AccountId: 011433970860
ContactId: 5f45760c-0ccc-4171-833e-3cdd97f5c8f2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 661349 ms
Total Talk Time (AGENT): 221252 ms
Total Talk Time (CUSTOMER): 323027 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/5f45760c-0ccc-4171-833e-3cdd97f5c8f2_20250513T14:14_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, this is [PII] over on the care team. How are you today?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][NEUTRAL] Doing good thank you so I've got a member on the line who is calling regarding an accident claim um and it is stating that we're needing the uh police report for the incident. She stated that when she spoke with them they're unable to give her anything as they don't know who did it. um, she said she does have a report number.
[CUSTOMER][NEUTRAL] So I'm gonna be I don't know how that works. Um, I'm assuming if there's a report number there is at least some sort of report. So do we have to wait for that to be completed and all of that, or is what she has, would that be sufficient?
[AGENT][NEUTRAL] Can I get her policy number please?
[CUSTOMER][NEUTRAL] Absolutely, um, that is 02449508.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And we are speaking with part one, the claim is for, uh, part 3.
[AGENT][NEUTRAL] OK, give me 1 2nd.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] One second, I'm just reviewing the notes.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so it looks like she's already been told that we can't use that.
[AGENT][NEUTRAL] So she's she's just gonna have to wait until she gets the report. The claim will just be in a.
[CUSTOMER][NEUTRAL] The completed report.
[AGENT][NEUTRAL] Yes, the claim would just be in an inactive status until then.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, you, you wanna tell her or you want me to, to speak with her?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Um, that's completely up to you. Um, because I'm not sure she might have further questions, but that's, I appreciate you letting me know that because that's, I've not run across this before, so I wasn't sure what to tell her. Um, yeah, I can go ahead and send her to you if you don't mind just in case she has anything further.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, that'll work.
[CUSTOMER][POSITIVE] All right thank you I appreciate it. All right, bye bye.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Bye bye.
[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] on on hold with uh someone else who was looking into a claim for me.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And who am I speaking with?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you Ms. [PII]. OK, she transferred you over to me so that I can uh assist you further. Uh, she stated that you were calling about the police report that we requested from you and you stated that you have the report number, um, and you want to know if that would work is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes ma'am.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] But that's what I, I mean, I told her I couldn't get the report and all I had was a number that they put on the paper that they gave me saying they couldn't give me a report.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright, and so um it looks like we, we are gonna need that report so uh whenever they finish the investigation.
[AGENT][NEUTRAL] Um, then they can go ahead and submit that you can just submit that police report to us.
[CUSTOMER][NEGATIVE] They're telling me that they can't.
[CUSTOMER][NEUTRAL] Complete the investigation because they don't know who did it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We have to have the police report so that we can move forward.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So is that with all of his claims because he was re-hospitalized, he got shot in November.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] He stayed in the hospital for those days or whatever. Then he went back and forth. Then he was re-admitted in January. So the re-admit in January still needs the police report.
[AGENT][NEUTRAL] Uh, if it's all related to the um.
[AGENT][NEUTRAL] To the act to that shooting.
[CUSTOMER][NEUTRAL] Because it was a wound infection.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Being that it was a wound infection from the gunshot, so he still wouldn't need the police report.
[CUSTOMER][NEGATIVE] And they're telling me they can't give me a police report because they don't, they can't complete the investigation because they don't, he was just riding down the street. They don't even know who shot him.
[AGENT][NEUTRAL] OK, so if you submit the information for the wound infection, you can submit that claim information to see if they would pay it, uh, because it, it would depend on the diagnosis code that they use on the claim.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh, give me one second.
[CUSTOMER][NEUTRAL] The diag
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] I never, I never submitted that because I didn't want to give y'all all that at one time.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Cause the, the, on the wound, cause I have the papers for the wounding section.
[CUSTOMER][NEUTRAL] They have it as not healing surgical wound.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's what diagnosis they have for that. They don't have.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And so that's what I was looking to see if that would be, you know, considered part of the accident because if it's uh.
[AGENT][NEUTRAL] I know it's due to
[AGENT][NEUTRAL] The shooting
[CUSTOMER][NEUTRAL] Yeah, what you need though? Can, can you look it up by the diagnosis code cause I have the diagnosis code.
[AGENT][NEUTRAL] Yeah, I mean, um.
[CUSTOMER][NEGATIVE] Cause if not, I'm submit all this information if it's not gonna be paid um.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So you want the diagnosis code?
[AGENT][NEUTRAL] I mean just for the uh I mean just for the hospital stay that you say he went back in January?
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] So if you submit that information.
[CUSTOMER][NEUTRAL] Yeah, yeah, it is.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] The bone infection, I know it's cold.
[AGENT][NEUTRAL] That
[CUSTOMER][POSITIVE] I'm looking at the people. I'm sorry.
[AGENT][NEUTRAL] Oh no, you're fine. I mean we we would actually need the paperwork anyway just to uh determine if we can pay it but I'm trying to see if there's any follow up benefits for.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Something like a wound infection.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] See that's why I didn't want to send all of it in at one time. I wanted to do one thing at a time cause I didn't want it to get all crossed and confused like.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because he was back and forth in the hospital.
[AGENT][NEUTRAL] Yes, so it looks like all of the hospital admission benefits and the hospital confinement benefits, they uh have to be due, due to the result of a covered accident. So if they're not that diagnosis code, um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Possibly, um, they're gonna consider it a sickness, even though it's related to the accident. It's gonna depend on how, how they call it.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] what they quote it was, they called it as the assets of the right lower extremity.
[CUSTOMER][NEUTRAL] Then they still also put gunshot wound of right thigh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So they have both of the codes on them.
[AGENT][NEUTRAL] OK, OK, as long as that code is on there.
[CUSTOMER][NEUTRAL] The uh as long as the gunshot wound is on that they're not gonna pay it though.
[AGENT][NEUTRAL] No, as long as the gunshot wound is on there that we still need the um police report once they finished that, yeah, once they finish that investigation, and I'm, I'm sorry, I know sometimes investigations can take long, a long time.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] But uh,
[CUSTOMER][NEUTRAL] Those people I haven't talked to.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEGATIVE] And every time I try to call, I, I said I haven't talked to them since November, ever since my son was shot. And every time I call I get no answer and when I went up there, it was in January and that's what they gave me. So looks like I'm not getting paid for this.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Yeah, and you even told them that you needed to file insurance and they still didn't give you anything?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Yeah, they gave me that paper. He wrote up a paper, the paper that I sent in with the um sheriff's office name, his name, he said they needed a thing called Lieutenant [PII] at the front desk. And on the report, he put a report number on the paper that he gave me. He gave me a report number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And he said, and this letter is to clarify that the incident did occur, but
[CUSTOMER][NEUTRAL] Uh, the, the, the case report cannot be.
[CUSTOMER][NEUTRAL] Uh, just, just made it due to the time due to the active investigation, so they can't give me nothing, he said.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All he could give me was the report number. You can't give me the actual report itself.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, that's uh
[CUSTOMER][NEUTRAL] So there wasn't no self-inflicted weed.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, yeah, that looks like that's what we're needing is that actual report, and I do apologize.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Well, I'll try to go back over there when I'm off, but they see if they could give him. How long do I have with this claim or I have to.
[AGENT][NEUTRAL] OK. There's no, there's no time.
[AGENT][NEUTRAL] Whenever you get it you can send it in and we'll still uh.
[AGENT][NEUTRAL] You know, review it for payment.
[AGENT][NEUTRAL] Because it was it it's because it happened within the time that his policy was active, so there's no time limit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And um
[CUSTOMER][NEUTRAL] They don't make sense to the other, the hospital stay because like I said, if it's a, if it's a gunshot wound, it's still gonna be in the report for that.
[AGENT][NEUTRAL] I'm sorry, can you repeat that?
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] I said it don't make sense for when he back, when he went back into the hospital in January because it's still on, it's still his diagnosis on his surgery report is still saying on show.
[AGENT][NEUTRAL] OK, well if that says gunshot wound that's gonna be pending for uh the police report as well.
[CUSTOMER][NEGATIVE] That's why I said don't make sense for me to sit today.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll try and see if I can get something else from them, but.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. As long as I know it don't expire because he's about to be [PII], so he's gonna be off my insurance next month.
[AGENT][NEUTRAL] Um, but that's still not gonna matter as long as it occurred while he was covered under the policy, we can still uh pro review it the benefits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] OK. All right. Thank you so much. I appreciate it.
[AGENT][POSITIVE] You're welcome and you have a great rest of your day.
[CUSTOMER][NEUTRAL] You do the same. Bye-bye.
[AGENT][NEUTRAL] OK, bye bye.