AccountId: 011433970860
ContactId: 70b61b67-deec-43f4-8f8b-ae4878ab16b3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 688299 ms
Total Talk Time (AGENT): 174400 ms
Total Talk Time (CUSTOMER): 224171 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.1, CUSTOMER=-2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/70b61b67-deec-43f4-8f8b-ae4878ab16b3_20250408T16:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], this is [PII], and I've been trying to get a hold of somebody to talk about my claims for about 1 day now. And every time that I get clicked over to the claims person, I stay on hold for 30 minutes to 1 hour and it disconnects.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Um, I'm trying to figure out, I've been trying to figure out for multiple days.
[CUSTOMER][NEGATIVE] Why I put in some forms for evidence into a claim. They sent me a letter, they said that, you know, my claims were being reviewed. And then all of a sudden everything's out of the computer. And then every time I tried to call back to talk about it, they say, oh, I don't understand what's going on here. I'm going to send you to a claims person called [PII], and I never get connected.
[AGENT][NEUTRAL] OK, let me take a look at the uh policy number. I'm sorry about all that. What's your policy?
[CUSTOMER][NEUTRAL] I can give you my social security number.
[AGENT][NEUTRAL] OK. Go ahead.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And then can I get your first and last name again, please?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] All right, and then for security, [PII], I need to verify please your date of birth and address.
[CUSTOMER][NEUTRAL] On [PII], [PII].
[AGENT][NEUTRAL] I'm just looking at the last couple of claims here. Give me just a second.
[CUSTOMER][NEGATIVE] Yeah, the claims that I put in, the forms I put in to provide evidence that um two of my appointments for follow ups is completely out of the system now.
[AGENT][NEUTRAL] Did you get um
[CUSTOMER][NEUTRAL] And that's the reason I called you.
[AGENT][NEUTRAL] I'm sorry, did you get claim numbers or anything?
[CUSTOMER][NEGATIVE] Claim numbers? No, they sent me a letter saying that the claims were being reviewed and I looked in the system and all three of them were in there, because I, I submitted them and yesterday I started calling because yesterday morning, they all 3 disappeared.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I know that y'all received them because 1 they were in the computer and 2 you'll send a letter saying my claims for now in review.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] But what it was is that on some of my things that y'all paid, they were follow-up appointments. And they, they didn't pay for a follow-up appointment, they just paid for a regular appointment. And my claim still says it's $100 for a follow-up. So they asked that I submit documents proving that I had referrals to those doctors. So I, I submitted those referrals, and they said that they would get it fixed and back to me and fix everything and then everything disappeared.
[AGENT][NEGATIVE] OK, and then that's when you were speaking to um [PII] in claim support that's who you were talking about you were transferred to and you're just not getting any responses back.
[CUSTOMER][NEGATIVE] Yeah, I've been on hold multiple times for this day in person and not responding to the email deal, not respond.
[CUSTOMER][NEGATIVE] You know, the phone call is not coming back. I talked to a representative, they're like, oh I'm gonna transfer you to somebody else. Well, I stay on line for 1015, 20 minutes sometimes and then just hangs up. So I'm calling again.
[CUSTOMER][NEUTRAL] I'm just trying to find an answer because you know, I have these policies and I have these claims and I've been submitting all these forms and doing all this work and.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Trying to get some kind of result.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm just reading all the notes in here as far as like when you've called and what they are putting in here from claims just so I have all the.
[AGENT][NEUTRAL] Information on it.
[CUSTOMER][NEGATIVE] Yeah, because when I called back because I told them that, you know, what I was given was wrong, they told me all they needed was these referral forms and so I, I, I put them in the system and I've been waiting.
[CUSTOMER][NEGATIVE] Well over 1 week, almost 2 weeks to, to get a response. And then I went to check it again and sure enough, they deleted the referral forms I put in.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I don't did they say when you had called previously were they trying to get you to Dina because she was the one actually working on your specific claims because there's quite a few and I was trying to see, I'm not just was curious why she was the contact did they advise on any of that?
[CUSTOMER][NEUTRAL] Nope, and what gets me is that like I said, the claims that I've put in to fix these claims is gone. It's completely gone. It's been in the system for over a week, and nobody can tell me why they were deleted, who deleted them.
[CUSTOMER][NEUTRAL] But on Saturday, I received a letter from y'all saying that um the claims information had been received and they were reviewing, reviewing this.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And I've been watching it in the computer system for over a week now. So my question is, is, where did it go?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And what do I need to do, because, um, I mean that's.
[CUSTOMER][NEGATIVE] Anywhere from $50 to $150 worth of stuff that I'm trying to, to collect on that I don't have. So what should I do in this scenario because y'all somehow magically lost these referral forms that I submitted.
[CUSTOMER][NEGATIVE] And completely lost this last claim. I don't know.
[AGENT][NEUTRAL] Yeah, I'm gonna, OK.
[CUSTOMER][NEUTRAL] I mean, can you see who took the referral forms out of the sale system?
[AGENT][NEUTRAL] No, I don't see that. I, I just, I see the um reported items, you know, and the dates, and then I was you know, I do see that you had called that you were concerned because
[CUSTOMER][NEUTRAL] So they were, they
[CUSTOMER][NEUTRAL] They
[AGENT][NEGATIVE] You had uploaded some stuff and now it's not showing and then you were referred to claims and they were supposed to be checking on it to see what was going on. I, I do see all of that. I don't see any sort of removal or anything and I'm sorry nobody has reached out.
[AGENT][NEUTRAL] I was trying to find also what what we had sent out to you.
[AGENT][NEUTRAL] OK. Um,
[AGENT][NEUTRAL] So I need to speak to somebody in claims because I'm not a claims adjuster and figure out what's going on.
[AGENT][NEUTRAL] The [PII] is a good call back number for you?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] Yes, and I've explained to them multiple times that I'm at work and if I've got kids in the classroom I can't answer the phone number and to please send me an email at the email address on file and they haven't been doing that either.
[AGENT][NEUTRAL] OK, let me just make sure that this is right.
[AGENT][NEUTRAL] So we have the [PII]. That's your valid email. Yes, ma'am?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well I'm just gonna place you on a brief hold if you have to disconnect you can disconnect um I have your email and phone number. I will definitely email you or call you. I'm not gonna leave you hanging or high and dry so my name is [PII] let me just reach out to claims and.
[AGENT][NEUTRAL] To see what we need to do to try and get this situated for you, OK?
[CUSTOMER][POSITIVE] All right, and if you would just um call me or email me back I'd greatly appreciate it thank you.
[AGENT][POSITIVE] Yeah, you're welcome.
[CUSTOMER][NEUTRAL] Bye bye.