AccountId: 011433970860
ContactId: 644fbe36-bc26-41ef-a18b-0629586d57e6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 795650 ms
Total Talk Time (AGENT): 376105 ms
Total Talk Time (CUSTOMER): 180556 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/644fbe36-bc26-41ef-a18b-0629586d57e6_20250509T20:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Oh, [PII], it's [PII] and the care team. I've got an insured on the line calling on claim status, and I'm not sure what's going on with the claim, so I was gonna see if you could help them or help me, um, if it's an easy explanation.
[AGENT][NEUTRAL] Certainly
[AGENT][NEUTRAL] [PII], what's the uh policy number?
[CUSTOMER][NEUTRAL] It's 711167.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me take a look here.
[AGENT][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] Yes, and it's for her spouse they're in the car together, um, I verified her information.
[CUSTOMER][NEUTRAL] It's for [PII]. There's 3, there's three claims in there that have a stat date of [PII], but and and it shows a potential payout of over 11,000.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] But we received them on [PII] and nothing's been done so I don't, and there's no comments by the radiation charges so I don't understand what's what's happening.
[CUSTOMER][NEUTRAL] That's what they're questioning is the radiation, um.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, I'm not sure what's going on with that. The [PII] usually means that it's.
[CUSTOMER][NEUTRAL] And processing, but that's really old.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I mean I know your turnaround faster than that so.
[AGENT][NEUTRAL] We might need
[CUSTOMER][NEUTRAL] I just didn't know what to tell her.
[AGENT][NEUTRAL] Right, and then I see another one that was processed for radiation that was for the March services. It looks like that one processed.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Yeah, we got, we got the one that processed [PII], um, and it says it's denied for [PII], but.
[CUSTOMER][NEGATIVE] But I, and then also what was throwing me off was on the policy certificate it says.
[CUSTOMER][NEUTRAL] Actual charges to 15,000, so I, I'm assuming you'll pay out 15,000 on the policy and that's my assumption.
[CUSTOMER][NEUTRAL] I don't.
[AGENT][NEUTRAL] So it looks like that one that's pending is just not been released, I'm guessing.
[AGENT][NEUTRAL] So I'm not sure why I would probably have to reach out to the adjuster looks like because I'm not sure on that to me, because like what that looks like to me is it's in the final processing stage but it's not been released. But like you said that that date is, I don't know when she processed it.
[AGENT][NEUTRAL] Um, it looked it to me if I was looking at it right now without you, it would, I would tell me that it's been sent to audit basically so like that for that amount that adjuster can't release it so she sent it to audit and it's up to the auditors to release it.
[CUSTOMER][NEUTRAL] Yeah, and what
[AGENT][NEUTRAL] Is the way it looks at this point because it doesn't show there's been any check or any direct deposit authorized as of yet, but with that uh 11-1900 data in there that shows me that it's like in that process and it, it most likely went to audit and it's waiting. Let me see if I can find the status this way. Bear with me for just a moment.
[CUSTOMER][NEUTRAL] OK, it's just she's, uh, just concerned or a little she she called last Friday. It's been a week, um, she talked to one of somebody else on the care team. I'm sure they sell the same thing I did, so they were like, give it another week, um, because we've got notes in there from another care team member from last Friday telling her, yeah, it's in processing you should get it by next Friday so.
[AGENT][NEUTRAL] So it's been in that status since then you think?
[CUSTOMER][NEUTRAL] Uh it's been in that status since [PII], so it's been, does it typically take the auditor seven days or a week to.
[CUSTOMER][NEUTRAL] Release
[AGENT][NEUTRAL] Not usually and that's what I'm looking at now to see if there's any notes because usually they'll tell me what queue it's in.
[AGENT][NEGATIVE] When you pull it up by the mail number but it's not, it's not telling me that's where it's at, so it's almost like it's kind of lost in.
[AGENT][NEUTRAL] Well somewhere
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And from what I'm seeing when I pulled the mail, it looks like it's completed, so.
[AGENT][NEUTRAL] I guess the best thing we could do, yeah, um, I guess we need to reach out to the adjuster and ask her if she can review it and let us know what the status is, um.
[CUSTOMER][NEUTRAL] I just don't know what's
[AGENT][NEUTRAL] And we're just speaking of that 4359-442-2 claim.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] Um, I mean, I, I guess probably the best thing would be to let me see, do you wanna go, I'm gonna send a message to [PII], that's who the adjuster is on this and see if she can just take a quick peek at it and let us know what the status is.
[AGENT][NEUTRAL] So if you wanna uh you said they're in the car on the phone, right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I sent a message to her let's see if she responds because I'm not really sure other than to tell him it's in the final processing stage because at this point that's normally what you know it looks like but like I said when I pull up the mail, it looks like it's completed so it's not, it's not been released or sent back to the adjuster bec[PII] usually there would be some kind of pin code there.
[CUSTOMER][NEUTRAL] OK, um, do you know what I should tell the member?
[AGENT][NEUTRAL] Um, if you wanna come either get a phone number from them if unless they wanna hold, um.
[AGENT][NEUTRAL] I'm waiting for her to respond.
[CUSTOMER][NEUTRAL] If I get a phone number
[CUSTOMER][NEUTRAL] Can I send it to [PII]?
[AGENT][NEUTRAL] Um, or to me. She's, she's looking at it now. She just said hello, OK, so she's gonna take a look at it.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] All right, let me, let me get her back on it.
[AGENT][NEUTRAL] If you want, if you, yeah, I was gonna say if you wanna get back with her and let her know that we're checking on it and, and ask if they wanna hold or if they wanna call back.
[CUSTOMER][NEUTRAL] OK, OK, hold on one moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, I told her she she wants to hold.
[AGENT][NEUTRAL] OK, I figured that you were gonna say that usually they don't wanna call back because they don't know if we're gonna actually call them back.
[CUSTOMER][NEUTRAL] Our money.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Sorry I'm eating some chips.
[AGENT][POSITIVE] Oh, you're fine, absolutely fine.
[AGENT][NEUTRAL] Yeah, I'm thinking that that's what happened either there was.
[AGENT][NEUTRAL] It it set back from audit or someone didn't release it or something happened here because I don't see anything wrong with it other than like I said I don't see any notes so.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] I think it just didn't get released for some reason.
[CUSTOMER][NEUTRAL] Hopefully.
[CUSTOMER][NEUTRAL] If it gets released, do you know when that typically would direct deposit, would that be like Monday, Tuesday, or?
[AGENT][NEUTRAL] Yeah, I usually tell them.
[AGENT][NEUTRAL] OK, she said it was sent to audit but not released, so she was gonna call [PII], and [PII] is the audit uh her auditor I guess for her team so um.
[AGENT][NEUTRAL] So usually what I tell them once it's released I usually tell them it's like 1 to 3 business days for a direct deposit most of the time it'll go in that next day, but because you know today of course typically Friday, um, it's probably gonna be Monday or Tuesday I would think.
[CUSTOMER][NEUTRAL] You know, [PII]'s here.
[AGENT][NEUTRAL] And they
[AGENT][NEUTRAL] I think so.
[AGENT][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] I didn't know she checking with her now or should I uh.
[CUSTOMER][NEUTRAL] Should I, um,
[AGENT][NEUTRAL] Well she said she was gonna call her, so.
[CUSTOMER][POSITIVE] Oh, OK, cool.
[AGENT][NEUTRAL] I'm, I'm assuming that she's just gonna was gonna give her a call. So I think [PII]'s getting ready to leave at [PII], so hopefully she can get her before she leaves. It does show her to be offline, so she may not.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hopefully she can grab her before she leaves.
[CUSTOMER][NEUTRAL] Is it typically like a claim that pays out over 10,000? Is that like an audit claim? Is that usually how it works or it depends?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Usually because it it right it it depends on that amount and what that adjuster um their what their limit is to release um but you know typically these larger claims like this they would you know require um someone, you know, above, uh, an adjuster more than likely to release it because it is over 10,000 so I believe that generally yes, it would go, it would be the auditors that release anything than those larger claims.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Excellent.
[AGENT][NEUTRAL] So I'm uh.
[AGENT][NEUTRAL] I'm still waiting to see if she responds. It does look like she's red as well, so it does look like [PII] maybe was able to grab her before she left, so.
[AGENT][POSITIVE] Hopefully she can, she'll respond to us here.
[CUSTOMER][POSITIVE] Oh, good. OK.
[CUSTOMER][POSITIVE] Hopefully I can give her good news.
[AGENT][POSITIVE] Right, absolutely.
[AGENT][NEUTRAL] I've never
[AGENT][NEUTRAL] I've never seen one like this before where this has happened.
[AGENT][NEUTRAL] Because
[CUSTOMER][POSITIVE] Yeah, I know you're are really fast on your turnaround time, so I'm surprised.
[AGENT][NEUTRAL] OK good, she said she just released it.
[CUSTOMER][POSITIVE] Oh awesome awesome awesome cool OK so probably tell her no later than Tuesday that should be direct deposited.
[AGENT][NEUTRAL] Yes, um, she's typing me another message, so just hang tight one second, see if she says anything else, OK.
[CUSTOMER][POSITIVE] She's still on the line so we're good.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yep, now, uh, let me see if I refresh if it's showing yep, OK, good, so it is showing that why now so when you refresh it, it, it does show it was released. So yeah, just let them know that, um, and I would just tell them that it was in that final processing stage but it now has been released and that um typically like I said that 1 to 3 days, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much for your help. I appreciate you.
[AGENT][NEUTRAL] No problem, [PII].
[CUSTOMER][POSITIVE] OK, have a good weekend.
[AGENT][POSITIVE] Have a great weekend, thank you.
[CUSTOMER][POSITIVE] Thanks bye.