AccountId: 011433970860
ContactId: 6577c62c-3c8b-4be2-ae15-dda03cf0836c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1496800 ms
Total Talk Time (AGENT): 106410 ms
Total Talk Time (CUSTOMER): 424260 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/6577c62c-3c8b-4be2-ae15-dda03cf0836c_20250411T13:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling about two claims.
[AGENT][NEUTRAL] OK, yes, I can help you with claims today. Do you have your policy number?
[CUSTOMER][NEUTRAL] Um, I don't
[AGENT][NEUTRAL] Uh, what is your first and last name?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. It's [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And [PII], what's a good call back number in case our call gets dropped?
[CUSTOMER][NEUTRAL] Sure, it's uh [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it looks like I found you.
[AGENT][NEUTRAL] All right, [PII], I just need to verify a couple pieces of information. What is your date of birth and address we have on file?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] Email [PII].
[AGENT][POSITIVE] OK, perfect, thank you.
[CUSTOMER][NEUTRAL] And the claims are for my husband.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then his date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] One for accident, another one for hospital indemnity.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and do you have the data service?
[CUSTOMER][NEUTRAL] Um, 42.
[CUSTOMER][NEUTRAL] 2025.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] 5411.
[AGENT][NEUTRAL] OK, let me check for one.
[AGENT][NEUTRAL] OK, it looks like it's the 41.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, can I just put you on a brief hold while I look into this uh claim number?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[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][POSITIVE] Hey, Ms. [PII], thank you for holding.
[AGENT][NEUTRAL] OK, do you have the charge amount that you're looking for? It looks like we have a couple on here for the same claim.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They were just the latest I put in.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They needed additional information I sent that in.
[AGENT][NEUTRAL] Oh you did? OK.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One was saying in progress and then the other one is saying completed.
[CUSTOMER][NEUTRAL] Yesterday it was completed.
[AGENT][NEUTRAL] OK. And when was this submitted?
[CUSTOMER][NEUTRAL] 44, but then I submitted additional information yesterday.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hi, I'm here. Sorry. Um, let's see.
[AGENT][NEUTRAL] OK, I'm going to check one more spot. OK. Just one moment.
[CUSTOMER][NEUTRAL] OK. Would the claim numbers help you?
[AGENT][NEUTRAL] Yes, ma'am. I found the claim number.
[AGENT][NEUTRAL] Um, it's just there's a lot of dates of service on here, so I'm just trying to wile it down a little bit.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sorry, there's just a lot of navigating. Just one moment, I'm almost there.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK and I can turn my side of everything.
[CUSTOMER][NEUTRAL] Which
[CUSTOMER][NEUTRAL] Oh, I got 20 minutes to go.
[CUSTOMER][NEUTRAL] based on.
[AGENT][NEUTRAL] OK, so it looks like we're waiting for this claim to be processed.
[AGENT][NEUTRAL] So as of right now, it is in line for processing and it usually takes 7 to 10 days.
[CUSTOMER][NEUTRAL] Well, I sent them one yesterday, the one yesterday was completed for the hospital indemnity.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you, did you call?
[CUSTOMER][NEUTRAL] Can you get a claims rep on the line?
[AGENT][NEUTRAL] Yes, ma'am. Just one moment, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey.
[CUSTOMER][NEUTRAL] OK, so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, she's just basically, so the additional information was received on yesterday and you said that's in line to be processed and you have put something in the chat earlier. She just now wants, uh, the claim status on the one that was processed on yesterday, but since she asked for an adjuster, you get uh transfer and we'll talk about it later.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and you can stay on the phone if you wanna join, you could do that.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, that would be great.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] My name is [PII] in the claims department. Um, the call was transferred over to me, so I do show that we received the additional information you submitted yesterday. Of course of course that information is in line for processing, so we've not reviewed it at this time. Generally takes about 7 to 10 business days, and I also do show a claim was processed on yesterday.
[CUSTOMER][NEUTRAL] Um, and I don't know if this could be the additional information that you sent us. Let me see what the remark codes are on this.
[CUSTOMER][NEUTRAL] OK, give me 1 2nd.
[CUSTOMER][NEUTRAL] Well, I called yesterday because the claim was denied. One of the claims was denied, the accident, and the lady said, was telling me what I didn't send in and I said no, the physician's statement was there and she said, hold on, and then she came back and she said, I'm gonna tell them push this through because I see the code, so they need to, I'm gonna call the adjuster and let them know that they need to rework this.
[CUSTOMER][NEUTRAL] What service was it for? Was it for the screening, the X-ray? What was it for? No, my husband had knee surgery.
[CUSTOMER][NEUTRAL] So it was knee surgery, OK. Yeah.
[CUSTOMER][NEUTRAL] So the claim that I'm looking at that was processed on yesterday.
[CUSTOMER][NEUTRAL] It's 11 line is.
[CUSTOMER][NEUTRAL] Uh, this is under the group accident policy.
[CUSTOMER][NEUTRAL] So are you checking claim status for the hospital indemnity as well? OK, I got a text this morning that said one of the claims were completed.
[CUSTOMER][NEUTRAL] The claim that was completed was 3587589 which is which is under the group accident policy that's the one I'm looking at now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And there's documents that are being required, so there's a screening charge, there's a charge for an X-ray. Let me see what we have here. Give me a second.
[CUSTOMER][NEUTRAL] OK, so you're the uh screening benefit is exhausted for this plan year.
[CUSTOMER][NEUTRAL] Let me look at the other two lines.
[CUSTOMER][NEUTRAL] You're telling me this is the accident. I'm telling you what was completed was the hospital indemnity. That's the policy number that you gave me the 3587589, that's under the accident policy. OK.
[CUSTOMER][NEUTRAL] So do you want me to go over this claim or do you want me to go to the HI policy? OK.
[CUSTOMER][NEUTRAL] So let me look at the other two lines that uh we processed on the accident policy.
[CUSTOMER][NEUTRAL] OK, so now I'm looking at um data service [PII].
[CUSTOMER][NEUTRAL] 25
[CUSTOMER][NEUTRAL] Mhm. And this looks to be like a $95,000 charge?
[CUSTOMER][NEUTRAL] Mhm. It's a surgery, a knee surgery. OK. OK, and so the remark code. This one.
[CUSTOMER][NEUTRAL] It says in order to process your claim, we need the itemized hospital bill with the admission and discharge dates and times. Now is that what you sent in on yesterday?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. For the accident claim.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I thought I sent that yes I did. Well she told me there should have been codes.
[CUSTOMER][NEUTRAL] Right, OK, so whatever you sent us yesterday is, is in line for processing. So if you included the itemized bill and the admission discharge dates in what you sent yesterday, that'll be reviewed within about 7 to 10 business days and then there's 11 other remark code let me look at that one.
[CUSTOMER][NEUTRAL] And then we'll move to the HI policy.
[CUSTOMER][NEUTRAL] OK. And so the X-ray benefit is exhausted.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] For this covered person for this plan year for that X-ray.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I'll go into your HI policy.
[CUSTOMER][NEUTRAL] Now did you receive a text message that uh claim under your HI was processed?
[CUSTOMER][NEUTRAL] It just gave me the claim number that was processed, but I looked online and it said this this was processed.
[CUSTOMER][NEUTRAL] OK, and that claim number actually was for your accident policy and not the HI.
[CUSTOMER][NEUTRAL] So I do show that 2 claims have been processed under your HI policy today.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] And I'm showing a check amount of 1100, so this appears to be uh for the inpatient stay on [PII] [PII].
[CUSTOMER][NEUTRAL] Mhm. So, so this is with Aer Medical Center?
[CUSTOMER][NEUTRAL] So I'm showing we paid $1000 for the um.
[CUSTOMER][NEUTRAL] First occurrence benefit under the HI policy and then $100 for the room and board charge, he was there one day.
[CUSTOMER][NEUTRAL] And that totals the check amount of 1100.
[CUSTOMER][NEUTRAL] OK that'll, let's see, you're set up on direct deposit, so that'll process in the morning, the direct deposit.
[CUSTOMER][NEUTRAL] And so, uh, allow for about 43 to 4 business days to see it in your account.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and that's the one that was processed under your HI.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then allow us some time to process the additional information you sent in yesterday under your accident policy.
[CUSTOMER][NEUTRAL] And you may want to check back with us, you know, within about 5 days or so.
[CUSTOMER][NEUTRAL] On that one.
[CUSTOMER][NEUTRAL] Alrighty Miss [PII], did you have any other questions?
[CUSTOMER][POSITIVE] No, that's it. Have a good day. Alright, well thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] Bye bye bye bye.