AccountId: 011433970860
ContactId: 5f416e82-47d3-41a3-b9ea-3594f999e53d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 920869 ms
Total Talk Time (AGENT): 212307 ms
Total Talk Time (CUSTOMER): 154447 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=-1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/5f416e82-47d3-41a3-b9ea-3594f999e53d_20250407T16:33_UTC.wav
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[AGENT][POSITIVE] Good morning and thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], how are you? This is [PII].
[AGENT][NEUTRAL] I'm fine, thanks. How are you?
[CUSTOMER][NEUTRAL] I'm good, thank you. I have a, a broker on the line. Um, her name is [PII], and she's calling about an accident claim. Um, the policy number is 2446222.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um she's just uh confused about the claim number 3583264. I did read out what we're needing, but she said that um she believes that they send all the information that is needed, so she needs to help understanding why we're still asking for these things or what's the purpose.
[AGENT][NEUTRAL] OK, I'm sorry, what was the claim number?
[CUSTOMER][NEUTRAL] It's 3583264.
[AGENT][NEUTRAL] Is this under, what's the, the part?
[CUSTOMER][NEUTRAL] For [PII], I'm sorry, part 2, part 2. I'm so sorry. Yeah, part 2.
[AGENT][NEUTRAL] OK, and I'm sorry, I'm sorry, can you tell me what the claim number was?
[CUSTOMER][NEUTRAL] I'm sorry, can you repeat?
[AGENT][NEUTRAL] I'm sorry, what was the claim number again for part two?
[CUSTOMER][NEUTRAL] 3583264.
[AGENT][NEUTRAL] OK, give me just a second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Are you ready for her?
[AGENT][NEUTRAL] Oh, I'm still pulling up the information. Um, are you able to tell her to give me just a second so I can pull the information and be able to assist her.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let me put you on hold and go back to her, OK? One moment.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Just let me know when you're ready, OK?
[AGENT][NEUTRAL] OK, I'm just still pulling it up here, the claim.
[AGENT][NEUTRAL] OK, I have everything up, so thank you. um, I'm sorry you said her name was [PII] and do you have a, a callback number?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] OK, great, thank you.
[CUSTOMER][POSITIVE] You're welcome. Here she goes. Thank you.
[CUSTOMER][POSITIVE] Thank you for holding, Ms. [PII]. I got Ms. [PII] on the line for us.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome have a good day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you for holding, this is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi [PII], I was just trying to get um a better explanation of the supporting documents that are needed. Um, when I was on the phone with the employee earlier she seemed a little upset that she saw the claim showed zero amount paid online, um.
[CUSTOMER][NEUTRAL] So I just wanna make sure I have a clear explanation when I give her a call back on.
[CUSTOMER][NEUTRAL] What documents to get because I, I see that we uploaded the first office visit with the diagnosis, then there was um some X-rays done from that visit.
[CUSTOMER][NEUTRAL] So the [PII] was the first visit and the diagnosis and then they had X-rays done and then um.
[CUSTOMER][NEUTRAL] A referral was sent for physical therapy on the following visit, which I wanna say it was in March, yeah, [PII].
[AGENT][NEUTRAL] OK. So I'm looking here, so I see that the the incident occurred on the [PII].
[AGENT][NEUTRAL] Um, and so, so, OK, so I see that we did receive.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, it looks like a summary of benefits, uh, let's see here.
[AGENT][NEUTRAL] OK, do you mind if I take just a quick look and see what we've received. Do you mind if I put you on hold for just another moment?
[CUSTOMER][POSITIVE] Yeah, no problem.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh hey there um you process on accident claims don't you?
[AGENT][NEUTRAL] OK, let me just ask you a quick question. I have a broker on the other line and it looks like this was [PII]'s claim, but [PII] is busy, but she denied it for additional information needed and the brokers wanna know exactly what else is needed. um, can you see my screen?
[AGENT][NEUTRAL] OK. So it looks like this, this was an incident that was um
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I'm just not just to understand exactly what else we need cause I see we have the diagnosis code. We have the bills.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah, so it looks like, yeah, during basketball.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The wellness.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] So all of these are pain, all of these are pain diagnoses?
[AGENT][NEUTRAL] And not, I guess that's not an accident.
[AGENT][NEUTRAL] It's weakness, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I see.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, well I'm gonna go ahead and I'm gonna transfer back over so I can uh let her know this. Thank you so much for your help.
[AGENT][POSITIVE] Thanks bye bye.
[AGENT][NEUTRAL] Uh, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Thank you for holding. I'm so sorry for the amount of time, but I was making sure I was going through everything that we've received. Um, so I do see the documents that we received, we received about a total of 10 pages, um, for that initial claim. And so the additional information that we are needing, uh, so it looks like the diagnosis codes we received were did not um specify an accidental or bodily injury diagnosis.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, which is what we would need for that accident benefit.
[AGENT][NEUTRAL] Um, so that's what, um, the examiner was indicating that we needed, um, just additional information and that would include um any X-ray report, the CT or MRI um results that detailed, you know, the accident, what the accident diagnosis was.
[AGENT][NEUTRAL] Um, uh, it can also include any office notes, admin and discharge summary, you know, if they were admitted or discharged from, um, a hospital or emergency room, um, just basically detailing what the accidental or bodily injury diagnosis was.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Like the diagnosis that we received was just a, an indication of pain. Um, and, and pain it is not an an accidental injury diagnosis.
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] Got it. OK, alright, I will go ahead and get with her and let her know.
[AGENT][NEUTRAL] Uh, sure, Ms. [PII], was there anything else I could do to help you today?
[CUSTOMER][POSITIVE] That was it thank you so much.
[AGENT][POSITIVE] Sure, thanks for calling APL. You have a good day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye bye.