AccountId: 011433970860
ContactId: 5a85f205-c8cd-4243-aac1-f758b6a8f709
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 686580 ms
Total Talk Time (AGENT): 246173 ms
Total Talk Time (CUSTOMER): 192478 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/5a85f205-c8cd-4243-aac1-f758b6a8f709_20250303T16:06_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. I'm calling regarding my late son [PII]. Um, he passed on, on [PII]. I'm calling for the accidental insurance section. I was listed as beneficiary.
[AGENT][POSITIVE] OK. Um, well, first, I'm sorry for your loss. Um, I'll be more than happy to help you. May I have your name and a good contact number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Number 786.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. and Ms. [PII], um, do you have the policy number or I can search it with the social?
[CUSTOMER][NEUTRAL] I have the policy in front of me. Let me grab my glasses one moment.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Sure, take your time.
[CUSTOMER][NEUTRAL] I had already sent in um a form. I spoke with a rep a few weeks ago. She was very polite um I sent back some forms on the policy 02570546.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, hold on one moment let me pull that up.
[AGENT][NEUTRAL] And OK, so I do see you sent some documents and it looks like last week, the [PII] looks like we received.
[AGENT][NEUTRAL] There's a claim here that
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh-huh, yeah, I faxed over and I also mailed in the originals, yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So I see it here. And do you mind if I place you on just a brief hold? I'm just looking at the claim for the decision. OK, hold on one moment.
[CUSTOMER][POSITIVE] No problem
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What now, temporary pending for claims in-house use only.
[AGENT][NEUTRAL] OK, is there anything in the notes?
[AGENT][NEUTRAL] Nope.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Not.
[CUSTOMER][NEUTRAL] Sorry
[CUSTOMER][NEUTRAL] Thank you for calling American Public Life. This is [PII]. Who am I speaking with?
[AGENT][NEUTRAL] Hey [PII], this is [PII] on the care team. How are you doing?
[CUSTOMER][POSITIVE] I'm doing good how are you?
[AGENT][MIXED] I'm doing good. I hope I'm doing this right, OK, so it's not.
[AGENT][NEUTRAL] Cancer, it's an accident policy, but I really just have a quick question. What does temporary pending for claims mean on the remark code?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] OK, let me see what kind of what's the policy number?
[AGENT][NEUTRAL] OK, um, it's 257-054-6.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, they're waiting for the the vendor to be added.
[AGENT][NEUTRAL] Waiting for the like the provider?
[CUSTOMER][NEUTRAL] Yeah, it says I want.
[AGENT][NEUTRAL] Can I tell them that?
[CUSTOMER][NEUTRAL] Uh, give me one second, let me just pull the claim just to make sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This is the um, the well, the insured's mom, the insured passed away.
[CUSTOMER][POSITIVE] Oh goodness, let's see.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII] she's got it pended.
[CUSTOMER][NEUTRAL] Oh, it's an insured claim. So why does she have a pending? Give me one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] I'm gonna check back with her.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. I just want to check back with you. I'm on the other line with claims. They're looking at the um claim with me to give me an update for you.
[CUSTOMER][POSITIVE] No problem thank you.
[AGENT][POSITIVE] You're very welcome. It'll be just a few more moments, OK?
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You are on
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So if I see this remark code again, did I do the right thing or am I supposed to know what this means? Because I tried to look.
[CUSTOMER][NEUTRAL] No, no, you're good, uh, usually we that's an in-house pin that means she's waiting for either vendors to be added or she's waiting for some kind of um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] She's waiting for something. That's why it's just being on a, a quick hold. Uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it, it doesn't really mean a whole lot but I'm asking her right now like what is it that why is it being held so she could tell me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it's just an in-house pin so that way a uh what's it called EOB won't be printed.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, it's because they're needing additional information, so, uh, [PII] was trying to get additional info to process the claim. I will deny today for major medical EOB. OK, so we're needing major medical EOB.
[AGENT][NEUTRAL] So am I
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Alrighty, thank you.
[CUSTOMER][NEGATIVE] No thank you appreciate it.
[AGENT][POSITIVE] All right, have a good day.
[CUSTOMER][POSITIVE] You too babe.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, thank you for holding. So it's um still in processing, but she said from what she can see, they do need the um explanation of benefits from the primary insurance. So if you have that, I will go ahead and send that in, um, so that they can continue processing.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] What did
[CUSTOMER][NEUTRAL] What is, what is it you need again?
[AGENT][NEUTRAL] The the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] The who?
[AGENT][NEUTRAL] Whoever his insurance, his medical insurance was with.
[CUSTOMER][NEUTRAL] Oh AdMed.
[AGENT][NEUTRAL] So AMed has a, let me go back to the date. Hold on one second, I'll tell you exactly what you need.
[CUSTOMER][NEUTRAL] Do you guys contact Admin or I have to find I have to contact Admin?
[AGENT][NEUTRAL] Yeah, they won't let, so this is a, will be considered a third party. So we'll need release of information and all of that. They, they're not going to release it to us as an insurance, but they will release it um to you all. So we'll just need an explanation of benefits from AdMed for data service.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Of [PII] and [PII].
[CUSTOMER][NEUTRAL] So I will call admin asking for an explanation of benefits.
[AGENT][NEUTRAL] Mhm. So you, so you'll call admin and say um,
[AGENT][NEUTRAL] I'm I'm filing an insurance claim and they're requesting an explanation of benefits and it's actually [PII] and [PII]. I just noticed that date range there.
[CUSTOMER][NEUTRAL] Yeah, he passed on the [PII] and he went and the accident was on [PII].
[CUSTOMER][NEUTRAL] [PII], right? That's what you have there.
[AGENT][NEUTRAL] Yes, ma'am. [PII].
[CUSTOMER][NEUTRAL] Oh to [PII].
[AGENT][NEUTRAL] Mhm. And then [PII].
[CUSTOMER][NEGATIVE] Question, so the medical bills, they sent a whole, I had requested the medical bills from [PII], that's not what you guys wanted.
[AGENT][NEUTRAL] No, so medical records is different than the billing. So, the billing, you're just going to reach out to the billing department and ask them for those dates of service. They usually email it to you and then you can just upload it. Um, medical records is totally different. You, you'll have to sign for the release and all of that and then they'll probably put on a disk or something.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] That's what I thought.
[CUSTOMER][NEUTRAL] Yeah, that's what I mailed in. I thought that's what you guys needed. OK, so call admin. OK then, let me work on that.
[CUSTOMER][POSITIVE] Thank you so much for your time. OK.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] So when I get that, do I fax it or mail that in?
[AGENT][NEUTRAL] Um, it's up to you. You can fax it, you can mail it, or you can um upload it. Well, the policy is not active anymore. So yes, you can fax it or mail it.
[CUSTOMER][POSITIVE] OK, alright, thank you kindly. OK, thank you.
[AGENT][POSITIVE] You're very welcome. Thanks for calling APL.
[CUSTOMER][POSITIVE] You're welcome bye.
[AGENT][NEUTRAL] Bye-bye.