well, he has a fro, and it's like super high.
[AGENT][NEUTRAL] Oh, he has his hair.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So he needs to get it. He's gonna, uh, he wants to get it cut into a faux hawk.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][MIXED] It should be cute. He had it before. His dad used to cut his hair like that long time ago, so he really needs a haircut. It just, it gets so long that it, it irritates his ears and all that stuff.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] A little turkey.
[CUSTOMER][NEUTRAL] So I see we got the claim form and then we got, what is this here aftercare summary.
[AGENT][NEUTRAL] And she's
[AGENT][NEUTRAL] Yeah, and it, and I was looking at that, but it didn't um
[AGENT][NEUTRAL] I didn't see anything as far as saying an injury besides just her claim form.
[CUSTOMER][NEUTRAL] Well, I see here it has a head injury or contusion, but I see we're requesting, uh, we're needing evidence that an accident occurred.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So that's what we're requesting like um office notes, the admin dis summary, diagnostic testing, or even medical records, something that's gonna let us know that.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] An accident occurred cause based off his diagnosed, it looks like maybe they maybe he had an injury because of their sickness.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And if that's the case, it wouldn't be covered.
[AGENT][NEUTRAL] And she had two claims, uh, one ending in 44, the other one ended 46.
[CUSTOMER][NEUTRAL] Uh let me glance, let's see.
[CUSTOMER][NEUTRAL] OK, that that's what I'm looking at the 461. OK, let me look at the 44. Let me pull that one up real quick.
[CUSTOMER][NEUTRAL] OK. Then when she sent us, it just gave us a diagnosis of neck pain and that doesn't indicate that an accident occurred. So yeah, yeah, we're needing supporting documentation that an accident did occur.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] This was missing, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Alrighty then, she gives me 2 that I call back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye.
[AGENT][NEUTRAL] Uh, Ms. [PII], I'm so sorry for that delay. I just spoke with an examiner and she is stating that they are needing support documents such as like medical notes or doctor's notes or ER notes or records or billing to indicate an accident because the diagnosis doesn't indicate a bodily injury.
[CUSTOMER][NEUTRAL] For which one?
[AGENT][NEUTRAL] Uh, for both.
[CUSTOMER][NEUTRAL] OK, the one that I submitted, I was abs like I was transported to the emergency department by ambulance because I fell and hit my head. I had CT scans of my brain. I hit my hip. I had an X-ray of my hip, and then a CT scan of my hip because the X-ray was like inconclusive and how is that not an injury or a fall?
[CUSTOMER][NEUTRAL] And then the other one, I actually have it on camera from my ring camera on my driveway from when I slipped and fell on ice, in which I went to the immediate care because I was having neck and back pain and numbness and tingling to both of my hands.
[CUSTOMER][NEUTRAL] So they gave me an x-ray of my cervical spine.
[AGENT][NEUTRAL] I understand, but based on the diagnosis, they are needing those additional medical notes or um
[AGENT][NEUTRAL] Discharge summary.
[AGENT][NEUTRAL] Am discharge summary.
[CUSTOMER][NEUTRAL] I did submit the discharge summaries. You have both of the discharge summaries.
[AGENT][NEUTRAL] I understand.
[AGENT][NEUTRAL] But the information is like medical notes um from the doctor or the uh places service.
[CUSTOMER][NEUTRAL] What else do you need?
[CUSTOMER][NEGATIVE] And how am I supposed to get that? I've submitted, I've submitted this before. I've never had to go through and actually submit any kind of doctor's notes because we don't have access to that.
[AGENT][NEUTRAL] OK. Let me let you speak with the examiner and she can explain it to you. Hold on one moment, please.
[CUSTOMER][POSITIVE] That would be great.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Blessed all the bless.
[CUSTOMER][NEUTRAL] Sing.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], I have an insured on the phone calling about a claim, um, her claims that were processed where we are requesting additional information and I tried to explain that we were needing like medical notes or records or additional documents for her claim, and she just wanted to speak with an examiner.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, what's the policy number?
[AGENT][NEUTRAL] 214501-1.
[CUSTOMER][NEUTRAL] OK, give me just one second to get over there.
[CUSTOMER][NEUTRAL] Um, is it the most recent ones that were done in December?
[AGENT][NEUTRAL] Uh, yeah, the one that, uh, it's for her, part two, and it's uh claim number ending in 44 and 46.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, so it's for part two.
[CUSTOMER][NEUTRAL] 44 OK alright let's see.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Supporting documentation.
[CUSTOMER][NEUTRAL] Oh, so what do we get?
[CUSTOMER][NEUTRAL] I don't know
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, I'm getting these claims pulled up so I can see what we have versus what we need.
[CUSTOMER][NEUTRAL] OK, I have those claims pulled up.
[AGENT][POSITIVE] Awesome sauce. I appreciate you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Alright, bye.
[CUSTOMER][NEUTRAL] All right. Bye.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How